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Papers by Scott Carruthers

Anz Journal of Surgery, Sep 4, 2022

BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant trea... more BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant treatment (pTNT) protocol, with treatment sequencing based on clinical stage at presentation.MethodsA multidisciplinary pTNT protocol was implemented across two metropolitan hospitals. This consists of two‐schema based on clinical stage: patients with distant failure risk were offered induction chemotherapy before chemoradiation (nCRT), and patients with locoregional failure risk received nCRT followed by consolidation chemotherapy. Patients underwent surgical resection unless a complete clinical response (cCR) was achieved, in which case non‐operative management (NOM) was offered. A prospective cohort analysis of all patients with rectal cancer who underwent pTNT with curative intent between Jan 2019 and Aug 2022 was performed.ResultsOf 270 patients referred with rectal cancer, 102 received pTNT with curative intent and 79 have completed their treatment thus far. Thirty‐three patients (41.8%) received induction chemotherapy and 46 (58.2%) received consolidation chemotherapy per protocol. The percentage of patients with EMVI, resectable M1 disease, cT4 disease, and positive lateral lymph nodes were 54.4%, 36.7%, 27.8% and 15.2%, respectively. Overall, 32 (40.5%) patients had cCR and 4 (5.1%) pCR, and 40 (50.6%) patients had non‐operative management. Grade 3 toxicity was reported in 10.1% of patients and only three patients (3.8%) experienced Grade 4 chemotherapy‐related toxicity, with no treatment related mortality.ConclusionEarly results with a defined two‐schema pTNT protocol are encouraging and suggest that tailoring sequencing to disease risk at presentation may represent the optimal balance between local and distant disease control, as well as treatment toxicity.

Colorectal Disease, Nov 1, 2017

To determine whether the addition of additional cycles of chemotherapy during the &am... more To determine whether the addition of additional cycles of chemotherapy during the "wait "period following neoadjuvant chemo-radiotherapy for rectal cancer improves the pathologic complete response rate (pCR). Rectal cancer patients were randomly allocated to either a standard 10 week wait period before surgery (standard chemo-radiotherapy, SCRT) or to receive 3 cycles of 5FU based chemotherapy following chemo-radiotherapy during a similar 10 week wait (extended chemo-radiotherapy, XCRT). Primary endpoint was pCR as determined by blinded pathologic assessment. Forty nine patients were randomized (SCRT n =24, XCRT n = 25). Pathologic complete response (pCR) occurred in 10 patients overall but there was no significant difference in pCR between the groups (SCRT n = 6, XCRT n = 4 p = 0.49). The addition of 3 cycles of 5FU/LV in a 10 week wait period after conventional chemoradiotherapy seems to result in similar pCR rates in patients with locally advanced rectal cancer based on this small randomized trial. This article is protected by copyright. All rights reserved.

ANZ Journal of Surgery

BackgroundColorectal cancer with synchronous liver‐only metastasis is managed with a multimodal a... more BackgroundColorectal cancer with synchronous liver‐only metastasis is managed with a multimodal approach, however, optimal sequencing of modalities remains unclear.MethodsA retrospective review of all consecutive rectal or colon cancer cases with synchronous liver‐only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival.ResultsData of over 5000 cases were analysed (n = 5244), 1420 cases had liver‐only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo‐radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5‐year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001)....

Journal of Surgical Oncology

ANZ Journal of Surgery

BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant trea... more BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant treatment (pTNT) protocol, with treatment sequencing based on clinical stage at presentation.MethodsA multidisciplinary pTNT protocol was implemented across two metropolitan hospitals. This consists of two‐schema based on clinical stage: patients with distant failure risk were offered induction chemotherapy before chemoradiation (nCRT), and patients with locoregional failure risk received nCRT followed by consolidation chemotherapy. Patients underwent surgical resection unless a complete clinical response (cCR) was achieved, in which case non‐operative management (NOM) was offered. A prospective cohort analysis of all patients with rectal cancer who underwent pTNT with curative intent between Jan 2019 and Aug 2022 was performed.ResultsOf 270 patients referred with rectal cancer, 102 received pTNT with curative intent and 79 have completed their treatment thus far. Thirty‐three patients (41.8...

Aizheng Shengwuxue yu Yixue(Yingwenban), 2017

Asia-Pacific Journal of Clinical Oncology, 2021

AimReviewing outcomes of regorafenib use in metastatic colorectal cancer using real‐world data fr... more AimReviewing outcomes of regorafenib use in metastatic colorectal cancer using real‐world data from the South Australian Metastatic Colorectal Cancer Registry.MethodsA retrospective review of the characteristics and outcomes of patients who received regorafenib in the Registry up to December 2018. The registry started in February 2006.ResultsFifty‐three patients received regorafenib therapy since approved by the therapeutic goods administration in November 2013. The median age was 66 (range 34–82). 66% were male, 66% had stage IV disease at diagnosis, 53% had liver only involvement, whereas 13% had liver and lung disease and 6% had lung only involvement. 75% had left‐sided primary. KRAS was available in 35/53 patients with 49% of them being WT. BRAF status was known in 8/53 with 25% of them having a mutated variant. MSI testing was known in 14 patients in whom 21% of them had MSI‐High tumors. Prior lines of treatment received: one line 4%, two 9%, three 23%, four 26%, >four 37%. ...

Annals of Surgical Oncology, 2019

Purpose. Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy includin... more Purpose. Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy including the influence of extent of surgery, use of radiotherapy, and patient factors. The aim of this study is to evaluate the effects of these factors on patient outcome, quality of life (QOL), regional symptoms, and limb volumes after inguinal or ilio-inguinal lymphadenectomy for melanoma. Methods. Analysis of the subgroup of patients with inguinal lymph node field relapse of melanoma, treated by inguinal or ilio-inguinal lymphadenectomy in the ANZMTG/TROG randomized trial of adjuvant radiotherapy versus observation. Results. Sixty-nine patients, 46 having undergone inguinal and 23 ilio-inguinal lymphadenectomy, with median follow-up of 73 months were analyzed. Mean limb volume Electronic supplementary material The online version of this article (

Acta oncologica (Stockholm, Sweden), Jan 18, 2018

Annals of Oncology, 2016

Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surv... more Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%. Methods: The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented. Results: Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status of the tumor was known, the majority harbored a KRAS mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months vs. 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years. Conclusions: Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of KRAS mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.

Journal of Clinical Oncology, 2017

701 Background: Management of rectal cancer with synchronous liver metastasis is not clear. Optim... more 701 Background: Management of rectal cancer with synchronous liver metastasis is not clear. Optimal timing of radiotherapy, chemotherapy, resection of primary and liver metastasis is debated. Methods: The South Australian Registry for metastatic colorectal cancer has entered all patients with mCRC since 1st February 2006. Registry data were analyzed to assess patient characteristics, therapy received and outcomes for patients with liver only metastasis and synchronous rectal or colon primary. KM analysis was used for survival outcomes. Results: 2677 patents had synchronous mCRC. 42% (n = 1125) had liver only metastasis (primary: 275 rectal/850 colon). The main differences between rectal/liver vs. colon/liver were: more males (68.7% v 57.8%, p = 0.001), younger age (65.8 v 73.3 years, p < 0.001) and less poorly differentiated histology (14.2% v 24.1%, p = 0.003). The rate of no surgery on the primary was 21.4% for rectal cancers v. 36% for colon (p ≤ 0.001). Liver surgery rates in...

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 15, 2017

To determine whether the addition of additional cycles of chemotherapy during the "wait &quo... more To determine whether the addition of additional cycles of chemotherapy during the "wait "period following neoadjuvant chemo-radiotherapy for rectal cancer improves the pathologic complete response rate (pCR). Rectal cancer patients were randomly allocated to either a standard 10 week wait period before surgery (standard chemo-radiotherapy, SCRT) or to receive 3 cycles of 5FU based chemotherapy following chemo-radiotherapy during a similar 10 week wait (extended chemo-radiotherapy, XCRT). Primary endpoint was pCR as determined by blinded pathologic assessment. Forty nine patients were randomized (SCRT n =24, XCRT n = 25). Pathologic complete response (pCR) occurred in 10 patients overall but there was no significant difference in pCR between the groups (SCRT n = 6, XCRT n = 4 p = 0.49). The addition of 3 cycles of 5FU/LV in a 10 week wait period after conventional chemoradiotherapy seems to result in similar pCR rates in patients with locally advanced rectal cancer based on...

Acta oncologica (Stockholm, Sweden), Jan 15, 2016

Background Randomized controlled trials evaluating biological therapy have shown improvements in ... more Background Randomized controlled trials evaluating biological therapy have shown improvements in survival from metastatic colorectal cancer (mCRC). Subjects in the trials represent a selected proportion of mCRC patients. We have the potential to assess the impact of biological therapy on mCRC outcomes, particularly the effect of bevacizumab, from a population-based clinical registry by comparing two time cohorts with differences in therapy accessibility. Material and methods A retrospective cohort study was performed by analyzing the South Australian (SA) mCRC registry data based on diagnosis in two time periods: 1 February 2006-31 May 2009 (Cohort A) versus 1 June 2009-30 June 2014 (Cohort B). The demarcation for these cohorts was chosen to reflect the change in accessibility of bevacizumab from July 2009. Results Between February 2006 and June 2014, 3308 patients were identified through the SA mCRC registry: 1464 (44%) in Cohort A and 1844 (56%) in Cohort B. 61 and 59% patients in...

Journal of Medical Imaging and Radiation Oncology, 2014

Introduction: The aims of the study were to evaluate interobserver variability in contouring the ... more Introduction: The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the RTOG-approved protocol and to analyse BP dosimetries. Methods: Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computedtomography images and antero-posterior digitally-reconstructed-radiographs (AP-DRRs)) and quantitatively (by volumetric and statistical analyses). Dose-volume-histograms (DVHs) of BPs were calculated and compared. Results: We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper with a mean volume of 20.8 cc (range 11-40.7 cc) compared with 33 ± 4 cc (25.1-39.4 cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2 Gy vs 44.8 Gy, 64.5 Gy vs 68.5 Gy, 6.1% vs 7.6%, 2.9% vs 2.4% and 0.6% vs 0.3% respectively. Conclusion: This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping especially when using IMRT, this atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term "brachial-plexus-regions (BPR)" to represent regions where BPs are likely to be present. Consequently, BPR should in principle be contoured generously.

Australasian Journal of Dermatology

A randomised controlled trial was undertaken to compare the efficacy of topical Calendula officin... more A randomised controlled trial was undertaken to compare the efficacy of topical Calendula officinalis (Calendula) versus standard of care (Sorbolene: 10% glycerine in cetomacragol cream) in reducing the prevalence of radiation‐induced dermatitis in women undergoing breast cancer radiotherapy.

Journal of Clinical Oncology

3531 Background: Surgical resection of oligometastases improves survival in metastatic colorectal... more 3531 Background: Surgical resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether such benefit is consistently observed for BRAF V600E mutant (MT) and wild type (WT) mCRC. We conducted a retrospective analysis to explore the influence of BRAF mutation status on survival outcomes after metastasectomy. Methods: Data collected from two large prospective population databases in Australia (Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) and South Australian cancer registry). Overall survival (OS) and recurrence free survival (RFS) for BRAF MT and WT mCRC were evaluated by Kaplan-Meier method and compared by log-rank test. Results: 513 patients who had undergone metastasectomy were identified, 6% were BRAF MT. Median age 63. Metastasectomy rate was lower in BRAF MT (13 v 27%). In BRAF WT, 4% underwent resection of metastases (mets) in >1 organ at diagnosis and 5% had 3 or 4 metastasectomies versus none in BRAF MT. Media...

Journal of Medical Imaging and Radiation Oncology

Introduction: Barriers exist for both Indigenous and remote patients attending cancer care facili... more Introduction: Barriers exist for both Indigenous and remote patients attending cancer care facilities. We sought to measure clinical attendance of all patients referred for consideration of radiation therapy (RT) at the single radiation therapy centre in the Northern Territory (NT), with particular attention to a comparison of Indigenous and non-Indigenous patients, and to analyse methods introduced to address the attendance of patients. Methods: Patients referred for radiation therapy over a 5 year period from the commencement of the Alan Walker Cancer Care Centre (AWCCC), NT, were analysed for attendance, and for possible improvement over time. Results: Multivariate analysis of non-attendance prior to RT (pre-RT) showed significance for Indigenous status (P < 0.001), and female gender (P < 0.001), and during RT showed significance for Indigenous status (P < 0.001) and curative intent RT (P = 0.012). Attendance during RT over the 5 years showed significant improvement over time for Indigenous patients from 70.6% to 81.6% (P = 0.038). There was no significant improvement with pre-RT attendance for either the Indigenous or non-Indigenous cohort. Conclusion: Indigenous patients experienced a lower level of attendance during RT, but this has significantly improved over the first 5 years of operation at AWCCC, as recognition and management of contributing factors has improved.

Journal of Medical Imaging and Radiation Oncology, 2013

Anz Journal of Surgery, Sep 4, 2022

BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant trea... more BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant treatment (pTNT) protocol, with treatment sequencing based on clinical stage at presentation.MethodsA multidisciplinary pTNT protocol was implemented across two metropolitan hospitals. This consists of two‐schema based on clinical stage: patients with distant failure risk were offered induction chemotherapy before chemoradiation (nCRT), and patients with locoregional failure risk received nCRT followed by consolidation chemotherapy. Patients underwent surgical resection unless a complete clinical response (cCR) was achieved, in which case non‐operative management (NOM) was offered. A prospective cohort analysis of all patients with rectal cancer who underwent pTNT with curative intent between Jan 2019 and Aug 2022 was performed.ResultsOf 270 patients referred with rectal cancer, 102 received pTNT with curative intent and 79 have completed their treatment thus far. Thirty‐three patients (41.8%) received induction chemotherapy and 46 (58.2%) received consolidation chemotherapy per protocol. The percentage of patients with EMVI, resectable M1 disease, cT4 disease, and positive lateral lymph nodes were 54.4%, 36.7%, 27.8% and 15.2%, respectively. Overall, 32 (40.5%) patients had cCR and 4 (5.1%) pCR, and 40 (50.6%) patients had non‐operative management. Grade 3 toxicity was reported in 10.1% of patients and only three patients (3.8%) experienced Grade 4 chemotherapy‐related toxicity, with no treatment related mortality.ConclusionEarly results with a defined two‐schema pTNT protocol are encouraging and suggest that tailoring sequencing to disease risk at presentation may represent the optimal balance between local and distant disease control, as well as treatment toxicity.

Colorectal Disease, Nov 1, 2017

To determine whether the addition of additional cycles of chemotherapy during the &amp;amp;am... more To determine whether the addition of additional cycles of chemotherapy during the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;wait &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;period following neoadjuvant chemo-radiotherapy for rectal cancer improves the pathologic complete response rate (pCR). Rectal cancer patients were randomly allocated to either a standard 10 week wait period before surgery (standard chemo-radiotherapy, SCRT) or to receive 3 cycles of 5FU based chemotherapy following chemo-radiotherapy during a similar 10 week wait (extended chemo-radiotherapy, XCRT). Primary endpoint was pCR as determined by blinded pathologic assessment. Forty nine patients were randomized (SCRT n =24, XCRT n = 25). Pathologic complete response (pCR) occurred in 10 patients overall but there was no significant difference in pCR between the groups (SCRT n = 6, XCRT n = 4 p = 0.49). The addition of 3 cycles of 5FU/LV in a 10 week wait period after conventional chemoradiotherapy seems to result in similar pCR rates in patients with locally advanced rectal cancer based on this small randomized trial. This article is protected by copyright. All rights reserved.

ANZ Journal of Surgery

BackgroundColorectal cancer with synchronous liver‐only metastasis is managed with a multimodal a... more BackgroundColorectal cancer with synchronous liver‐only metastasis is managed with a multimodal approach, however, optimal sequencing of modalities remains unclear.MethodsA retrospective review of all consecutive rectal or colon cancer cases with synchronous liver‐only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival.ResultsData of over 5000 cases were analysed (n = 5244), 1420 cases had liver‐only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo‐radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5‐year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001)....

Journal of Surgical Oncology

ANZ Journal of Surgery

BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant trea... more BackgroundThis study aimed to assess short‐term outcomes of a personalized total neoadjuvant treatment (pTNT) protocol, with treatment sequencing based on clinical stage at presentation.MethodsA multidisciplinary pTNT protocol was implemented across two metropolitan hospitals. This consists of two‐schema based on clinical stage: patients with distant failure risk were offered induction chemotherapy before chemoradiation (nCRT), and patients with locoregional failure risk received nCRT followed by consolidation chemotherapy. Patients underwent surgical resection unless a complete clinical response (cCR) was achieved, in which case non‐operative management (NOM) was offered. A prospective cohort analysis of all patients with rectal cancer who underwent pTNT with curative intent between Jan 2019 and Aug 2022 was performed.ResultsOf 270 patients referred with rectal cancer, 102 received pTNT with curative intent and 79 have completed their treatment thus far. Thirty‐three patients (41.8...

Aizheng Shengwuxue yu Yixue(Yingwenban), 2017

Asia-Pacific Journal of Clinical Oncology, 2021

AimReviewing outcomes of regorafenib use in metastatic colorectal cancer using real‐world data fr... more AimReviewing outcomes of regorafenib use in metastatic colorectal cancer using real‐world data from the South Australian Metastatic Colorectal Cancer Registry.MethodsA retrospective review of the characteristics and outcomes of patients who received regorafenib in the Registry up to December 2018. The registry started in February 2006.ResultsFifty‐three patients received regorafenib therapy since approved by the therapeutic goods administration in November 2013. The median age was 66 (range 34–82). 66% were male, 66% had stage IV disease at diagnosis, 53% had liver only involvement, whereas 13% had liver and lung disease and 6% had lung only involvement. 75% had left‐sided primary. KRAS was available in 35/53 patients with 49% of them being WT. BRAF status was known in 8/53 with 25% of them having a mutated variant. MSI testing was known in 14 patients in whom 21% of them had MSI‐High tumors. Prior lines of treatment received: one line 4%, two 9%, three 23%, four 26%, >four 37%. ...

Annals of Surgical Oncology, 2019

Purpose. Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy includin... more Purpose. Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy including the influence of extent of surgery, use of radiotherapy, and patient factors. The aim of this study is to evaluate the effects of these factors on patient outcome, quality of life (QOL), regional symptoms, and limb volumes after inguinal or ilio-inguinal lymphadenectomy for melanoma. Methods. Analysis of the subgroup of patients with inguinal lymph node field relapse of melanoma, treated by inguinal or ilio-inguinal lymphadenectomy in the ANZMTG/TROG randomized trial of adjuvant radiotherapy versus observation. Results. Sixty-nine patients, 46 having undergone inguinal and 23 ilio-inguinal lymphadenectomy, with median follow-up of 73 months were analyzed. Mean limb volume Electronic supplementary material The online version of this article (

Acta oncologica (Stockholm, Sweden), Jan 18, 2018

Annals of Oncology, 2016

Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surv... more Objective: Brain metastasis is considered rare in metastatic colorectal cancer (mCRC); thus, surveillance imaging does not routinely include the brain. The reported incidence of brain metastases ranges from 0.6% to 3.2%. Methods: The South Australian mCRC Registry (SAmCRC) was analyzed to assess the number of patients presenting with brain metastasis during their lifetime. Due to small numbers, a descriptive analysis is presented. Results: Only 59 patients of 4,100 on the registry at the time of analysis had developed brain metastasis (1.4%). The clinical characteristics of those with brain metastasis were as follows: the median age was 65.3 years and 51% were female. Where the V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status of the tumor was known, the majority harbored a KRAS mutation (55%); 31 (53%) underwent craniotomy and 55 (93%) underwent whole-brain radiotherapy. The median survival time from diagnosis of brain metastasis was 4.2 months (95% confidence interval 2.9-5.5). Patients who underwent craniotomy and radiotherapy had superior survival compared to those who underwent whole-brain radiotherapy (8.5 months vs. 2.2 months, respectively). Data from the SAmCRC (a population-based registry) confirm that brain metastases are rare and the median time to development is approximately 2 years. Conclusions: Brain metastasis is a rare outcome in advanced CRC. Patients within the registry tended to be female, young in age, and harbored with higher rates of KRAS mutations. Whether routine surveillance brain scanning should be considered remains controversial given the relative rarity of developing brain metastases in mCRC and ultimately, most patients with central nervous system involvement die from their extracranial disease.

Journal of Clinical Oncology, 2017

701 Background: Management of rectal cancer with synchronous liver metastasis is not clear. Optim... more 701 Background: Management of rectal cancer with synchronous liver metastasis is not clear. Optimal timing of radiotherapy, chemotherapy, resection of primary and liver metastasis is debated. Methods: The South Australian Registry for metastatic colorectal cancer has entered all patients with mCRC since 1st February 2006. Registry data were analyzed to assess patient characteristics, therapy received and outcomes for patients with liver only metastasis and synchronous rectal or colon primary. KM analysis was used for survival outcomes. Results: 2677 patents had synchronous mCRC. 42% (n = 1125) had liver only metastasis (primary: 275 rectal/850 colon). The main differences between rectal/liver vs. colon/liver were: more males (68.7% v 57.8%, p = 0.001), younger age (65.8 v 73.3 years, p < 0.001) and less poorly differentiated histology (14.2% v 24.1%, p = 0.003). The rate of no surgery on the primary was 21.4% for rectal cancers v. 36% for colon (p ≤ 0.001). Liver surgery rates in...

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 15, 2017

To determine whether the addition of additional cycles of chemotherapy during the "wait &quo... more To determine whether the addition of additional cycles of chemotherapy during the "wait "period following neoadjuvant chemo-radiotherapy for rectal cancer improves the pathologic complete response rate (pCR). Rectal cancer patients were randomly allocated to either a standard 10 week wait period before surgery (standard chemo-radiotherapy, SCRT) or to receive 3 cycles of 5FU based chemotherapy following chemo-radiotherapy during a similar 10 week wait (extended chemo-radiotherapy, XCRT). Primary endpoint was pCR as determined by blinded pathologic assessment. Forty nine patients were randomized (SCRT n =24, XCRT n = 25). Pathologic complete response (pCR) occurred in 10 patients overall but there was no significant difference in pCR between the groups (SCRT n = 6, XCRT n = 4 p = 0.49). The addition of 3 cycles of 5FU/LV in a 10 week wait period after conventional chemoradiotherapy seems to result in similar pCR rates in patients with locally advanced rectal cancer based on...

Acta oncologica (Stockholm, Sweden), Jan 15, 2016

Background Randomized controlled trials evaluating biological therapy have shown improvements in ... more Background Randomized controlled trials evaluating biological therapy have shown improvements in survival from metastatic colorectal cancer (mCRC). Subjects in the trials represent a selected proportion of mCRC patients. We have the potential to assess the impact of biological therapy on mCRC outcomes, particularly the effect of bevacizumab, from a population-based clinical registry by comparing two time cohorts with differences in therapy accessibility. Material and methods A retrospective cohort study was performed by analyzing the South Australian (SA) mCRC registry data based on diagnosis in two time periods: 1 February 2006-31 May 2009 (Cohort A) versus 1 June 2009-30 June 2014 (Cohort B). The demarcation for these cohorts was chosen to reflect the change in accessibility of bevacizumab from July 2009. Results Between February 2006 and June 2014, 3308 patients were identified through the SA mCRC registry: 1464 (44%) in Cohort A and 1844 (56%) in Cohort B. 61 and 59% patients in...

Journal of Medical Imaging and Radiation Oncology, 2014

Introduction: The aims of the study were to evaluate interobserver variability in contouring the ... more Introduction: The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the RTOG-approved protocol and to analyse BP dosimetries. Methods: Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computedtomography images and antero-posterior digitally-reconstructed-radiographs (AP-DRRs)) and quantitatively (by volumetric and statistical analyses). Dose-volume-histograms (DVHs) of BPs were calculated and compared. Results: We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper with a mean volume of 20.8 cc (range 11-40.7 cc) compared with 33 ± 4 cc (25.1-39.4 cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2 Gy vs 44.8 Gy, 64.5 Gy vs 68.5 Gy, 6.1% vs 7.6%, 2.9% vs 2.4% and 0.6% vs 0.3% respectively. Conclusion: This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping especially when using IMRT, this atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term "brachial-plexus-regions (BPR)" to represent regions where BPs are likely to be present. Consequently, BPR should in principle be contoured generously.

Australasian Journal of Dermatology

A randomised controlled trial was undertaken to compare the efficacy of topical Calendula officin... more A randomised controlled trial was undertaken to compare the efficacy of topical Calendula officinalis (Calendula) versus standard of care (Sorbolene: 10% glycerine in cetomacragol cream) in reducing the prevalence of radiation‐induced dermatitis in women undergoing breast cancer radiotherapy.

Journal of Clinical Oncology

3531 Background: Surgical resection of oligometastases improves survival in metastatic colorectal... more 3531 Background: Surgical resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether such benefit is consistently observed for BRAF V600E mutant (MT) and wild type (WT) mCRC. We conducted a retrospective analysis to explore the influence of BRAF mutation status on survival outcomes after metastasectomy. Methods: Data collected from two large prospective population databases in Australia (Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) and South Australian cancer registry). Overall survival (OS) and recurrence free survival (RFS) for BRAF MT and WT mCRC were evaluated by Kaplan-Meier method and compared by log-rank test. Results: 513 patients who had undergone metastasectomy were identified, 6% were BRAF MT. Median age 63. Metastasectomy rate was lower in BRAF MT (13 v 27%). In BRAF WT, 4% underwent resection of metastases (mets) in >1 organ at diagnosis and 5% had 3 or 4 metastasectomies versus none in BRAF MT. Media...

Journal of Medical Imaging and Radiation Oncology

Introduction: Barriers exist for both Indigenous and remote patients attending cancer care facili... more Introduction: Barriers exist for both Indigenous and remote patients attending cancer care facilities. We sought to measure clinical attendance of all patients referred for consideration of radiation therapy (RT) at the single radiation therapy centre in the Northern Territory (NT), with particular attention to a comparison of Indigenous and non-Indigenous patients, and to analyse methods introduced to address the attendance of patients. Methods: Patients referred for radiation therapy over a 5 year period from the commencement of the Alan Walker Cancer Care Centre (AWCCC), NT, were analysed for attendance, and for possible improvement over time. Results: Multivariate analysis of non-attendance prior to RT (pre-RT) showed significance for Indigenous status (P < 0.001), and female gender (P < 0.001), and during RT showed significance for Indigenous status (P < 0.001) and curative intent RT (P = 0.012). Attendance during RT over the 5 years showed significant improvement over time for Indigenous patients from 70.6% to 81.6% (P = 0.038). There was no significant improvement with pre-RT attendance for either the Indigenous or non-Indigenous cohort. Conclusion: Indigenous patients experienced a lower level of attendance during RT, but this has significantly improved over the first 5 years of operation at AWCCC, as recognition and management of contributing factors has improved.

Journal of Medical Imaging and Radiation Oncology, 2013