Postoperative local recurrence affects 20-30% of patients with rectal
cancer. Between 1993 and 2013, University of Leeds researchers identified
the importance of pathology studies to show a disease-free margin around
the excised tumour and how to predict this margin routinely and accurately
using simple histopathology and preoperative MRI.
We also used photography in the pathological assessment of the quality of
surgery and were instrumental in the adoption of modern techniques by
professional organisations around the world.
Following adoption of our techniques in England and Scotland, local
recurrence has halved with 10% better survival and cost savings of £60
million. Our methods have also become the gold standard in the treatment
of rectal cancer patients around the world.
Impact: Health and welfare; a UK clinical trial of uterine artery
embolisation (UAE), with five-year
follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations
internationally and changed clinical
practice. Women worldwide can now make an informed choice about their
factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare
Attribution: G. Murray, UoE, developed and delivered innovative
trial methodology; clinical
aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on
clinical practice that will
impact up to 25% of women.
Colorectal cancer is a common disease, which frequently causes death or
because of failure to control the primary tumour or failure to prevent
distant metastases. Leeds
researchers have devised new treatment approaches using chemotherapy and
tested them in large randomised controlled trials which have led to major
changes in clinical
practice in the management of rectal cancer and advanced colorectal cancer
clinical decision-making and improving outcomes for patients. This
treatment for elderly patients and patient stratification on the basis of
Severe Limb Ischaemia (SLI), in which there is reduced blood flow to the
leg(s), is the commonest
cause worldwide of gangrene and limb loss. The BASIL trial, led by
Professor Andrew Bradbury at
the University of Birmingham, was the first (and remains the only)
randomised controlled trial to
investigate whether surgical bypass or endovascular (`keyhole') treatment
is best at relieving
symptoms and preventing amputation and/or death in patients with SLI. The
outcomes of the study
have been of worldwide interest, and the recommendations put forward by
the team have been
endorsed by a number of high profile clinical organisations. These
findings are also
nowincorporated within a series of national and international guidelines
Research at Cardiff University is underpinning the abandonment of the
100-year-old surgical practice of removing all axillary lymph nodes in
cases of breast cancer. Such surgery frequently caused arm lymphoedema,
loss of arm mobility and lymphatic system damage. Cardiff led the seminal
ALMANAC trial which showed that full node clearance was unnecessary if a
biopsy of the first draining `sentinel' node was cancer-free. Cardiff then
spearheaded the impact on practice through a training and awareness
programme for surgeons, primarily in the UK, but also in China, India,
Brazil and Turkey. By 2010 these efforts had established the Sentinel
Lymph Node Biopsy (SLNB) procedure as standard in the UK, while the study
was also cited in USA guidelines. The main beneficiaries of the impact are
the 50-75% of breast cancer patients who now enjoy lower levels of pain,
shoulder disability and arm lymphoedema. Healthcare providers also benefit
financially from a reduced need for extensive surgery.
Researchers at the MRC Clinical Trials Unit conducted a systematic review
and meta-analysis of individual patient data on neoadjuvant chemotherapy
for invasive bladder cancer. This work has been cited as evidence in 19
national and international clinical practice guidelines from 2008 to 2013.
In most cases, the guidelines citing this review substantiate their
clinical recommendations by directly quoting the review content.
Before 2010, there was no accepted standard treatment for patients with
advanced biliary tract cancer. The ABC02 trial showed that the combination
of two drugs (gemcitabine and cisplatin) significantly improves survival,
with acceptable side effects. Consequently, national and international
guidelines have been revised to recommend this regimen as a standard of
care. Furthermore, in ongoing trials of novel therapies,
gemcitabine/cisplatin has become the comparator group, and the aim is to
improve survival above what this can already achieve.
Bowel cancer is the third most frequently diagnosed cancer worldwide.
University of Glasgow researchers have established Xeloda (an oral
5-fluorouracil precursor) and XELOX (a chemotherapeutic regimen combining
Xeloda with oxaliplatin) as highly effective, targeted therapies for
patients with bowel cancer. Since 2008, European regulatory approval of
these therapies has been incorporated into major international clinical
guidelines. The research has transformed patient care by improving the
treatment experience, with more convenient dosing schedules and fewer side
effects compared with previous chemotherapy procedures. Xeloda and XELOX
have transformed chemotherapy for bowel cancer and decreased therapeutic
costs, potentially saving around £4,762 (Xeloda) and £947 (XELOX) per
patient for the NHS.
Work led by researchers at UCL has had a national and international
impact on the way that patients with symptoms suggestive of colorectal
cancer are investigated. Specifically, investigation of the role of CT
colonography (a relatively novel and non-invasive method of investigating
the large bowel using an X-ray scanner) has led to this examination
replacing the standard alternative of barium enema in the UK National
Bowel Cancer Screening Programme and for symptomatic patients in the NHS.
The research has also led to easing of pressure on over-subscribed
endoscopy services in the NHS because patients can be safely diverted
towards CT colonography as an alternative.
The University of Oxford's International Subarachnoid Aneurysm Trial
(ISAT) changed clinical practice worldwide by showing that endovascular
coiling is a more effective and safer treatment than neurosurgery
following subarachnoid haemorrhage, with fewer complications and improved
quality of life. Subarachnoid haemorrhages account for 1 in 14 strokes and
are caused by bleeding in and around the brain; approximately 85% occur
when cerebral aneurysms rupture. ISAT was the first trial to compare
neurosurgery, or neuroradiological endovascular coiling in patients with
ruptured cerebral aneurysms causing acute subarachnoid haemorrhage.