Mount Vernon Hospital

To provide an initial estimate of the carbon footprint of PET/CT imaging at a UK imaging centre, indicating the major contributing factors to the emission of greenhouse gases. Data were collected for patient and staff travel, energy use, consumables and waste from the PET/CT department at the Paul Strickland Scanner Centre (PSSC). Additional travel data from two other UK departments were used as a guide to ensure reasonable representation of UK travel distances. Data were converted to carbon dioxide equivalent emissions (kg CO2e) and expressed in terms of emissions per patient scanned. The carbon footprint of PET/CT imaging at PSSC was measured as 19kg CO2e or 21kg CO2e per patient, depending on the scanner used. The most significant contributors to this were patient travel, and the energy taken by the scanner (this includes the energy taken when the scanner is not operating). Whilst 20kg CO2e is not large by healthcare standards, it is not negligible, representing around 4% to 10% of the emissions of a typical course of radiotherapy. The findings demonstrate the areas of focus to reduce the footprint, and act as a base for future work. This is an initial estimate and does not include the footprint of production and distribution of the radiotracer, nor the "embedded footprint" of the imaging facility and equipment.

Abstract Background: Mammographic screening programmes reduce breast cancer mortality but detect many small good-prognosis tumours which may not progress. Screen-detected cancers are currently treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies are evaluating omission of radiotherapy in low-risk disease. However, there is little evidence for surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of lesions of uncertain malignant potential and benign lesions. SMALL (ISRCTN 12240119) aims to determine the feasibility of using this approach to treat small invasive tumours detected within the UK NHS Breast Screening Programme. Methods: SMALL is a phase III multicentre RCT comparing standard surgery with VAE for screen-detected cancers. Main eligibility criteria are age ≥47 years, unifocal grade 1 tumours with maximum diameter 15mm, strongly ER/PR+ve and HER2-ve, with negative axillary staging. Patients are randomised 2:1 to VAE or surgery, with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are1. Non-inferiority comparison of the requirement for a second procedure following excision2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results: SMALL opened in December 2019. Recruitment halted in 2020 for 5 months due to COVID-19. At 9th July 2025, 49 centres are open, with 640 patients randomised. The randomisation rate is approximately 45%, and per site recruitment rate is 0.4-0.5 patients/month. Drawing from QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback is ongoing, and wider feedback is being delivered across sites via recruitment training workshops. Patient interviews are ongoing to explore patient views and experiences of the trial. Conclusion: SMALL continues to have excellent recruitment, is expected to complete recruitment in 2026 and have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme award 17/42/32 Citation Format: S. McIntosh, C. Coles, D. Dodwell, K. Elder, B. Elsberger, J. Foster, C. Gaunt, J. Henderson, C. Mabena, J. Morgan, Z. Nabi, I. Lyburn, S. Paramasivan, S. Pinder, S. Pirrie, S. Potter, T. Roberts, N. Sharma, E. Southgate, H. Stobart, A. Talwalkar, S. Taylor-Phillips, W. Teh, E. Turner, M. Wallis, D. Rea. Small: open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer - a UK phase III randomised multi-centre trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-09-12.

PurposeThere are multiple contemporary systemic therapy options for patients with HER2-positive advanced breast cancer. However, there are few longitudinal data regarding what proportion of patients go on to receive later lines of therapy, real-world outcomes and the impact of brain metastases. We therefore conducted a prospective, multicentre non-interventional study to describe the anti-cancer treatment regimens used and clinical outcomes in patients with HER2-positive advanced breast cancer across multiple lines of therapy undergoing treatment in routine clinical care.MethodsAdult patients diagnosed with HER2-positive advanced breast cancer were recruited to a prospective, multicentre non-interventional study to observe treatment patterns and outcomes.ResultsThree hundred and eleven patients were recruited with median age 57 years. Of those patients initiating first, second-, and third-line treatment, 72 (23.2%), 59 (41.3%), and 20 (35%), respectively had passed away without advancing on to subsequent lines of therapy. The median progression-free survival in the first line was 25.8 months and overall survival 56.7 months. Over the course of the study 107 (34.4%) of participants were diagnosed with CNS metastases. Median overall survival from diagnosis of brain metastases was 15.4 months.ConclusionsMany patients treated in routine practice may not get to benefit from contemporary second and later line treatments, where brain metastases become increasingly common. These findings have implications for selection of optimal systemic therapy sequencing in advanced HER2-positive breast cancer.Clinical Trial RegistrationThis study was approved by Nottingham Research Ethics Committee on 29th December 2014. Clinical Trial Registration: NCT02393924.

IntroductionMammographic screening identifies many women with small breast cancers with favourable biological features, which have an excellent prognosis. Some of these may never have become clinically apparent without screening and are commonly described as ‘overdiagnosed’ cancers. Despite this, all patients with screen-detected cancers are currently treated with surgical excision and sentinel lymph node biopsy, although this may represent overtreatment. There is, therefore, a need for less invasive approaches to reduce treatment burden for patients while maintaining current excellent oncological outcomes. Vacuum-assisted excision (VAE) may represent such an alternative treatment approach, and the SMALL (Open Surgery versus Minimally invasive-vacuum Assisted excision for smaLL screen-detected breast cancer) trial aims to investigate the use of VAE for the safe de-escalation of surgical treatment for such excellent prognosis invasive breast cancers.MethodsSMALL is a prospective, multicentre, randomised phase III trial of VAE versus surgery in patients with small, biologically favourable screen-detected invasive breast cancer. SMALL has an innovative hybrid design with coprimary endpoints. These include a randomised non-inferiority comparison of surgical re-excision rates following initial treatment, and a single-arm analysis of local recurrence at 5 years following VAE. Secondary outcomes include complication rates, overall survival, quality of life and a health economic analysis. The trial includes a QuinteT Recruitment Intervention to support recruitment.Ethics and disseminationEthical approval was obtained from the Office for Research Ethics (Northern Ireland) for all UK sites. Results will be submitted for publication in a peer-reviewed journal, presented, shared with patient partners and with relevant professional organisations to inform future guideline development for the management of screen-detected breast cancer.Trial registration numberISRCTN12240119.

PurposeCorticosteroid injections are commonly used to treat symptomatic knee osteoarthritis; however, pain relief is usually transient. Genicular artery embolization (GAE) has shown promise as an effective minimally invasive intervention to alleviate symptomatic knee osteoarthritis. The MOTION study is being conducted to compare outcomes following GAE versus corticosteroid injection.Materials and MethodsThis is an international, multicenter, randomized controlled investigational device exemption (IDE) study enrolling adults (≥ 21 years old) with symptomatic knee osteoarthritis (Kellgren–Lawrence grades 1–4) across ≥ 45 centers worldwide. Patients will be randomized 1:1 to receive GAE with Embosphere® Microspheres (Merit Medical Systems, Inc.) or corticosteroid injections. The primary efficacy measure is clinical success at 6 months, defined as ≥ 50% improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale. The primary safety measure is the proportion of patients free from treatment-related safety event(s) through 6-month post-index procedure (GAE or corticosteroid injection). Following the 6-month visit, patients in either cohort who do not achieve clinical success may crossover to the other study arm. Additional study measures will assess safety and efficacy outcomes throughout the 24-month follow-up period. The target sample size is 264 (132 per arm) and is based on the number of patients needed to confirm superior efficacy of GAE versus corticosteroid injections and non-inferiority with respect to safety. The overall study power is > 80%.DiscussionFindings from the MOTION study are expected to provide information on the magnitude of the therapeutic benefits associated with GAE versus standard of care over 24 months.Trial RegistrationNCT05818150.Graphical

Survey-based research is increasingly used in radiation oncology, yet survey-based research methodology is often unfamiliar in the field. This guideline offers comprehensive instructions for conducting survey-based research in radiation oncology, covering critical aspects such as survey design, validation, dissemination, analysis and reporting. Tailored to professionals, it emphasizes the importance of methodological rigour to ensure reliable and actionable data collection. Dissemination strategies are highlighted to maximize response rates and enhance data completeness across diverse clinical, research and industrial settings. Rigorous analysis techniques are discussed to uncover insights that optimize operational efficiencies and inform evidence-based practices. Transparent reporting is underscored as crucial for enhancing the credibility and applicability of findings. This guideline aims to be a practical resource for enhancing research standards in survey-based research for researchers and practitioners in radiation oncology.

89 Background: Darolutamide has authorisation for treatment of metastatic hormone sensitive prostate cancer (MHSPC) in combination with docetaxel chemotherapy and androgen deprivation therapy (triplet therapy) based on ARASENS trial results. The RECOMMEND study is a prospective real-world evaluation (RWE) of clinical outcomes in patients with MHSPC treated with this regimen in the UK. Methods: 318 patients were enrolled from 21 UK centres over 20 months from November 2022. Data cut-off was 14 August 2024. Disease characteristics were evaluated. Descriptive statistics have been used for patient demographics and PSA changes with treatment were analysed. Results: Patients on the study had a median age of 67 (range 38-84) years. Majority of the patients were de novo metastatic (91.2%). 68.2% have a Gleason score ≥8. 76 patients (23.9%) had next generation imaging (NGI) at diagnosis. Performance score was 0 (62.7%) or 1 (37.3%). The distribution of metastases (%) were: bone (84.9), nodal (60.4), lung (12.6) and liver (2.5). The median PSA level was 134 (range 1 to 5628) ng/mL at diagnosis. At the end of docetaxel chemotherapy median PSA was 0.35 ng/mL. PSA response see in the 226 patients who had completed 6 cycles of docetaxel chemotherapy at the data cut-off, PSA 50 was seen in 87.6% (198/226) and PSA 90 in 53.2%. PSA responses in those who only completed 4/5 cycles of docetaxel (n=14) did not significantly differ compared to those who completed all 6 cycles (PSA 50 p=0.445 and PSA 90 p-0.664). At 6 months from darolutamide initiation, quality of life (QoL) data is currently available for 173 patients, of these 88.4% reported either stable or improved QoL and 11.6% had a decline in QoL at the end of chemotherapy. Conclusions: The tolerability and efficacy profile of treatment with ADT+Darolutamide+Docetaxel in MHSPC in the RECOmMEnD study is similar to that reported in the ARASENS trial. The QoL data available for 173 patients to date reports either stable or improved QoL at 6 months for 88.4% cases. This provides important prospective RWE data, enabling patients and clinical teams to make informed choices in this setting.