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Aim This is the first randomised study to evaluate toxicity and survival outcomes of two neoadjuvant chemoradiotherapy (CRT) regimens for patients with localised oesophageal adenocarcinoma (OAC) or gastro-oesophageal junction (GOJ) adenocarcinoma. The initial results showed comparable toxicity between regimens and pathological complete response (pCR) rate favouring CarPacRT. Herein, we report survival, progression patterns, and long-term toxicity after a median follow-up of 40.7 months. Methods NeoSCOPE was an open-label, UK multicentre, randomised, phase II trial. Eighty-five patients with resectable OAC or GOJ adenocarcinoma, ≥cT3 and/or ≥cN1 (TNM v7), suitable for neoadjuvant CRT, were recruited between October 2013 and February 2015. Patients were randomised to OxCapRT (oxaliplatin 85 mg/m2 on Days 1, 15, and 29; capecitabine 625 mg/m2 orally twice daily on days of radiotherapy [RT]) or CarPacRT (carboplatin AUC2; paclitaxel 50 mg/m2 on Days 1, 8, 15, 22, and 29). RT dose was 45 Gy/25 fractions/5 weeks. Both arms received induction chemotherapy (two cycles oxaliplatin 130 mg/m2 on Day 1, capecitabine 625 mg/m2 orally twice daily on Days 1–21) before CRT. Surgery was performed 6–8 weeks after CRT. The primary end-point was pCR. Secondary end-points were toxicity, progression-free survival (PFS), overall survival (OS), and patterns of progression. Results Eighty-five patients were recruited from 17 UK centres. The median OS was 41.7 months (95% confidence interval [CI] 19.6 to not reached) in the OxCapRT arm and was not reached in the CarPacRT arm (multivariable hazard ratio [HR] = 0.48, 95% CIs: 0.24–0.95, P = 0.035). The median PFS was 32.6 months (95% CIs: 17.1 to not reached) in the OxCapRT arm and was not reached in the CarPacRT arm (multivariable HR = 0.54, 95% CIs: 0.29–1.01, P = 0.053). In both arms, the distant progression was twice as common as locoregional progression. Conclusions OS and PFS favoured neoadjuvant CarPacRT over OxCapRT. Distant was more common than locoregional progression; therefore, priority should be given to optimising the systemic treatment component. Clinical trial information EudraCT Number: 2012-000640-10; ClinicalTrials.gov: NCT01843829., Highlights • Randomised study of neoadjuvant chemoradiotherapy for oesophageal adenocarcinoma. • The median overall survival was significantly better with CarPacRT. • Across both arms, the distant was more common than locoregional progression.

Skin cancer is the most common malignancy in the UK, and up to a third of lesions are ulcerated at the time of excision. Ulceration has been shown to increase the risk of developing surgical site infection following excision, with some studies finding infection rates of 33%. However, no specific guidelines for the use of antibiotic prophylaxis in such cases exist. We surveyed 129 clinicians (covering Dermatology, Plastic Surgery, Ear, Nose and Throat Surgery, and Oral and Maxillofacial Surgery) who all excise skin lesions on a regular basis. There was significant variability in their practice with regard to antibiotic prophylaxis, with 9% always prescribing them and 19% never prescribing them. Variation exists both among and between specialities. This variation increases the risk of antimicrobial resistance and shows a paucity of good clinical evidence, indicating that a well-designed clinical trial is needed to guide future practice.

The IPCC’s pledge to reach net zero GHG target by 2050 to keep global warming below 1.5oC means that it is now critical to focus on some non-power high emitting industrial sectors from which CO2 emission is unavoidable either due to the inherent process chemistry producing CO2 or burning fossil fuel to provide required energy to the process. Fossil fuels are an essential input to several vital industries, not as a primary energy source to generate electricity, but to provide necessary thermal input that can’t be replaced by renewables. Currently, fossil CO2 emissions continue to grow by over 1% annually and reached a record high of 37 gigatonnes of CO2 in 2018. To reach net zero emissions, CO2 emissions have to fall by 45% by 2030 and to net zero by 2050. The necessity of net zero has been recognised by many countries around the world along with UK which has set net-zero GHG target for 2050 into law. Deep emission reductions from high emitting industrial sectors e.g. cement, steel, fertiliser, chemical is an absolute necessary. CCS is the only large-scale technology available that can enable significant decarbonisation of these industries. Energy efficiency measures must be complemented by CCS in order to achieve deep emission reduction. This paper builds on the concept developed during OGCI Net Zero Teesside project and further developed focusing on CO2 emission reduction and associated challenges from two such high emitting industries - Fertiliser and Cement. For this paper, we have created generic cases using typical plant data and generic amine performance data. Plants are assumed to be located in the UK as a design basis, but the design will be applicable to similar plants elsewhere. Both industries have been techno-economically evaluated for ~90% CO2 capture, transportation of supercritical CO2 at 110 bara to permanent geological storage. Two sensitivity cases have been developed for the fertiliser industry to assess the impact of lower emission reduction on overall economics. Typically, nitrogen fertilisers are produced by energy-intensive processes using natural gas as initial feedstock and deriving the required nitrogen from the air. The first stage in the ammonia production process is the synthesis of hydrogen from natural gas by steam methane reforming. Carbon dioxide is removed from the syngas to produce hydrogen rich gas which is then combined with nitrogen to form ammonia. There are therefore two CO2 sources from a fertiliser plant: relatively pure process CO2 stream that is captured from syngas and CO2 in the flue gas from the reformer that can be removed by CCS. It is important to note that process CO2 emissions cannot be easily reduced as they are an inherent by-product of the production process. Approximately 2/3 of the overall CO2 emission from a fertiliser plant is process CO2; rest is in the flue gas. Three cases have been developed for fertiliser plant: Case 1 (~1.2 MTPA of CO2) includes both process CO2 and ~90% CO2 capture from reformer flue gas; Case 2 is based on process CO2 only (~0.8 MTPA of CO2) with reformer flue gas assumed to be emitted to atmosphere; Case 3 is ~90% CO2 capture from reformer flue gas only excluding process CO2 stream. These cases have been developed to evaluate the impact of CO2 captured from the different sources on the project cost and Levelised Cost of Capture (LCOC). Case 2 represents the lowest LCOC case at $57/tCO2 with ~ 67% overall CO2 capture whereas highest LCOC is associated with the Case 3 at ~$134/tCO2 capturing only ~ 33% CO2. Case 1 achieves a LCOC of ~$81/tCO2 with an overall >90%. This clearly shows the advantage of the availability of process CO2 on the overall capture rate and cost of capture as well. Case 3 suffers from higher LCOC as it doesn’t benefit from having a readily available process CO2 stream that doesn’t require any capture plant. In the cement manufacturing process, more than half of the CO2 emissions are process-related (generated from decarbonation of limestone in the kiln) and rest are from fossil fuel combustion. Generally, hot flue gas from the combustion in the rotary kiln combines with additional flue gas generated by the pre-calciner burner and heats up the raw mix entering the rotary kiln. After as much useful heat as possible is recovered from the flue gas, and bag filters remove the dust before flue gas release to atmosphere through the stack. The cement carbon capture plant considered for this paper is based on post combustion capture of ~0.5 MTPA of CO2 from the flue gas. The cement process does not have any requirement for steam, therefore new boiler is needed to generate steam for the carbon capture reboiler. A natural gas fired auxiliary boiler is assumed for steam generation and flue gas from this auxiliary boiler is sent to the same capture plant. NO2 in the flue gas degrades amine-based carbon capture solvents as it reacts to produce nitrite and nitrate heat stable salts (HSS). Most of the available carbon capture licensed technologies have very stringent NO2 acceptable limit of typically

373 Background: Initial results of the NEOSCOPE trial comparing pre-operative CarPac vs OxCap based chemoradiotherapy (CRT) in patients with adenocarcinoma of the oesophagus or oesophagogastric junction showed comparable toxicity and improvement in pathological complete response (pCR) in favour of the CarPacRT. Here we report survival after a median follow-up of 40.7 months (95% CI: 45.1-53.6). Methods: NEOSCOPE was an open, randomised, ‘pick a winner’ phase II trial. Patients with resectable oesophageal adenocarcinoma ≥ cT3 and/or ≥ cN1 were randomised to OxCapRT (oxaliplatin 85 mg/m2 day 1, 15, 29; capecitabine 625 mg/m2 bd on days of RT) or CarPacRT (carboplatin AUC2; paclitaxel 50 mg/m2 day 1, 8, 15, 22, 29). RT dose was 45 Gy/25 fractions/5 weeks. Induction OxCap (2 cycles) was given prior to CRT. Surgery was performed 6–8 weeks after CRT.The primary endpoint was pCR, secondary endpoints were toxicity, PFS and OS. Results: Between Oct 2013 and Feb 2015, 85 patients were recruited from 17 UK centres. Median OS was not reached in the CarPacRT group and was 41.72 months (95% CI 19.58-.)in the OxCap group (HR 0.56[95% CI 0.29-1.07]; p=0.079). 3-year and 5-year OS rates were 74% (95% CI 58%-85%) and 54% (95% CI 34%-71%) (CarPacRT), and 52% (95% CI 35%-67%) and 39% (95% CI 21%-56%) (OxCapRT). Median PFS (not reached vs 35.3 months, HR=0.61 [95% CI 0.33-1.12]; p=0.111) and metastatic PFS (not reached vs 39.0 months, HR=0.61 [95% CI 0.32-1.14], p=0.118) both favoured the CarPacRT arm. Local recurrence rate was low (OxCapRT= 10%; CarPacRT= 7%). The OS benefit for CarPacRT was consistent across subgroups but not statistically significant. Conclusions: In this longer term analysis there was some evidence that induction OxCap followed by switch to CarPacRT was superior to continuing OxCapRT, with efficacy similar to that seen in other published studies such as ‘CROSS’ and ‘FLOT’. Taken together with the previously published pCR results CarPacRT rather than OxCapRT warrants inclusion in future trials. Funding: Cancer Research UK (C44694/A14614). Clinical trial information: NCT01843829.

BACKGROUND:Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here.METHODS:Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented.RESULTS:Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups.CONCLUSIONS:CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.

BACKGROUND: Definitive chemoradiotherapy (CRT) is an alternative to surgery for the curative treatment of oesophageal carcinoma. The SCOPE1 trial aimed to investigate the addition of cetuximab to cisplatin and fluoropyrimidine-based definitive CRT in patients with localised oesophageal squamous-cell cancer and adenocarcinomas to assess activity, safety, and feasibility of use. METHODS: In this multicentre, randomised, open-label, phase 2/3 trial, we recruited patients aged 18 years and older from UK radiotherapy centres who had non-metastatic, histologically confirmed carcinoma of the oesophagus (adenocarcinoma, squamous-cell, or undifferentiated; WHO status 0-1; stage I-III disease) and been selected to receive definitive CRT. Patients were randomly assigned (1:1) via a central computerised system using stratified minimisation (with an 80:20 random element) to receive CRT alone or CRT with cetuximab (400 mg/m(2) on day 1 followed by 250 mg/m(2) weekly), stratified by recruiting hospital, primary reason for not having surgery, tumour histology, and tumour stage. CRT consisted of cisplatin 60 mg/m(2) (day 1) and capecitabine 625 mg/m(2) twice daily (days 1-21) for four cycles; cycles three and four were given concurrently with 50 Gy in 25 fractions of radiotherapy. The primary endpoint was the proportion of patients who were treatment failure free at week 24 for the phase 2 trial and overall survival for the phase 3 trial, both measured from randomisation. We analysed data by intention to treat. This trial is an International Standard Randomised Controlled Trial, number 47718479. FINDINGS: 258 patients (129 assigned to each treatment group) from 36 UK centres were recruited between Feb 7, 2008, and Feb 22, 2012. Recruitment was stopped without continuation to phase 3 because the trial met criteria for futility, but we continued to follow-up recruited patients until all had reached at least 24-week follow-up (median follow-up of patients who survived was 16.8 months [IQR 11.2-24.5]). Fewer patients were treatment failure free at 24 weeks in the CRT plus cetuximab group (79 of 119 patients [66·4%, 90% CI 58·6-73·6]) than in the CRT only group (93 of 121 patients [76.9%, 69.7-83.0]). The CRT plus cetuximab group also had shorter median overall survival (22.1 months [95% CI 15.1-24.5] vs 25.4 months [20.5-37.9]; adjusted HR 1.53 [95% CI 1.03-2.27]; p=0.035). Patients who received CRT plus cetuximab had more non-haematological grade 3 or 4 toxicities (102 [79%] of 129 patients vs 81 [63%] of 129 patients; p=0.004). The most common grade 3 or 4 toxicities were low white blood cell count (14 [11%] in the CRT plus cetuximab group vs 21 [16%] in the CRT only group), low absolute neutrophil count (15 [12%] vs 24 [19%]), fatigue (26 [20%] vs 25 [19%]), and dysphagia (35 [27%] vs 37 [29%]). INTERPRETATION: The addition of cetuximab to standard chemotherapy and radiotherapy cannot be recommended for patients with oesophageal cancer suitable for definitive CRT. FUNDING: Cancer Research UK.

The disposal of End-of-Life Vehicles (ELVs) results in a highly heterogeneous polymeric waste stream of Automobile shredder residue (ASR). Within Europe, strict legislation, such as the End-of-Life Vehicle Directive and the Landfill Directive, has imposed targets for reducing this waste stream and diverting the material away from landfill. One pathway open to recyclers is to thermally process these wastes, but the presence of chlorine and metallic species can present challenges to traditional incineration technologies. This paper discusses the use of Gasplasma®, an advanced thermal treatment technology, comprising fluidised bed oxy-steam gasification followed by plasma treatment, for ASR, refuse derived fuel (RDF) and blends of ASR and RDF wastes. The work demonstrates the ability to process these highly heterogeneous materials achieving high energy conversion (87–94%) and virtually complete carbon conversion, producing a calorific synthetic gas (syngas) capable of being used for power generation or as a chemical feedstock. The actual conversion efficiency achieved is dependent on feed chemistry and properties. The study also shows that ash components of the feed material can be transformed into an environmentally stable vitrified product.

Objective: We sought to develop a process that would allow us to perform a prospective review of outlining in trials using expert reviewers based in multiple centres. Methods: We implemented a specific information technology infrastructure and workflow that could serve all organizations involved in the radiotherapy quality assurance (RTQA) process. Results: Data were processed and packaged in the computational environment for radiotherapy research (CERR) binary format and securely transmitted to the expert reviewer at the designated remote organization. It was opened and reviewed using the distributed CERR-compiled application, and a standardized report was sent to the respective centre. Centres were expected to correct any unacceptable deviations and resubmit outlining for approval prior to commencing treatment. 75% of reviews were completed and fed back to centres within 3 working days. There were no delays in treatment start date. Conclusion: Our distributed RTQA review approach provides a method of prospective outlining review at multiple centres, without compromising the quality, delaying the start of treatment or the need for significant additional infrastructure resources. Future progress in the area of prospective individual case review will need to be supported by additional resources for clinician time to undertake the reviews. Advances in knowledge: Trial groups around the world have formulated different approaches to address the need for the prospective review of radiotherapy (RT) data with clinical trials, in line with available resources. We report a UK solution that has allowed the workload for outlining review to be distributed across a wider group of volunteer reviewers without the need for any additional infrastructure costs and has already been adopted within the UK RT trials community.

The Gasplasma® process developed by APP is an advanced thermal conversion (ATC) technology which has been developed for the treatment of household and trade wastes and has also been successfully applied to the handling of wastes derived from landfill and would be capable of achieving effective energy conversion when utilised as an integrated part of the Enhanced Landfill Mining (ELFM) concept. The core Gasplasma® technology comprises a two-stage thermal treatment system—firstly, a fluidizing bed gasifier which converts the wastes to a crude syngas using oxy-steam and, secondly, a plasma converter that efficiently cracks problematic tars in the raw syngas to produce a reformed and clean syngas suitable for generating electrical power in gas engines and also recovering an environmentally stable vitrified product for use as a secondary aggregate material. The utilization of oxy-steam as a gasifying agent greatly reduces the syngas volume compared to other ATC processes and incineration and hence reduces the cost of the gas cleaning system while improving the efficiency of the process. By adopting this two-stage approach, high energy conversion (74–90%) and carbon conversion (95 ± 1.6%) efficiencies were achieved with the Gasplasma® plant that compare favourably with published efficiencies data. The calculated net exportable power generation efficiency for a commercial scale plant is significantly in excess of 25%. This compares well with the published figures of 17.7–23% for fluidized bed technologies processing MSW.

The pyrolysis behaviour of predried vegetable market waste has been investigated using TGA within the temperature range 523 to 923 K under inert atmosphere and a comparison has been made with other lignocellulosic materials in order to point out the difference between the pyrolysis of nearly homogeneous and perfectly mixed heterogeneous biomass. Kinetic parameters of the pyrolysis material have been evaluated from the simulation of the TG data. A reaction mechanism involving two parallel 1st order reactions evolving gaseous products lumped as volatiles and solid products lumped as char has been proposed for prediction of rate constants as a function of normalized fractional change. Four kinetic models incorporating the effect of deactivation have been used for this purpose. In another attempt, using concentration independent model of solid deactivation, simulation has been carried out to predict concentration time history of the system components as well as quantitative change of rate constants with the propagation of time. On a etudie le comportement de pyrolyse de dechets de legumes preseches venant de marches en recourant a la methode TGA a des temperatures comprises entre 523 et 923 K et sous atmosphere inerte. Une comparaison a ete faite avec d'autres materiaux lignocellulosiques afin de souligner la difference entre la pyrolyse de biomasse presque homogene et la pyrolyse de biomasse heterogene parfaitement melangee. Les parametres cinetiques du materiau de pyrolyse ont ete evalues a partir de la simulation des donnees de TG. Un mecanisme de reaction faisant intervenir deux reactions paralleles du premier ordre produisant des produits gazeux decomposes en produits volatils et des produits solides decomposes en charbon, est propose pour la prediction des constantes de vitesse en fonction du changement fractionnel normalise. Quatre modeles cinetiques introduisant l'effect de desactivation ont ete utilises a cette fin. Dans une autre tentative, a l'aide d'un modele de desactivation des solides independant de la concentration, on a procede a une simulation pour predire l'evolution de la concentration des composantes de systeme ainsi que le changement quantitatif des constantes de vitesses dans le temps.

This work arises from substantial problems found in the modelling of the gasification and combustion of solid fuel, both coal and biomass in the following different systems: • Coal fired non-slagging cyclone combustors. • Pre-calciners on cement plant. • Fuel rich inverted cyclone combustors used to simulate the time temperature history of large utility boilers. • Cyclonic gasifiers for sawdust and direct firing of small gas turbines. • Deposition studies for slagging and fouling in large utility boilers. • Prediction of final carbon in ash from pulverised coal systems. Commercial CFD codes such as Fluent are well developed and have well proven routines for lagrangian tracking of burning particles through complex flow fields. However what has become apparent in numerous studies is that existing models for solid fuel combustion can be adjusted to predict the initial flow field aerodynamics, sometimes the temperature, but fall down when particles have to be followed completely through a system. This is manifested with cyclone combustors and gasifiers via enhanced retention of burning particles in centrifugal force fields, which can only be resolved by changes in the particle size distribution and thus fragmentation as the particle gasify or burn. This problem also becomes apparent in studies of processes in pre-calciners and in deposition in large utility boilers and furnaces. The paper will review the literature of the fragmentation of pulverised coal and biomass during gasification, devolatilisation and combustion and relate it to observed phenomena in the type of system under consideration. The difficulties of incorporating models of fragmentation in CFD codes such as Fluent are discussed. Then the implementation of such a model in Fluent is described, together with results from a number of different systems. It is concluded that the model so implemented shows improved prediction in many difficult areas, but still needs development to better reflect actual fragmentation conditions in different experimental systems. It is concluded that the model needs to be further extended beyond the single step fragmentation at present used, especially to include many of the fine particles known to be generated in such systems.

In the present investigation, the pyrolysis of predried vegetable market waste (dp=5.03 mm) has been studied using a cylindrical pyrolyser having diameter of 250 mm under both isothermal and non-isothermal conditions within the temperature range of 523–923 K with an intention to investigate the effective contribution of different heat transfer controlling regime namely intra-particle, external along with kinetically control regime on the overall global rate of pyrolysis. Thermogravimetric method of analysis was utilized to obtain experimental data for both isothermal and non-isothermal cases by coupling a digital balance with the pyrolyser. The pyrolysis of vegetable market waste has been observed to exhibit deactivated concentration independent pyrolysis kinetics, analogous to catalytic poisoning, throughout the entire range of study. The deactivation is of 1st order up to 723 K and follows the 3rd order in the temperature range of 723

BACKGROUND: In the UK, chemotherapy is the standard treatment for inoperable, locally advanced, non-metastatic pancreatic cancer. Chemoradiotherapy is also an acceptable treatment option, for which gemcitabine, fluorouracil, or capecitabine can be used as concurrent chemotherapy agents. We aimed to assess the activity, safety, and feasibility of both gemcitabine-based and capecitabine-based chemoradiotherapy after induction chemotherapy for patients with locally advanced pancreatic cancer. METHODS: In this open-label, randomised, two-arm, phase 2 trial, patients aged 18 years or older with histologically proven, locally advanced pancreatic cancer (with a tumour diameter of 7 cm or less) were recruited from 28 UK centres between Dec 24, 2009 and Oct 25, 2011. After 12 weeks of induction gemcitabine and capecitabine chemotherapy (three cycles of gemcitabine [1000 mg/m(2) on days 1, 8, 15 of a 28-day cycle] and capecitabine [830 mg/m(2) twice daily on days 1-21 of a 28-day cycle]), patients with stable or responding disease, tumour diameter of 6 cm or less, and WHO performance status 0-1 were randomly assigned to receive a further cycle of gemcitabine and capecitabine chemotherapy followed by either gemcitabine (300 mg/m(2) once per week) or capecitabine (830 mg/m(2) twice daily, Monday to Friday only), both in combination with radiation (50·4 Gy in 28 fractions). Randomisation (1:1) was done via a central computerised system and used stratified minimisation. The primary endpoint was 9-month progression-free survival, analysed by intention to treat including only those patients with valid CT assessments. This trial is registered with ISRCTN, number 96169987. FINDINGS: 114 patients were registered and 74 were randomly allocated (38 to the gemcitabine group and 36 to the capecitabine group). After 9 months, 22 of 35 assessable patients (62·9%, 80% CI 50·6-73·9) in the capecitabine group and 18 of 35 assessable patients (51·4%, 39·4-63·4) in the gemcitabine group had not progressed. Median overall survival was 15·2 months (95% CI 13·9-19·2) in the capecitabine group and 13·4 months (95% CI 11·0-15·7) in the gemcitabine group (adjusted hazard ratio [HR] 0·39, 95% CI 0·18-0·81; p=0·012). 12-month overall survival was 79·2% (95% CI 61·1-89·5) in the capecitabine group and 64·2 (95% CI 46·4-77·5) in the gemcitabine group. Median progression-free survival was 12·0 months (95% CI 10·2-14·6) in the capecitabine group and 10·4 months (95% CI 8·9-12·5) in the gemcitabine group (adjusted HR 0·60, 95% CI 0·32-1·12; p=0·11). Eight patients in the capecitabine group had an objective response at 26 weeks, as did seven in the gemcitabine group. More patients in the gemcitabine group than in the capecitabine group had grade 3-4 haematological toxic effects (seven [18%] vs none, p=0·008) and non-haematological toxic effects (ten [26%] vs four [12%], p=0·12) during chemoradiation treatment; the most frequent events were leucopenia, neutropenia, and fatigue. Two patients in the capecitabine group progressed during the fourth cycle of induction chemotherapy. Of the 34 patients in the capecitabine group who received chemoradiotherapy, 25 (74%) received the full protocol dose of radiotherapy, compared with 26 (68%) of 38 patients in the gemcitabine group. Quality-of-life scores were not significantly different between the treatment groups. INTERPRETATION: Our results suggest that a capecitabine-based regimen might be preferable to a gemcitabine-based regimen in the context of consolidation chemoradiotherapy after a course of induction chemotherapy for locally advanced pancreatic cancer. However, these findings should be interpreted with caution because the difference in the primary endpoint was non-significant and the number of patients in the trial was small. FUNDING: Cancer Research UK.

119 Background: Failure to adhere to trial protocols for target volume delineation (TVD) within radiotherapy (RT) trials may have an adverse effect on, and potentially invalidate trial outcomes. NeoSCOPE, a UK phase II study RCT of two neo-adjuvant CRT regimens in oesophageal cancer, undertook prospective individual case-reviews (ICR) to identify and correct such variations. Methods: All participating centres had passed a pre-accrual outlining benchmark case with detailed feedback provided. Prospective ICR was undertaken for all patients. Real time review (feedback to centres within 3 working days) was performed on the first 20 patients recruited and the first case submitted from each participating centre. Subsequent cases were subject to ‘timely retrospective review’, with review within 2 weeks of the start of RT. Target volumes (including organ at risk), along with diagnostic information, were submitted in DICOM format to the RTQA centre. Each case was reviewed by an upper gastrointestinal radiation oncologist, against pre-determined acceptable and unacceptable variations, using a standardised proforma. Unacceptable variation required re-submission. The outlining reviews were complimented by prospective review of planning. Results: 83 cases were reviewed in total, 39 (47%) of which were real-time and 44 (53%) timely- retrospective. 9(11%) cases required re-submission, of which 6 were real-time reviews and 3 timely-retrospective. Delineation of the tumour (GTV) and elective nodal areas (CTVB) were the most common unacceptable variations. 29 (74%) of real time reviews were returned within 3 working days and 100% of retrospective returned by 3rdfraction. The review process did not result in any delay in starting treatment. Conclusions: Prospective review of outlining in the NeoSCOPE trial has enabled identification and correction of unacceptable variations from the protocol without introducing treatment delays. The reduction in the re-submission rate for timely-retrospective review cases suggests an educational benefit from the pre-trial RTQA and the real-time review process. Clinical trial information: NCT01843829.

118 Background: One of the largest trials in dCRT for localised oesophageal cancer, SCOPE 1 tested the role of adding cetuximab to conventional dCRT, and showed that this was associated with greater toxicity and worse survival. Here we present the long-term outcomes. Methods: Phase II/III trial. Randomisation: cisplatin 60mg/m2 D1 and capecitabine 625mg/m2 daily D1-21 for 4 cycles with/without Cetuximab 400mg/m2 D1 followed by 250mg/m2weekly. RT: 50Gy in 25 fractions given concurrent with cycles 3 and 4. Recruitment: Feb 2008 - Feb 2012, when the IDMC recommended trial closure on the basis of futility. Results: 258 patients (dCRT = 129; dCRT+C = 129) were recruited from 36 centres. Median follow-up (IQR): 46.7 (36.0-49.0) months for all surviving pts. 65.1% (dCRT arm) and 69.8% (dCRT+C arm) of patients had died. Esophageal cancer was the cause in 82.1% and 86.7% of deaths respectively (p = 0.41). Median OS months (95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (HR 1.25, p = 0.137); corresponding 3-year OS (95% CI) was 47.2% (38.2%-55.7%) and 37.6% (29.1%-46.0%). Median PFS (95% CI): 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months respectively (HR1.28, p = 0.114). There was some evidence that local PFS (within RT field) was lower in the dCRT+C arm (HR1.38, p = 0.051). On multivariable analysis including treatment arm, Stage I-II ds (vs Stage III), full-dose RT and higher cisplatin dose intensity ( ≥ 75% vs < 75%) were associated with improved OS and PFS. Patterns of recurrence (n [%]) were similar in both arms (see table). In dCRT arm, 31/38 pts (81.6%) with local relapse within the RT field compared to 40/48 (83.3%) in the dCRT+C arm (p = 0.8). Conclusions: The mature analysis shows unprecedented survival in dCRT arm, comparable to surgical trials (e.g. 3-year OS % [95% CIs] in OE05: CF 39 [35, 44] and ECX 42 [37, 46], in OE02: 31 [27, 36]). OS inferiority of dCRT+C is no longer statistically significant. The lower PFS (within RT field) in the dCRT+C arm was consistent with the lower number of patients receiving full dose of RT in the dCRT+C arm. Clinical trial information: 47718479. [Table: see text]

3 Background: NEOSCOPE compared toxicity and efficacy of 2 pre-op CRT regimens. Methods: Eligibility: Resectable ACA of the oesophagus/GOJ ≥ T3 and/or ≥ N1. Randomisation: 1:1 to OXCAP-CRT (oxaliplatin 85 mg/m2 Day 1,15,29; capecitabine 625 mg/m2 bd on days of RT) or CarPac-CRT (Carboplatin AUC2; paclitaxel 50 mg/m2 Day 1,8,15,22,29); concurrent RT: 45Gy/25 fractions/5 weeks. Both arms received induction chemo: 2 cycles of OXCAP (oxaliplatin 130 mg/m2 D1, Cape 625 mg/m2D1-21, q 3wk). Surgery: 6-8 weeks after naCRT. Detailed RT and pathology quality assurance was built into the protocol. Primary end-point: pathological complete response (pCR). Secondary: toxicity, surgical morbidity/mortality, R1 rate, OS. Statistics: A pCR of 15% would not warrant further investigation but a pCR of 35% would. 76 patients (38/arm) gave 90% power and one-sided type I error of 10% meaning that either arm having ≥10 pCR out of first 38 patients would be considered for Phase III. 85 patients to be recruited (allows 10% loss to follow up). Results: 85 patients were randomised between Oct 2013 and Feb 2015 from 17 UK centres. Patient characteristics: median age 65 yrs, Male (81%), WHO PS 0 (85%). Tumour characteristics: T3 (86%), N1 (48%), lower third/GOJ (90%), median tumour length 5.8cm. CTCAE grade 3/4 toxicity rate during CRT was OXCAP-CRT 42.1%, CarPac-CRT 52.4% (p=0.358). Protocol dose RT OXCAP-CRT 90.5%, CarPac-CRT 93%. Conclusion:Both regimens were well tolerated. CarPac-CRT passed the criteria for taking forward to a phase III study but OXCAP-RT did not. Funding: Cancer Research UK (C44694/A14614), ClinicalTrials.gov: NCT01843829, coordinated by Wales Cancer Trials Unit. Clinical trial information: NCT01843829. [Table: see text]

Deviations from trial protocols are associated with adverse outcome and can be minimized by a robust Radiation therapy Quality Assurance (RTQA) Program. Our center is one of the four designated RTQA units in the UK making up the NCRI RTTQA Group. It has undertaken the RTQA on several Cancer Research UK funded GI trials including SCOPE 1 (grant number C20177/A7256), ARISTOTLE (C19942/A10016) and NeoSCOPE (C44694/A14614). Review of patient-specific outlining in SCOPE 1 was retrospective (R), not allowing deviations to be identified and corrected prior to trial entry.

This paper presents a thermodynamic model for the estimation of impurities in the raw synthesis gas and in the slag resulting from gasification of solid waste. Based on thermodynamic equilibrium calculations and mass balances, the model takes into account the possibility of each impurity becoming an oxide, a chloride, or remaining in its elemental form. The model includes a comprehensive set of thermodynamic data for a wide variety of chemical species used to estimate the equilibrium constants. By solving the equilibrium reaction equations, the model predicts which pollutants are formed and in what amounts as well as their distribution in the raw synthesis gas and in the slag. Predicting the distribution and fate of these pollutants is particularly important for the design of a gas cleaning system for the raw synthesis gas and for deciding on the disposal options of the slag. The model can be applied to different waste materials, including municipal solid waste, mixed plastics waste, auto-shredder residue (ASR) and biomass. A comparison between the model predictions and the operational data from a commercially-available gasification process (Thermoselect) shows a close agreement between the estimated and real data.

In the present investigation, pyrolysis and gasification, two widely used thermochemical processes, are compared as potential chemical recycling methods for MWP and plastic rich MSW in terms of products of high value and their end uses. High temperature pyrolysis results in a wide spectrum of products which also contain monomers of C2-C4 range such as ethylene and 1,3-butadiene. Recovery of monomers from their isomers and other products is difficult and energy-intensive. Gasification breaks solid wastes into simple molecules (mainly CO & H2) which subsequently can be converted to value added liquid chemicals (namely alcohols) by a catalytic synthesis processes. Synthetic alcohol then can be converted to the desired petrochemical precursors. After reviewing different aspects of both pyrolysis and gasification, recycling through gasification is chosen as the preferred route for project SPORT as syngas product can be converted into several key petrochemical products in high yield.

Background: Both oxaliplatin/capecitabine-based chemoradiation (OXCAP-RT) and carboplatin-paclitaxel based radiation (CarPac-RT) are active regimens in oesophageal cancer, but no randomized study has compared their efficacy/toxicity. This study compares the two regimens to identify the optimum regimen to take forward to a phase III trial against neo-adjuvant chemotherapy, the current standard in the UK. Methods: Eligibility: Resectable adenocarcinoma of oesophagus and Type 1-2 Gastro-Osophageal Junction; ≥T3 and/or ≥N1 staged with EUS and PET-CT; PS 0-1. Intervention: Both arms receive 2 cycles induction OXCAP (oxaliplatin 130mg/m2 D1, Cape 625mg/m2 D1-21, q 3wk) followed by randomization to OXCAP-RT (oxali 85mg/m2 Day 1,15,29; cape 625mg/m2 on days of RT; RT-45Gy/25 fractions/5weeks) or CarPac-RT (Carbo AUC2 and paclitaxel 50mg/m2 Day 1,8,15,22,29; RT-45Gy/25 fractions/5weeks). Restaging CT/PET-CT 4-6 weeks after CRT, and 2-phase oesophagectomy with 2-field lymphadenectomy 6-8 weeks after CRT. Primary End-Point: Pathological complete response. Secondary: 1) Feasibility of recruitment; Toxicity; 30-day surgical morbidity/mortality; resection margin positivity rate; median, 3- and 5-yr OS. Statistics: Randomised phase II with 1:1 randomisation; planned accrual 76 patients (38/arm) over 18 months. In each arm, this sample size gives 90% power and one-sided type 1 error of 10% to detect that pCR is not 35%. Interim safety analysis: Toxicity analysis after 10 patients have completed treatment. RT Quality Assurance: Pre-trial: Detailed RT protocol and guidance document, RT workshop, central evaluation of test-case contours and adequacy of RT plan. On-trial: Real-time central review of contours and plans of first 20 patients on trial, 1st case from each centre, and 10% of cases selected at random.

LBA3 Background: SCOPE 1 is the largest multicentre trial of definitive chemo-radiotherapy (dCRT) in localised oesophageal cancer (LOC) in the UK and investigated adding cetuximab to standard cisplatin and fluoropyrimidine treatment. Methods: Patients in this phase II/III trial had LOC and been selected to receive dCRT and were randomised to receive cisplatin 60mg/m2 D1 and capecitabine 625mg/m2 daily D1-21 for 4 cycles, cycles 3 and 4 given concurrently with 50Gy in 25 fractions of RT with or without cetuximab 400mg/m2 D1 followed by 250mg/m2weekly. Recruitment continued from 02/2008 until analysis of the phase II endpoint (24 week failure free survival in the cetuximab arm, overall sample size 180: p1=0.60 and p2=0.75, α=0.05, β=0.9) in 01/2012. The phase II endpoint was not met and the IDMC recommended trial closure on the basis of futility. Results: 258 patients were recruited. Median age 67; morphology(%) SCC:ACA 73:27; tumour location(%) upper:middle:lower 11:45:44; stage(%) I:II:III 3:37:60; reason not for surgery(%) disease extent:patient choice:comorbidity 47:38:16. Patients who received cetuximab had: higher non-haematologic toxicity (78 vs 62.8%, p=0.004; primarily dermatological (22 vs 4%) and metabolic (24% vs 11%)); a lower rate of completion of standard therapy (capecitabine 69 vs 85%, p=0.002; cisplatin 77 vs 90%, p=0.005 and radiotherapy (75 vs 86%, p=0.027); reduced failure free survival at 24 weeks (66 vs 77%), median survival (22 vs 25 months, log rank p=0.043) and 2-yr survival (41 vs 56%). Conclusions: In SCOPE 1, disease control and survival in the standard dCRT arm is superior to any previous published multi-centre studies. The use of cetuximab was associated with greater toxicity, lower doses of dCRT and worse survival. Cetuximab cannot be recommended in combination with standard dCRT for unselected patients with oesophageal cancer. Strategies to build on these results should incorporate biomarker driven treatment and latest radiotherapy technologies to safely intensify treatment. This trial was sponsored by Velindre NHS Trust, conducted by Wales Cancer Trials Unit at Cardiff University and supported by CR-UK [grant number C20177/A7256]. Clinical trial information: 47718479.