About
186
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Introduction
Honorary Professor of Surgery
University College London
Division of Surgery and Interventional Science
NIHR MIAMI trial Multiple Ipsilateral Breast Cancers
Surgical & Interventional Trials Unit
Division of Surgery & Interventional Science
Faculty of Medical Sciences, University College London
132 Hampstead Road (4th Floor, Room 4.24)
London, NW1 2BX
UK
Current institution
Additional affiliations
December 2017 - present
June 2017 - June 2017
May 2017 - present
Breast Surgery
Position
- Consultant
Publications
Publications (186)
Background
Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgi...
Background
A multicentre feasibility trial (MIAMI), comparing outcomes and quality of life of women with multiple ipsilateral breast cancer randomised to therapeutic mammoplasty or mastectomy, was conducted from September 2018 to March 2020. The MIAMI surgical trial aimed to investigate recruitment of sufficient numbers of women. Multidisciplinary...
Background. A multicentre feasibility trial (MIAMI), comparing outcomes and quality of life of women with multiple ipsilateral breast cancer (MIBC) randomised to therapeutic mammoplasty or mastectomy, has been conducted. The MIAMI feasibility trial aimed to investigate recruitment of sufficient numbers of women to this surgical trial, however only...
Background
A multicentre feasibility trial (MIAMI), comparing outcomes and quality of life of women with multiple ipsilateral breast cancer randomised to therapeutic mammoplasty or mastectomy, was conducted from September 2018 to March 2020. The MIAMI surgical trial aimed to investigate recruitment of sufficient numbers of women. Multidisciplinary...
Background: Conflicting evidence challenges clinical decision-making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods: Studies on...
Background:
The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23 was one of the first disease-specific questionnaires developed in 1996 to assess quality of life (QoL) in patients with breast cancer (BC). However, since 1996 major changes in BC treatment have occurred, requiring an update of the EORTC BC module. This stu...
Background:
Effects of postmastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial regarding surgical complications, cosmetic appearance and quality of life (QOL). This systematic review evaluated these outcomes after abdominal free flap reconstruction in patients undergoing postoperative adjuvant radiotherapy (P...
Background:
Conflicting evidence challenges clinical decision-making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017.
Methods:
Studies...
The oncological safety of treating multiple ipsilateral breast cancers (MIBCs) with types of breast conserving surgery (BCS) compared to mastectomy remains uncertain. This is predicated on the absence of any randomised controlled trials or high-quality protocol defined prospective cohort studies. A single recently published systematic review by the...
Background: The Breast Cancer Campaign Gap analysis (2013) established breast cancer research priorities without specific focus on surgical research nor the role of surgeons. The majority of breast cancer patients encounter a surgeon at diagnosis or during treatment, thus surgical involvement in design and delivery of high-quality research to impro...
The oncological safety of treating multiple ipsilateral breast cancers (MIBCs) with types of breast conserving surgery (BCS) compared to mastectomy remains uncertain. This is predicated on the absence of any randomised controlled trials or high-quality protocol defined prospective cohort studies. A single recently published systematic review by the...
Background: Clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast-conserving surgery (BCS) compared to the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and inter-tumoural heterogeneity. This novel systematic review’s primary aim(s) were to c...
Background
The clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to com...
Appendix S1 Search strategy
Appendix S2 Data extraction pro‐forma
Table S1 Summary of characteristics of papers reviewed and overall quality
Table S2 Newcastle–Ottawa scale scoring
Table S3 Clinical‐pathology characteristics and treatments
Table S4 Clinical outcomes
To develop and pretest an European Organization for the Research and Treatment of Cancer Sexual Health Questionnaire (EORTC SHQ-22) for the assessment of physical, psychological, and social aspects of sexual health (SH) in male and female cancer patients and survivors. Questionnaire construction started with creating a list of relevant SH issues ba...
Towards more breast conservation?
To develop and pretest an European Organization for the Research and Treatment of Cancer Sexual Health Questionnaire (EORTC SHQ-22) for the assessment of physical, psychological, and social aspects of sexual health (SH) in male and female cancer patients and survivors. Questionnaire construction started with creating a list of relevant SH issues ba...
Citation Ankur Khajuria, Zoe Winters, Afshin Mosahebi. A systematic review and meta-analysis of clinical and patient-reported outcomes (PROs) of immediate versus delayed autologous abdominal-based flap breast reconstruction in the context of post-mastectomy radiotherapy. PROSPERO 2017 CRD42017077945 Available from: http://www.crd.york.ac.uk/PROSPER...
Background:
The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and...
PurposeTo explore quality-of-life (QOL) issues considered important when deciding on treatment for ductal carcinoma in situ (DCIS). Methods
Breast Cancer Network of Australia members diagnosed with DCIS in the past 5 years (self-identified) participated in an online survey (Sep–Nov 2015). From a list of 74 QOL issues, participants selected all issu...
This abstract was withdrawn by the authors.
Ductal carcinoma in situ (DCIS) is a pre-invasive breast cancer with excellent prognosis but with potential adverse impacts of diagnosis and treatment on quality of life and other patient-reported outcomes (PROs). We undertook a systematic review to synthesise current evidence about PROs following diagnosis and treatment for DCIS. We searched five...
Pre-surgical studies allow study of the relationship between mutations and response of oestrogen receptor-positive (ER+) breast cancer to aromatase inhibitors (AIs) but have been limited to small biopsies. Here in phase I of this study, we perform exome sequencing on baseline, surgical core-cuts and blood from 60 patients (40 AI treated, 20 control...
Background
Randomised controlled trials (RCTs) often fail to recruit sufficient participants, despite altruism being cited as their motivation. Previous investigations of factors influencing participation decisions have been methodologically limited. This study evaluated how women weigh up different motivations after initially expressing altruism,...
Introduction: Historically, multiple synchronous breast cancers are defined as multifocal (MF) when they aoccur in the same quadrant of the breast, and multicentric (MC) they are in different quadrants; a number of authors continue to use this distinction. Multifocality has been reported to be an independent prognostic factor for survival and local...
Ductal carcinoma in situ (DCIS) is a pre-invasive breast cancer with excellent prognosis but with potential adverse impacts of diagnosis and treatment on quality of life and other patient-reported outcomes (PROs). We undertook a systematic review to synthesise current evidence about PROs following diagnosis and treatment for DCIS. We searched five...
Introduction: Historically, multiple synchronous breast cancers are defined as multifocal (MF) when they are in the same quadrant of the breast, and multicentric (MC) they are in different quadrants; a number of authors continue to use this distinction. Multifocality has been reported to be an independent prognostic factor for survival and local re...
Background:
The aim of this study was to estimate the impact 2 and 3 years after surgery of implant-assisted latissimus dorsi (LDI) and autologous latissimus dorsi (ALD) flap breast reconstructions on patient-reported outcomes (PROs), and, secondarily, to determine whether baseline characteristics can predict PROs.
Methods:
This was a multicentr...
A systematic review of sexual health patient reported outcome instruments based on the Cleary model
Systematic review to support the rationale for a new clinical trial in multifocal breast cancers
Aims: To estimate the impact at two and three years post-surgery of implant-assisted latissimus dorsi (LDI) and autologous LD (ALD) flap breast reconstructions (BRRs) on patient-reported outcomes (PROs), and secondarily, to determine whether baseline characteristics predict PROs.
Methods: Multi-centre prospective cohort study. The European Organis...
Patient reported outcomes (PROs) are considered fundamentally important in the evaluation of clinical and cosmetic outcomes after types of immediate and delayed breast reconstruction. They are intrinsic considerations in the development and content of all newly proposed surgical studies and clinical trials. The patient self- report information is c...
Background
Breast reconstruction aims to improve health-related quality of life after mastectomy. However, evidence guiding patients and surgeons in shared decision-making concerning the optimal type or timing of surgery is lacking.MethodsQUEST comprised two parallel feasibility phase III randomized multicentre trials to assess the impact of the ty...
Patient reported outcomes (PROs) are considered fundamentally important in the evaluation of clinical and cosmetic outcomes after types of immediate and delayed breast reconstruction. They are intrinsic considerations in the development and content of all newly proposed surgical studies and clinical trials. The patient self-report information is co...
The BJC is owned by Cancer Research UK, a charity dedicated to understanding the causes, prevention and treatment of cancer and to making sure that the best new treatments reach patients in the clinic as quickly as possible. The journal reflects these aims. It was founded more than fifty years ago and, from the start, its far-sighted mission was to...
Introduction: International decision-making bodies recommend integrating Patient Reported Outcome Measures (PROMs) alongside clinical outcomes. Methodology evaluating PROMs after types of breast reconstruction (BRR) has been poor in a systematic review of all studies since 19781. Few studies investigate the clinical meaning and magnitude of HRQL ch...
Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention...
Too many unanswered questions to justify widespread adoption
Background:
Comprehensive outcome assessments after breast reconstruction (BRR) require surgery-specific patient-reported outcome measures. The aims of this study were to assess the relevance, acceptability and redundancy of questions/items (phase III pretesting) of a new BRR questionnaire evaluating patients' health-related quality of life before...
s: Thirty-Sixth Annual CTRC-AACR San Antonio Breast Cancer Symposium - Dec 10-14, 2013; San Antonio, TX
Background: Breast reconstruction (BRR) aims to improve health related quality of life (HRQL) after mastectomy, but with poor evidence to date informing the optimal type or timing of surgery to guide shared-decision making. Systematic reviews sh...
The purpose of this study is to examine the importance that real patients attach to their right to withdraw from an on-going feasibility randomised trial (RCT) evaluating types and timings of breast reconstruction (two parallel trials) following mastectomy for breast cancer. Our results show that, while some respondents appreciated that exercising...
One Step Nucleic Acid Amplification (OSNA) method for the intraoperative analysis of sentinel lymph nodes (SLNs) in breast cancer, obviates a second operation to the axilla and thereby expedites progression to adjuvant therapy. Recent NICE guidelines have approved OSNA as a method of sentinel node diagnosis to support the above case.(1) METHOD: Thi...
Background:
Clinical evidence on patient-reported outcome measures (PROMS) in breast reconstruction is lacking. The aim of this study was to evaluate PROMs in implant-assisted latissimus dorsi (LDI) or tissue-only autologous latissimus dorsi (ALD) flap reconstruction in relation to complications and adjuvant treatments.
Methods:
This was a prosp...
Introduction: Appropriate outcome selection is essential if research is to guide decision-making for patients, professionals and policy makers. Systematic reviews evaluating the clinical, cosmetic and patient-reported outcomes of breast reconstruction, however, have demonstrated marked heterogeneity of outcome reporting such that results from indiv...
Introduction:
A comprehensive evaluation of breast reconstruction (BRR) surgery includes measurement of patient reported outcomes (PROs). There is, however, a lack of validated BRR-specific PRO measures (PROMs) that adequately assess relevant issues. This study is developing a European Organisation for Research and Treatment of Cancer (EORTC) ques...
Latissimus dorsi (LD) flap procedures comprise 50 per cent of breast reconstructions in the UK. They are frequently complicated by seroma formation. Fibrin sealants may reduce seroma volumes at the donor site. The aim was to investigate the effect of fibrin sealant (Tisseel(®) ) on total seroma volumes from the breast, axilla and back (donor site)...
s: Thirty-Fourth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 6‐10, 2011; San Antonio, TX
Introduction : Evidence for the clinical effectiveness of breast reconstruction based on Patient Reported Outcome Measures (PROMS) is lacking. Methodology evaluating PROMS after types of breast reconstruction has been poor with respect to study...
Introduction: The OSNA method for the intra-operative analysis of sentinel lymph nodes (SLNs) in breast cancer has been introduced in 3 UK centres since 2007. The methodology uses a polymerase chain reaction to quantitate CK19, a cytokeratin specific to breast duct epithelial cells. OSNA provides “real-time” results on SLNs analysed as negative (−)...
Introduction: Failure to prospectively define and report surgical complications across a range of study designs is a confounding factor that fundamentally compromises the interpretation of data on health-related quality of life (HRQL) and PROMS. The UK National Mastectomy and Breast Reconstruction audit on 5000 breast reconstruction patients found...
The QUEST trials are the first surgical trials comparing different types (A) and timing (B) of Latissimus dorsi (LD) reconstruction with a primary outcome of quality of life (QoL) in an attempt to improve clinical evidence. Surgical trials are challenging, necessitating a feasibility study, and the QUEST Perspectives Study (QPS), to assess the acce...
There is a pressing need for further clinical evidence to better inform both patients and clinicians when recommending the optimal type and timing of breast reconstruction. The QUEST trials are unique; the first surgical trials comparing different types (A) and timing (B) of Latissimus dorsi (LD) reconstruction with a primary outcome of quality of...
Introduction: Donor site seromas are common complications following Latissimus dorsi breast reconstructions (LDBR), as shown in the UK National Mastectomy and Breast Reconstruction audit. Level I clinical evidence following the performance of an RCT supports ‘fixation’ of the back skin flaps by quilting sutures1. Fibrin sealants (Tisseel) have been...
