The NPRI predicts BCSS and DFS, with a higher sensitivity than pCR. The NPRI can also improve the sensitivity and specificity of clinicopathologic response as a study endpoint, for assessing response to Neo-ACT, and can serve as a valuable tool for the discovery of future predictive molecular markers.

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Background: Studies have shown that rectal distension has a significant impact on treatment failure in patients receiving radical radiotherapy for prostate cancer. A distended rectum contributes to excessive organ movement during treatment, resulting in significant underdosing of the target volume and higher treatment failure rates. The increasing use of highly conformal, precise radiotherapy techniques places greater importance on reducing this risk. We tested whether imaging during radiotherapy helps minimise the negative impact that rectal distension has on long-term tumour control. Findings: The rectal diameter (anterior/posterior and lateral) was prospectively measured at radiotherapy planning in 172 consecutive patients undergoing radical radiotherapy with three-dimensional conformal radiotherapy. Daily, and then weekly, imaging during radiotherapy ensured that prostate movement remained within predefined tolerances. Patients were followed up for a median of 72 months with regular prostate-specific antigen (PSA) measurements to ascertain biochemical PSA relapse and survival information. Conclusions: In this cohort of predominately high-risk localised prostate cancer, rectal distension had no significant impact on PSA relapse. We suggest that regular imaging during radiotherapy negates the risk caused by rectal distension on local treatment failure.

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BackgroundAdvanced incurable cancer patients quite often live by milestones such as son or daughter's graduation, birth of a new grandchild or festive periods such as Christmas. Cancer patients need practical and real life survival information to plan their limited life. But most of survival data available in literature is from fitter patients in clinical trials who have a better survival. There is a dearth of real-life, pragmatic, survival information from routine clinical practice. To address this need, we assessed the chances of patients having palliative chemotherapy during 2011 Christmas period to survive until the 2012 Christmas period.MethodsAll adult cancer patients, who had palliative chemotherapy in Dec 2011, were identified from the electronic chemotherapy prescription system (ChemoCare®) and survival data was extracted from the Hospital electronic records. 30-day mortality assessed as per NCEPOD SACT report recommendation.ResultsMedian age was 65 years (range 31 to 87 years) and 52% were female. Site of primary cancer was Breast (18%), Lung (17%), Ovary (12%), Colon (11%), Prostate (10%), Kidney 8% & other sites in 24%. Median survival was 10.5 months (range 0 to 21 months). 1.9% of patients died within 30 days of chemotherapy. Only 45% of patients who had palliative chemotherapy during December 2011 were alive on 2012 Christmas day. But reassuringly, 30% of patients were still alive in August 2013 and these relatively long term survivors were distributed across the disease spectrum.ConclusionA significant number of patients (55%) died before the next Christmas period. Hence clinical judgement is critical in prescribing palliative chemotherapy to patients during the Christmas period. Patients, who are clinically judged to be poorly and unlikely to survive a year, should be given the opportunity to skip chemotherapy and spend time with family during Christmas period if they wish to do so.