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Peter Graham

Publications and source records attributed to Peter Graham.

11 recordsLinked to original sources
PubMed2005

Intralesional targeted alpha therapy for metastatic melanoma.

UNLABELLED: This paper reports the development and application of intralesional targeted alpha therapy (TAT) for melanoma, being the first part of a program to establish a new systemic therapy. RATIONALE: Labelling the benign targeting vector 9.2.27 with 213Bi forms the alpha-immunoconjugate (AIC), which is highly cytotoxic to targeted melanoma cells. OBJECTIVE: To investigate the safety and efficacy of intralesional AIC in patients with metastatic skin melanoma. FINDINGS: 16 melanoma patients were recruited. All the patients were positive to the monoclonal antibody 9.2.27. AIC doses from 50 to 450 mCi injected into lesions of different sizes resulted in massive cell death, as observed by the presence of tumour debris. The AIC was very effective in delivering a high dose to the tumour while sparing other tissues. There were no significant changes in blood proteins and electrolytes. There was no evidence of a human-antimouse-antibody reaction. Evidence of significant decline in serum marker melanoma-inhibitory-activity protein (MIA) at 2 weeks post-TAT was observed. CONCLUSIONS: Intralesional TAT for melanoma was found to be quite safe up to 450 mCi, and efficacious at a dose of 200 mCi. MIA, apoptosis and ki67 proliferation marker tests all indicated that TAT is a promising therapy for the control of inoperable secondary melanoma or primary ocular melanoma.

Aged↗
PubMed2005

Evaluation of the ACRRM national radiology program for Australian rural and remote medical practitioners.

INTRODUCTION: In 2000, the Australian College of Rural and Remote Medicine (ACRRM) developed a national radiology quality assurance (QA) and continuing medical education (CME) program for rural and remote non-specialist Australian doctors. The program commenced on 1 January 2001. It required rural doctors to obtain 30 radiology QA/CME points over a 4 year period. At least 15-20 of these points had to be obtained by one of two mandatory options of the program, either: (1) film interpretation, report and review clinical audit activity; or (2) a radiology clinical attachment. METHOD: Doctors submitted their completed film review forms and clinical attachment logbooks to the program manager as confirmation of their educational activity to receive their professional development points. Data from film review forms and clinical attachment logbooks were de-identified and entered into two Microsoft EXCEL spreadsheets. The data were categorised and analysed in EXCEL. RESULTS: From 1 January 2001 to September 2004, 823 rural and remote doctors enrolled in the ACRRM radiology program. This included 281 locums who enrolled in the short-term locum option of the program and 563 doctors who enrolled in the full program. In September 2004, 419 doctors had completed a radiology film review with a radiologist and 41 doctors completed a radiology clinical attachment in 31 different public and private radiology practices. One hundred and ninety-five doctors completed the short-term locum activity. Ninety-two different specialist radiologists participated in the program and assisted rural and remote doctors to enhance their radiology knowledge, confidence and skills. This article describes results from the two mandatory activities. CONCLUSION: The evaluation of the ACRRM radiology program after its first 3 years and 9 months shows there are a large number of rural and remote Australian doctors undertaking professional development and quality assurance activities in radiology.

Attitude of Health Personnel↗
PubMed2004

Effect of oral sucralfate on late rectal injury associated with radiotherapy for prostate cancer: A double-blind, randomized trial.

PURPOSE: To assess whether oral sucralfate is effective in preventing late rectal injury in prostate cancer patients treated with radiotherapy. METHODS AND MATERIALS: A double-blind, placebo-controlled, randomized trial was conducted across four institutions in Australia. Patients receiving definitive radiotherapy for prostate cancer were randomized to receive either 3 g of oral sucralfate suspension or placebo twice daily. Data on patients' symptoms were collected for 2 years, and flexible sigmoidoscopy was scheduled at 12 months after treatment. RESULTS: A total of 338 patients were randomized, of whom 298 had adequate follow-up data available for an analysis of late symptoms. Of the 298 patients, 143 were randomized to receive sucralfate and 155 placebo. The cumulative incidence of Radiation Therapy Oncology Group Grade 2 or worse late rectal toxicity at 2 years was 28% for placebo and 22% for the sucralfate arm (p = 0.23; 95% confidence interval for the difference -3% to 16%). Seventeen percent of patients in the sucralfate group had significant bleeding (Grade 2 or worse) compared with 23% in the placebo group (p = 0.18, 95% confidence interval -15% to 3%). No statistically significant difference was found between the two groups with respect to bowel frequency (p = 0.99), mucus discharge (p = 0.64), or fecal incontinence (p = 0.90). Sigmoidoscopy findings showed a nonstatistically significant reduction in Grade 2 or worse rectal changes from 32% with placebo to 27% in the sucralfate group (p = 0.25). CONCLUSION: This trial demonstrated no statistically significant reduction in the incidence of late rectal toxicity in patients randomized to receive sucralfate. However, this result was considered inconclusive, because the trial was unable to exclude clinically important differences in the late toxicity rates.

Adult↗
PubMed2004

Targeted alpha therapy for cancer.

Targeted alpha therapy (TAT) offers the potential to inhibit the growth of micrometastases by selectively killing isolated and preangiogenic clusters of cancer cells. The practicality and efficacy of TAT is tested by in vitro and in vivo studies in melanoma, leukaemia, colorectal, breast and prostate cancers, and by a phase 1 trial of intralesional TAT for melanoma. The alpha-emitting radioisotope used is Bi-213, which is eluted from the Ac-225 generator and chelated to a cancer specific monoclonal antibody (mab) or protein (e.g. plasminogen activator inhibitor-2 PAI2) to form the alpha-conjugate (AC). Stable alpha-ACs have been produced which have been tested for specificity and cytotoxicity in vitro against melanoma (9.2.27 mab), leukaemia (WM60), colorectal (C30.6), breast (PAI2, herceptin), ovarian (PAI2, herceptin, C595), prostate (PAI2, J591) and pancreatic (PAI2, C595) cancers. Subcutaneous inoculation of 1-1.5 million human cancer cells into the flanks of nude mice causes tumours to grow in all mice. Tumour growth is compared for untreated controls, nonspecific AC and specific AC, for local (subcutaneous) and systemic (tail vein or intraperitoneal) injection models. The 213Bi-9.2.27 AC is injected into secondary skin melanomas in stage 4 patients in a dose escalation study to determine the effective tolerance dose, and to measure kinematics to obtain the equivalent dose to organs. In vitro studies show that TAT is one to two orders of magnitude more cytotoxic to targeted cells than non-specific ACs, specific beta emitting conjugates or free isotopes. In vivo local TAT at 2 days post-inoculation completely prevents tumour formation for all cancers tested so far. Intra-lesional TAT can completely regress advanced sc melanoma but is less successful for breast and prostate cancers. Systemic TAT inhibits the growth of sc melanoma xenografts and gives almost complete control of breast and prostate cancer tumour growth. Intralesional doses up to 450 microCi in human patients are effective in regressing melanomas, with no concomitant complications. These results point to the application of local and systemic TAT in the management of secondary cancer. Results of the phase 1 clinical trial of TAT of subcutaneous, secondary melanoma indicate proof of the principle that TAT can make tumours in patients regress.

Alpha Particles↗
PubMed2004

Randomized, paired comparison of No-Sting Barrier Film versus sorbolene cream (10% glycerine) skin care during postmastectomy irradiation.

PURPOSE: Postmastectomy irradiation provides an excellent model for irradiated skin care practices because of the relatively uniform surface and radiation compared with other situations in which radiation-induced moist desquamation is common. We designed a study to test the effect of prophylactic 3M Cavilon No-Sting Barrier Film (No-Sting) on the rates of moist desquamation compared with sorbolene cream (with 10% glycerin). METHODS AND MATERIALS: The irradiated chest wall was divided into medial and lateral halves. Sixty-one women were randomized to have No-Sting applied to either the medial or lateral half, with the alternate half treated with sorbolene. RESULTS: For all patients, the skin toxicity, calculated as the area under the curve, mean No-Sting and sorbolene score was 8.1 vs. 9.2, respectively (p = 0.005, Wilcoxon signed rank test). The total number of weeks of moist desquamation for the 61 patients was 40 vs. 45, equating to a mean of 0.65 week vs. 0.74 week per patient in the No-Sting and sorbolene-treated areas, respectively. The rates of moist desquamation were 33% vs. 46% (p = 0.096, McNemar's Exact test). For 58 fully assessable patients (minimum of 7 weekly observations), the area under the curve and rates of moist desquamation were significantly different statistically (p = 0.002 and 0.049, respectively). No statistically significant differences were noted in the pain scores. The pruritus scores were significantly reduced in the No-Sting area (area under the curve, p = 0.011). CONCLUSION: No-Sting reduces the duration and frequency of radiation-induced moist desquamation.

Adult↗
PubMed2003

Type of consent does not influence patient recall of serious potential radiation toxicity of adjuvant breast radiotherapy.

In a sample of 174 women who had received verbal consent (n = 35), general written consent (n = 34) or detailed toxicity-specific written consent (n = 105), no significant differences were found in recall of serious potential toxicities by consent type. Age younger than 70 years and employment outside of the home were significantly associated with better recall. Factors not significantly associated with different recall rates were work status, use of interpreters for consent, time elapsed from treatment or the extent of radiotherapy (tangents only vs other). Overall recall was poor. Twenty-eight percent of women could not correctly recall if their treatment risked any of four nominated complications (lymphoedema, pneumonitis, rib fracture or brachial plexopathy). Significant numbers of women erroneously attributed a number of 'complications' or symptoms to radiotherapy.

Adult↗
PubMed2003

The Beck inventory.

Explore the source record for details and available documents.

Depressive Disorder↗
PubMed2002

Women's choice between sentinel lymph node biopsy and axillary clearance.

PURPOSE: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. METHODS: The expected 5-year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. RESULTS: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. CONCLUSIONS: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC.

Adult↗
PubMed2002

What happens to testosterone after prostate radiation monotherapy and does it matter?

PURPOSE: There is uncertainty in the literature regarding the extent and relevance of temporary decreases in testosterone levels which occur after external radiation therapy for prostate cancer. We describe the phenomenon in detail and assess the impact on biochemical control and prostate specific antigen (PSA) doubling time in patients with relapse. MATERIALS AND METHODS: A total of 666 men were followed after external beam radiation without neoadjuvant or adjuvant androgen ablation. Serial testosterone and PSA were measured before and at 3 to 6-month intervals after therapy. RESULTS: At a median nadir time of 6 months testosterone decreased to an average of 83% of baseline. Of the patients 7.5% experienced a decrease greater than 50%. All but 3% of those with normal initial testosterone levels experienced recovery to at least normal levels but only 60% had recovery to their individual pretreatment level. Multivariate analysis showed that patients with a low pre-intervention testosterone level, and those treated with larger radiation volumes had a lower testosterone nadir. In regard to biochemical control rates, initial testosterone level, degree of decrease, and absolute testosterone nadir had no effect in either univariate or multivariate analysis. PSA doubling times in patients with relapse were no different than in those with a small or larger testosterone decrease. CONCLUSIONS: Temporary testosterone decrease after radiation therapy to the prostate is a real phenomenon with no impact on subsequent tumor outcomes.

Adult↗
PubMedDate not supplied

Muddling through a merger: a qualitative study of two combined family practice residencies.

BACKGROUND AND OBJECTIVES: Mergers of residency training programs have become more common, but little has been published about their educational impact. Following our own merger, we sought to understand this process and its aftermath by conducting focus groups. METHODS: Three 1-hour focus groups were conducted-one with third-year residents, one with first- and second-year residents, and one with core faculty members. The interview script was based on a five-factor transitional model where each factor represented a potential fracture point that could result in organizational conflict. The five factors were curriculum, corporate culture, day-to-day operations, teaching environment, and financial resources. Focus group audiotapes were transcribed, and the investigators independently identified themes using an immersion and crystallization approach. Feedback from participants was obtained. RESULTS: Themes identified included unmet potential of the combined curriculum, a blending of two disparate cultures resulting in feelings of loss and displacement for some, and a sense of rapid policy change and lack of resident and faculty accountability. Faculty recommendations for other programs involved in mergers include creating frequent facilitated retreats, acknowledging loss, and establishing new rituals for the combined program. CONCLUSIONS: The transition through a merger of two residency programs is difficult and has direct educational and emotional impact. Such difficulties can, in part, be predicted, and improved communication and planning may facilitate this process.

Adult↗