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Kim T, Laugeman E, Kiser K, Schiff J, Marasini S, Price A, Gach HM, Knutson N, Samson P, Robinson C, Hatscher C, Henke L. Feasibility of surface-guidance combined with CBCT for intra-fractional breath-hold motion management during Ethos RT. J Appl Clin Med Phys 2024; 25:e14242. [PMID: 38178622 PMCID: PMC11005966 DOI: 10.1002/acm2.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE High-quality CBCT and AI-enhanced adaptive planning techniques allow CBCT-guided stereotactic adaptive radiotherapy (CT-STAR) to account for inter-fractional anatomic changes. Studies of intra-fractional respiratory motion management with a surface imaging solution for CT-STAR have not been fully conducted. We investigated intra-fractional motion management in breath-hold Ethos-based CT-STAR and CT-SBRT (stereotactic body non-adaptive radiotherapy) using optical surface imaging combined with onboard CBCTs. METHODS Ten cancer patients with mobile lower lung or upper abdominal malignancies participated in an IRB-approved clinical trial (Phase I) of optical surface image-guided Ethos CT-STAR/SBRT. In the clinical trial, a pre-configured gating window (± 2 mm in AP direction) on optical surface imaging was used for manually triggering intra-fractional CBCT acquisition and treatment beam irradiation during breath-hold (seven patients for the end of exhalation and three patients for the end of inhalation). Two inter-fractional CBCTs at the ends of exhalation and inhalation in each fraction were acquired to verify the primary direction and range of the tumor/imaging-surrogate (donut-shaped fiducial) motion. Intra-fractional CBCTs were used to quantify the residual motion of the tumor/imaging-surrogate within the pre-configured breath-hold window in the AP direction. Fifty fractions of Ethos RT were delivered under surface image-guidance: Thirty-two fractions with CT-STAR (adaptive RT) and 18 fractions with CT-SBRT (non-adaptive RT). The residual motion of the tumor was quantified by determining variations in the tumor centroid position. The dosimetric impact on target coverage was calculated based on the residual motion. RESULTS We used 46 fractions for the analysis of intra-fractional residual motion and 43 fractions for the inter-fractional motion analysis due to study constraints. Using the image registration method, 43 pairs of inter-fractional CBCTs and 100 intra-fractional CBCTs attached to dose maps were analyzed. In the motion range study (image registration) from the inter-fractional CBCTs, the primary motion (mean ± std) was 16.6 ± 9.2 mm in the SI direction (magnitude: 26.4 ± 11.3 mm) for the tumors and 15.5 ± 7.3 mm in the AP direction (magnitude: 20.4 ± 7.0 mm) for the imaging-surrogate, respectively. The residual motion of the tumor (image registration) from intra-fractional breath-hold CBCTs was 2.2 ± 2.0 mm for SI, 1.4 ± 1.4 mm for RL, and 1.3 ± 1.3 mm for AP directions (magnitude: 3.5 ± 2.1 mm). The ratio of the actual dose coverage to 99%, 90%, and 50% of the target volume decreased by 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.05, respectively. The mean percentage of the target volume covered by the prescribed dose decreased by 2.8 ± 4.4%. CONCLUSION We demonstrated the intra-fractional motion-managed treatment strategy in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT. While the controlled residual tumor motion measured at 3.5 mm exceeded the predetermined setup value of 2 mm, it is important to note that this motion still fell within the clinically acceptable range defined by the PTV margin of 5 mm. Nonetheless, additional caution is needed with intra-fractional motion management in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT.
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Affiliation(s)
- Taeho Kim
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Eric Laugeman
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Kendall Kiser
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Joshua Schiff
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Shanti Marasini
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Alex Price
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
| | - H Michael Gach
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiology and Biomedical EngineeringWashington University School of MedicineWashingtonUSA
| | - Nels Knutson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Pamela Samson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Clifford Robinson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Casey Hatscher
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Lauren Henke
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
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Waters MR, Inkman M, Jayachandran K, Kowalchuk RM, Robinson C, Schwarz JK, Swamidass SJ, Griffith OL, Szymanski JJ, Zhang J. GAiN: An integrative tool utilizing generative adversarial neural networks for augmented gene expression analysis. Patterns (N Y) 2024; 5:100910. [PMID: 38370125 PMCID: PMC10873154 DOI: 10.1016/j.patter.2023.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 02/20/2024]
Abstract
Big genomic data and artificial intelligence (AI) are ushering in an era of precision medicine, providing opportunities to study previously under-represented subtypes and rare diseases rather than categorize them as variances. However, clinical researchers face challenges in accessing such novel technologies as well as reliable methods to study small datasets or subcohorts with unique phenotypes. To address this need, we developed an integrative approach, GAiN, to capture patterns of gene expression from small datasets on the basis of an ensemble of generative adversarial networks (GANs) while leveraging big population data. Where conventional biostatistical methods fail, GAiN reliably discovers differentially expressed genes (DEGs) and enriched pathways between two cohorts with limited numbers of samples (n = 10) when benchmarked against a gold standard. GAiN is freely available at GitHub. Thus, GAiN may serve as a crucial tool for gene expression analysis in scenarios with limited samples, as in the context of rare diseases, under-represented populations, or limited investigator resources.
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Affiliation(s)
- Michael R. Waters
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Matthew Inkman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Kay Jayachandran
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | | | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julie K. Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - S. Joshua Swamidass
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Obi L. Griffith
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey J. Szymanski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jin Zhang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Institute for Informatics (I), Washington University School of Medicine, St. Louis, MO 63110, USA
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Kiser K, Schiff J, Laugeman E, Kim T, Green O, Hatscher C, Kim H, Badiyan S, Spraker M, Samson P, Robinson C, Price A, Henke L. A feasibility trial of skin surface motion-gated stereotactic body radiotherapy for treatment of upper abdominal or lower thoracic targets using a novel O-ring gantry. Clin Transl Radiat Oncol 2024; 44:100692. [PMID: 38021090 PMCID: PMC10652138 DOI: 10.1016/j.ctro.2023.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose A novel O-ring gantry can deliver stereotactic body radiation therapy (SBRT) with artificial intelligence-facilitated, CT-guided online plan adaptation. It gates mobile targets by optically monitoring skin surface motion. However, this gating solution has not been clinically validated. We conducted a trial to evaluate the feasibility of optical skin surface-guided gating for patients with mobile upper abdominal or lower thoracic malignancies treated with SBRT on this platform (NCT05030454). Materials and methods Ten patients who were prescribed SBRT to a thoracic or abdominal target and were capable of breath-hold for at least 17 s enrolled. They received SBRT in five fractions with breath-hold technique and optical skin surface motion monitored-gating with a ± 2 mm tolerance. Online plan adaptation was left to the discretion of the daily treating physician. The primary endpoint was defined as successful completion of > 75 % of attempted fractions. Exploratory endpoints included local control and acute grade ≥ 3 toxicity rates after three months. For adapted fractions the contouring, planning, quality assurance, and treatment delivery times were recorded. Results Forty-seven of 51 SBRT fractions (92 %) were successfully gated at breath-hold by optical skin surface motion monitoring. The tumor centroid position during breath-hold varied by a mean of approximately 2 mm. Sixty-three percent of fractions were adapted online with a median total treatment time of 78.5 min. After three months no local recurrences or acute grade ≥ 3 toxicities were observed. Conclusions SBRT treatment to mobile targets with surface-monitored gating on a novel O-ring gantry was prospectively validated.
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Affiliation(s)
- Kendall Kiser
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Joshua Schiff
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Taeho Kim
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
- Varian Medical Systems, 3100 Hansen Way, Palo Alto, CA 94304, USA
| | - Casey Hatscher
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Shahed Badiyan
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Matthew Spraker
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
- Centura Health, 2525 S Downing St., Denver, CO 80210, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
- Department of Radiation Oncology, Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, MSC 8224-35-LL, St. Louis, MO 63110, USA
- Department of Radiation Oncology, Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Waters M, Price A, Laugeman E, Henke L, Hugo G, Stowe H, Andruska N, Brenneman R, Hao Y, Green O, Robinson C, Gay H, Michalski J, Baumann BC. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 2024; 44:100693. [PMID: 38021093 PMCID: PMC10663731 DOI: 10.1016/j.ctro.2023.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is an emerging treatment modality for clinically localized prostate cancer (PCa). Online daily adaptive radiotherapy (ART) could potentially improve the therapeutic ratio of prostate SBRT by accounting for inter-fraction variation in target and OAR volumes. To our knowledge, no group has evaluated the clinical utility of a novel AI-augmented CT-based ART system for prostate SBRT. In this study we hypothesized that adaptive prostate SBRT plans would result in improved target coverage and lower dose to OARs in comparison to unadapted treatment plans. Methods Seven patients with favorable intermediate to oligometastatic PCa treated with 5-fx prostate adaptive SBRT were retrospectively reviewed. Patients were treated with 3625 cGy to the prostate and seminal vesicles. 6 patients additionally received 2500 cGy to the pelvic nodes, 5 patients underwent a boost to 4000 cGy to the prostate. For each fraction, a CBCT was acquired and OARs (rectum, bladder, bowel, sigmoid, femurs) were segmented/deformed using AI. CTVs were rigidly registered. Volumes were adjusted manually and PTV expansions added. Adaptive treatment plans were developed based on the contoured targets and OARs and dose to these volumes for the adapted vs. initial plans were compared for each fraction. V100 and the D0.03 cc between scheduled and adapted treatment plans were compared using a Student's t-test, with significance threshold of P < 0.05. Results Seven patients completed 35 Fx's of adaptive RT. Daily adaptation resulted in a statistically significant mean improvement in PTV V100 for all targets: [21.4 % ± 4.3 % for PTV 4000 (p < 0.0001); 8.7 % ± 1.1 % for PTV 3625 (p < 0.0001); and 11.5 % ± 3.1 % for PTV 2500 (p = 0.0013)]. Mean rectal D0.03 was significantly reduced by 38.8 cGy ± 5.95 cGy (p < 0.0001) per fraction (194 cGy/5 fractions) compared to the initial plans. There was a modest increase in bladder dose of 10.9 cGy ± 4.93 cGy per fraction (p = 0.0424) for the adaptive plans. The adaptive plans met bladder constraints for every fraction. There were no statistically significant differences between sigmoid or bowel dose for adapted vs. initial plans. No patients experienced acute CTCAE grade ≥ 3 GI/GU adverse events (median F/U 9.5 months). All statistically significant differences were maintained in the presence and absence of rectal hydrogel spacer (p < 0.05). Conclusions CT-based online adaptive SBRT resulted in statistically significant and clinically meaningful improvements in PTV coverage and D0.03 cc dose to the rectum. A trial evaluating CT adaptive whole-pelvis prostate SBRT is underway.
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Affiliation(s)
- Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Geoff Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
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Pedersen LN, Valenzuela Ripoll C, Ozcan M, Guo Z, Lotfinaghsh A, Zhang S, Ng S, Weinheimer C, Nigro J, Kovacs A, Diab A, Klaas A, Grogan F, Cho Y, Ataran A, Luehmann H, Heck A, Kolb K, Strong L, Navara R, Walls GM, Hugo G, Samson P, Cooper D, Reynoso FJ, Schwarz JK, Moore K, Lavine K, Rentschler SL, Liu Y, Woodard PK, Robinson C, Cuculich PS, Bergom C, Javaheri A. Cardiac radiation improves ventricular function in mice and humans with cardiomyopathy. Med 2023; 4:928-943.e5. [PMID: 38029754 PMCID: PMC10994563 DOI: 10.1016/j.medj.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Rapidly dividing cells are more sensitive to radiation therapy (RT) than quiescent cells. In the failing myocardium, macrophages and fibroblasts mediate collateral tissue injury, leading to progressive myocardial remodeling, fibrosis, and pump failure. Because these cells divide more rapidly than cardiomyocytes, we hypothesized that macrophages and fibroblasts would be more susceptible to lower doses of radiation and that cardiac radiation could therefore attenuate myocardial remodeling. METHODS In three independent murine heart failure models, including models of metabolic stress, ischemia, and pressure overload, mice underwent 5 Gy cardiac radiation or sham treatment followed by echocardiography. Immunofluorescence, flow cytometry, and non-invasive PET imaging were employed to evaluate cardiac macrophages and fibroblasts. Serial cardiac magnetic resonance imaging (cMRI) from patients with cardiomyopathy treated with 25 Gy cardiac RT for ventricular tachycardia (VT) was evaluated to determine changes in cardiac function. FINDINGS In murine heart failure models, cardiac radiation significantly increased LV ejection fraction and reduced end-diastolic volume vs. sham. Radiation resulted in reduced mRNA abundance of B-type natriuretic peptide and fibrotic genes, and histological assessment of the LV showed reduced fibrosis. PET and flow cytometry demonstrated reductions in pro-inflammatory macrophages, and immunofluorescence demonstrated reduced proliferation of macrophages and fibroblasts with RT. In patients who were treated with RT for VT, cMRI demonstrated decreases in LV end-diastolic volume and improvements in LV ejection fraction early after treatment. CONCLUSIONS These results suggest that 5 Gy cardiac radiation attenuates cardiac remodeling in mice and humans with heart failure. FUNDING NIH, ASTRO, AHA, Longer Life Foundation.
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Affiliation(s)
- Lauren N Pedersen
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | | | - Mualla Ozcan
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Zhen Guo
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Aynaz Lotfinaghsh
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Shiyang Zhang
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Sherwin Ng
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Carla Weinheimer
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Jessica Nigro
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Attila Kovacs
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Ahmed Diab
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Amanda Klaas
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Felicia Grogan
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Yoonje Cho
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Anahita Ataran
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Hannah Luehmann
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Abigail Heck
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kollin Kolb
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Lori Strong
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Rachita Navara
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Gerard M Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT97AE, Northern Ireland
| | - Geoff Hugo
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Pamela Samson
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Daniel Cooper
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Francisco J Reynoso
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Julie K Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kaitlin Moore
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kory Lavine
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Stacey L Rentschler
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Yongjian Liu
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Clifford Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Carmen Bergom
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
| | - Ali Javaheri
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA; John J. Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA.
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Cho BC, Lee JS, Wu YL, Cicin I, Dols MC, Ahn MJ, Cuppens K, Veillon R, Nadal E, Dias JM, Martin C, Reck M, Garon EB, Felip E, Paz-Ares L, Mornex F, Vokes EE, Adjei AA, Robinson C, Sato M, Vugmeyster Y, Machl A, Audhuy F, Chaudhary S, Barlesi F. Bintrafusp Alfa Versus Pembrolizumab in Patients With Treatment-Naive, Programmed Death-Ligand 1-High Advanced NSCLC: A Randomized, Open-Label, Phase 3 Trial. J Thorac Oncol 2023; 18:1731-1742. [PMID: 37597750 DOI: 10.1016/j.jtho.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGF-βRII (a TGF-β "trap") fused to a human immunoglobulin G1 monoclonal antibody blocking programmed death-ligand 1 (PD-L1), has exhibited clinical activity in a phase 1 expansion cohort of patients with PD-L1-high advanced NSCLC. METHODS This adaptive phase 3 trial (NCT03631706) compared the efficacy and safety of bintrafusp alfa versus pembrolizumab as first-line treatment in patients with PD-L1-high advanced NSCLC. Primary end points were progression-free survival according to Response Evaluation Criteria in Solid Tumors version 1.1 per independent review committee and overall survival. RESULTS Patients (N = 304) were randomized one-to-one to receive either bintrafusp alfa or pembrolizumab (n = 152 each). The median follow-up was 14.3 months (95% confidence interval [CI]: 13.1-16.0 mo) for bintrafusp alfa and 14.5 months (95% CI: 13.1-15.9 mo) for pembrolizumab. Progression-free survival by independent review committee was not significantly different between bintrafusp alfa and pembrolizumab arms (median = 7.0 mo [95% CI: 4.2 mo-not reached (NR)] versus 11.1 mo [95% CI: 8.1 mo-NR]; hazard ratio = 1.232 [95% CI: 0.885-1.714]). The median overall survival was 21.1 months (95% CI: 21.1 mo-NR) for bintrafusp alfa and 22.1 months (95% CI: 20.4 mo-NR) for pembrolizumab (hazard ratio = 1.201 [95% CI: 0.796-1.811]). Treatment-related adverse events were higher with bintrafusp alfa versus pembrolizumab; grade 3-4 treatment-related adverse events occurred in 42.4% versus 13.2% of patients, respectively. The study was discontinued at an interim analysis as it was unlikely to meet the primary end point. CONCLUSIONS First-line treatment with bintrafusp alfa did not exhibit superior efficacy compared with pembrolizumab in patients with PD-L1-high, advanced NSCLC.
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Affiliation(s)
- Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Seok Lee
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - Manuel Cobo Dols
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kristof Cuppens
- Department of Pulmonology and Thoracic Oncology, Jessa Hospital, Hasselt, Belgium
| | - Rémi Veillon
- Centre Hospitalier Universitaire (CHU) Bordeaux, Service des Maladies Respiratoires, Bordeaux, France
| | - Ernest Nadal
- Catalan Institute of Oncology and Clinical Research in Solid Tumors Group, Oncobell Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | | | - Martin Reck
- Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany
| | - Edward B Garon
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H12O-CNIO Lung Cancer Unit, Universidad Complutense and CiberOnc, Madrid, Spain
| | | | - Everett E Vokes
- University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | | | | | - Masashi Sato
- Merck Biopharma Co., Ltd., Tokyo, Japan, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | | | | | | | - Fabrice Barlesi
- Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France; Université Paris-Saclay, Gustave Roussy, Villejuif, France.
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7
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Beardmore S, Adeley J, Brookes A, Robinson C, Davendralingam N, Joseph J, McManoman B, Morgan B. Impact of changing from autopsy to post-mortem CT in an entire HM Coroner region due to a shortage of available pathologists. Clin Radiol 2023; 78:797-803. [PMID: 37827590 DOI: 10.1016/j.crad.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/31/2023] [Accepted: 08/13/2023] [Indexed: 10/14/2023]
Abstract
A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected.
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Affiliation(s)
- S Beardmore
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - J Adeley
- HM Senior Coroner Lancashire and Blackburn with Darwen, Coroner's Court, 2 Faraday Court, Faraday Drive, Preston, Lancashire, PR2 9NB, UK
| | - A Brookes
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - C Robinson
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - N Davendralingam
- Imaging Department, King's College Hospital, Denmark Hill, SE5 9RS, UK
| | - J Joseph
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - B McManoman
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
| | - B Morgan
- Department of Life Sciences, University of Leicester, Radiology Department, Leicester Royal Infirmary, Infirmary Square, Leicester, LE2 7LX, UK.
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8
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Tait D, Scriba MF, Robinson C, Jonas EG, Chinnery GE. Technical success of endoscopic stenting for malignant gastric outlet obstruction. S AFR J SURG 2023; 61:33-39. [PMID: 38450694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Palliation of irresectable malignant gastric outlet obstruction (GOO) using self-expanding metal stents (SEMS) is gaining popularity with high technical success rates. The aim of this study was to review and compare GOO stenting for malignancy with other series. METHODS A retrospective review of all patients undergoing pyloroduodenal stenting for malignant GOO at Groote Schuur Hospital, 1 March 2018-31 August 2021, evaluating demographics, technical success, pathology, and stentrelated complications was done. RESULTS One hundred and fourteen patients, of which 38.6% were female, were included, with gastric malignancies (74.6%) being the most frequent underlying pathology. Median age was 64 years (IQR 53-70 years), with 48.2% having at least one comorbidity. The majority (96 patients; 85.7%) required only one stent. In total, 132 stent insertion attempts were undertaken. Three technical failures were experienced (one incorrect stent placement and two failed insertions), equating to a 97.4% technical success rate. Four immediate complications occurred (3.1%): two related to sedation, one incorrect stent placement and an oesophagogastric junction perforation with procedural death. Fifteen delayed complications occurred: 13 tumour in-growth blockages, one stent fracture and one case of poor radial stent expansion. Stent blockages occurred at a median of 107 days (IQR 80-275 days). Salvage stenting was 100% successful in 14 cases requiring re-stenting. CONCLUSION Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.
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Affiliation(s)
- D Tait
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - M F Scriba
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - C Robinson
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - E G Jonas
- Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - G E Chinnery
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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9
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James J, Robinson C, Mason C, Richards C, West K, Morgan B. Impact of the COVID-19 pandemic on a post-mortem CT service for adult non-suspicious death. Clin Radiol 2023; 78:822-831. [PMID: 37827592 DOI: 10.1016/j.crad.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 10/14/2023]
Abstract
Due to the COVID-19 pandemic, the post-mortem computed tomography (PMCT) service was expanded from three to seven cases per day to help mortuary services and avoid invasive autopsy. Additional targeted angiography and pulmonary ventilation procedures were stopped and triage rules relaxed to allow more indications to be scanned, including those requiring toxicology. A service evaluation was performed for the first 3-months of the COVID-19 pandemic compared to the equivalent period the previous year to study the impact of these changes. It was found that, despite the increase in deaths regionally, coronial referrals remained about 100 per month, a reduction in referral rate. The number undergoing PMCT rose from 28% to 74% of cases. Turnaround time remained the same. For cases triaged to PMCT, the need for subsequent autopsy increased from 7.9% to 15.8%. No significant changes were seen in diagnosis rates, including cardiac or respiratory. There was an increase in patients with coronary death without severe coronary calcification who underwent autopsy after PMCT. These may have been diagnosed by targeted coronary angiography. Fifty-three cases requiring toxicology/biochemistry had PMCT, with 38 having PMCT only. In 8/11 (72.7%) cases with normal PMCT and toxicology as the key diagnostic test, autopsy was performed prior to results. This suggests the pathology team were reluctant to risk an "unascertained" outcome. This study shows that it is possible to increase PMCT services by widening referral criteria and by limiting the use of enhanced imaging techniques, without significantly changing diagnosis rates of key diseases; however, selectively restarting targeted angiography may help avoid autopsy in some cases.
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Affiliation(s)
- J James
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - C Robinson
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - C Mason
- The Coroner's Court, Town Hall, Town Hall Square, Leicester, UK
| | - C Richards
- Histopathology Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - K West
- Histopathology Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - B Morgan
- Department of Life Sciences, University of Leicester, Radiology Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE2 7LX, UK.
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10
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Wilkes MA, Carrivick JL, Castella E, Ilg C, Cauvy-Fraunié S, Fell SC, Füreder L, Huss M, James W, Lencioni V, Robinson C, Brown LE. Glacier retreat reorganizes river habitats leaving refugia for Alpine invertebrate biodiversity poorly protected. Nat Ecol Evol 2023:10.1038/s41559-023-02061-5. [PMID: 37142743 DOI: 10.1038/s41559-023-02061-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023]
Abstract
Alpine river biodiversity around the world is under threat from glacier retreat driven by rapid warming, yet our ability to predict the future distributions of specialist cold-water species is currently limited. Here we link future glacier projections, hydrological routing methods and species distribution models to quantify the changing influence of glaciers on population distributions of 15 alpine river invertebrate species across the entire European Alps, from 2020 to 2100. Glacial influence on rivers is projected to decrease steadily, with river networks expanding into higher elevations at a rate of 1% per decade. Species are projected to undergo upstream distribution shifts where glaciers persist but become functionally extinct where glaciers disappear completely. Several alpine catchments are predicted to offer climate refugia for cold-water specialists. However, present-day protected area networks provide relatively poor coverage of these future refugia, suggesting that alpine conservation strategies must change to accommodate the future effects of global warming.
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Affiliation(s)
- M A Wilkes
- School of Life Sciences, University of Essex, Colchester, UK
| | - J L Carrivick
- School of Geography and water@leeds, University of Leeds, Leeds, UK
| | - E Castella
- Section of Earth and Environmental Sciences and Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - C Ilg
- VSA, Swiss Water Association, Glattbrugg, Switzerland
| | - S Cauvy-Fraunié
- INRAE, UR RIVERLY, Centre de Lyon-Villeurbanne, Villeurbanne, France
| | - S C Fell
- School of Geography and water@leeds, University of Leeds, Leeds, UK
| | - L Füreder
- Institute of Ecology, University of Innsbruck, Innsbruck, Austria
| | - M Huss
- Swiss Federal Institute for Forest, Snow and Landscape Research (WSL), Birmensdorf, Switzerland
| | - W James
- School of Geography and water@leeds, University of Leeds, Leeds, UK
| | - V Lencioni
- Climate and Ecology Unit, Research and Museum Collections Office, MUSE- Science Museum of Trento, Trento, Italy
| | - C Robinson
- Department of Aquatic Ecology, Eawag, Duebendorf, CH and Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
| | - L E Brown
- School of Geography and water@leeds, University of Leeds, Leeds, UK.
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11
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Housten AJ, Kozower BD, Engelhardt KE, Robinson C, Puri V, Samson P, Cooksey K, Politi MC. Developing an Educational and Decision Support Tool for Stage I Lung Cancer Using Decision Science. Ann Thorac Surg 2023; 115:299-308. [PMID: 35926640 DOI: 10.1016/j.athoracsur.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines recommend shared decision-making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision-making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities. METHODS The purpose of this review is to reflect on the process of tool development; identify the challenges associated with meeting the needs of patients, clinicians from multiple disciplines, and institutional workflow during implementation; and propose recommendations for future clinicians who wish to develop, refine, or implement similar tools into routine care. RESULTS In this review, we: (1) discuss guidelines for decision aid development; (2) describe how we applied those to create an education and decision support tool for patients with clinical stage I lung cancer deciding between radiation therapy and surgical resection; and (3) highlight challenges in implementing and evaluating the tool. CONCLUSIONS We provide recommendations for those seeking to develop, refine, or implement similar tools into routine care.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Krista Cooksey
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri.
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12
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Hurwitz V, La J, Lavrador J, Brazil L, Chia K, Swampillai A, Al-Salihi O, Bhangoo R, Vergani F, Ashkan K, Hedges S, Kostick E, Suarez A, Robinson C. P16.03.A Epithelioid gliobastoma requires rapid treatment and BRAF inhibitors should be made readily available for their treatment. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Epithelioid glioblastoma is a rare subtype of Glioblastoma. We examine two cases who presented acutely with symptoms of headache, neck stiffness and an eye squint. The purpose of this case review is to look at their management, the spread of the disease and propose the availability of BRAF inhibiting agents be made readily available for this subtype.
Material and Methods
The clinical records including pathology and surgical reports, multi-disciplinary team meeting documents, oncology plans and inpatient notes have all been reviewed alongside the literature on epithelioid GBM and BRAF V600e mutations and inhibitors.
Results
Patients were females aged 25 and 32 presenting with acute onset headache and neck stiffness to emergency Department. The 25 year old had developed a right eye squint within seven days of the other symptoms, her tumour was right frontal with midline shift. The 32 year old had symptoms for 10 days prior to presentation, the tumour was right temporal. They both underwent craniotomies. The frontal tumour was totally resected, while the temporal lobe tumour was haemorrhagic in nature and minimally de-bulked. Pre-operative stealth imaging showed that there had been an increase in the size of the temporal lesion in the fourteen days since presentation. Histology proved these to be epithelioid GBM’s with BRAF V600e mutations, IDH wild-type and TERT promoter mutant. Full pathology reports with molecular markers were available within ten days. The frontal lobe patient began chemo-radiation sixteen days from her surgical date. On day two she was admitted with severe headache and nausea. She became agitated, confused, and transferred back to the neurosurgery unit for management of hydrocephalus. She was diagnosed with PRES and simultaneously treated for this and hydrocephalus. Clinically she suffered storming, passing away exactly eight weeks from presentation. Seven days after surgery the temporal lobe tumour patient suffered a seizure and admitted for symptom management and expedite oncology treatment. She passed away six days later suffering continual neurological deterioration and the tumour progression with leptomeningeal spread. This was exactly four weeks from initial presentation.
Conclusion
The prognosis for epithelioid Glioblastoma is limited to weeks to short months. Extent of resection in these case studies demonstrates benefit in delaying progression though it is clear that time is of the essence from presentation, to surgery, to adjuvant treatment. Neither of these tumours were methylated meaning the standard treatment for glioblastoma is likely to lack efficacy. BRAF inhibitors should be made readily available for this rare sub-type to commence treatment expediently. Both patients suffered distressing neurological symptoms in their final days which require expert management and are best managed in a neurosurgical centre.
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Affiliation(s)
- V Hurwitz
- Kings College Hospital , London , United Kingdom
| | - J La
- Kings College Hospital , London , United Kingdom
| | - J Lavrador
- Kings College Hospital , London , United Kingdom
| | - L Brazil
- Kings College Hospital , London , United Kingdom
| | - K Chia
- Kings College Hospital , London , United Kingdom
| | - A Swampillai
- Kings College Hospital , London , United Kingdom
| | - O Al-Salihi
- Guys and St Thomas , London , United Kingdom
| | - R Bhangoo
- Kings College Hospital , London , United Kingdom
| | - F Vergani
- Kings College Hospital , London , United Kingdom
| | - K Ashkan
- Kings College Hospital , London , United Kingdom
| | - S Hedges
- Kings College Hospital , London , United Kingdom
| | - E Kostick
- Kings College Hospital , London , United Kingdom
| | - A Suarez
- Kings College Hospital , London , United Kingdom
| | - C Robinson
- Kings College Hospital , London , United Kingdom
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13
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La J, Bhangoo R, Hurwitz V, Ashkan K, Vergani F, Gullan R, Lavrador JP, Robinson C, Kostick E, Suarez A, Hedges S, Brazil L, Swampillai A, Al-Salihi O, Chia K, Cikurel K, Joe D. P11.06.A benefits of carbohydrate loading drinks pre-operatively for patients with a presumed high-grade glioma planned for an awake craniotomy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
As part of enhanced recovery after surgery in neuro oncology, carbohydrate loading drinks were reviewed to see if there were any benefits in administering this pre operatively, in particularly for patients for awake craniotomy electively. This method is currently used in colorectal and spinal teams within the trust. Carbohydrate loading drinks are clear, and can be consumed up to 2 hours before induction of anaesthesia. Currently reviewed for patients for awake craniotomy with the vision to implement for all patients planned for craniotomy, both asleep and awake. The concept of this drink, is that it helps with post-operative nausea and vomiting , insulin resistance, helps with energy boost which is helpful during awake craniotomies and potentially during their engagement with therapists post operatively and wound healing (Hausel J et al, 2005). This could essentially lead to safer discharge, reduced risk of wound infection and reduced length of stay.
Material and Methods
In a single centre, data for patients who have undergone awake craniotomies this year were abstracted. Patients planned for an awake surgery were prescribed carb-loading drinks. Due to the start date of this study, there were already a number of patients who have had their awake craniotomies without having carb-loading drinks prescribed. The data for both cohorts enabled comparison on engagement during and after awake craniotomies with therapists and length of stay.
Results
The current data collected has found that the average length of stay in the group who were not prescribed carbohydrate loading drinks pre operatively, had an average length of stay 7.2 days in total, 50% had experienced nausea and vomiting post operatively, which led therapists unable to perform assessments. 66% of patients in this group were found to have some form of difficulties engaging with the therapists during the awake phase of their craniotomies. Compared with patients who were prescribed the carbohydrate loading drink, the average length of stay was 4.6 days, with no post operative nausea and vomiting, no difficulties engaging with therapists post operatively.
Conclusion
Though the current data is of a small volume, carbohydrate loading pre-operatively can help patients for elective awake craniotomies and reduce length of stay in hospital, optimising their recovery in a fast yet safe manner to ensure they are in the best performance status prior to commencing oncology treatment. With further analysis into the use of carb-loading drinks pre-operatively, this can be used widely within neuro-oncology surgeries.
Hausel J, Nygren J, Thorell A et al Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg 2005; : 415-421. [PubMed] [Google Scholar]
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Affiliation(s)
- J La
- Kings College Hospital , London , United Kingdom
| | - R Bhangoo
- Kings College Hospital , London , United Kingdom
| | - V Hurwitz
- Kings College Hospital , London , United Kingdom
| | - K Ashkan
- Kings College Hospital , London , United Kingdom
| | - F Vergani
- Kings College Hospital , London , United Kingdom
| | - R Gullan
- Kings College Hospital , London , United Kingdom
| | - J P Lavrador
- Kings College Hospital , London , United Kingdom
| | - C Robinson
- Kings College Hospital , London , United Kingdom
| | - E Kostick
- Kings College Hospital , London , United Kingdom
| | - A Suarez
- Kings College Hospital , London , United Kingdom
| | - S Hedges
- Kings College Hospital , London , United Kingdom
| | - L Brazil
- Guys & St Thomas Hospital , London , United Kingdom
| | - A Swampillai
- Guys & St Thomas Hospital , London , United Kingdom
| | - O Al-Salihi
- Guys & St Thomas Hospital , London , United Kingdom
| | - K Chia
- Guys & St Thomas Hospital , London , United Kingdom
| | - K Cikurel
- Kings College Hospital , London , United Kingdom
| | - D Joe
- Kings College Hospital , London , United Kingdom
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14
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Owen D, Siva S, Salama JK, Robinson C, Kruser TJ, Giuliani M. If at First You Don't Succeed-Stereotactic Body Radiation Therapy for Recurrent Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 114:5-9. [PMID: 35964631 DOI: 10.1016/j.ijrobp.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Timothy J Kruser
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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15
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McPeake J, Bateson M, Christie F, Robinson C, Cannon P, Mikkelsen M, Iwashyna TJ, Leyland AH, Shaw M, Quasim T. Hospital re-admission after critical care survival: a systematic review and meta-analysis. Anaesthesia 2022; 77:475-485. [PMID: 34967011 DOI: 10.1111/anae.15644] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.
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Affiliation(s)
- J McPeake
- Intensive Care Unit, Glasgow Royal Infirmary and School of Medicine, Dentistry and Nursing, University of Glasgow, UK
| | - M Bateson
- University of the West of Scotland, Glasgow, UK
| | - F Christie
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Robinson
- Belfast Health and Social Care Trust, Belfast, UK
| | - P Cannon
- University of Glasgow Library, Glasgow, UK
| | - M Mikkelsen
- Center for Clinical Epidemiology and Biostatistics, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - T J Iwashyna
- Centre for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| | - A H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Shaw
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - T Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.,Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
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16
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Robinson C, Xing L, Tanaka H, Tasaka S, Badiyan S, Nasrallah H, Biswas T, Shtivelband M, Schuette W, Shi A, Hepner A, Barrett K, Rigas J, Jiang H, Lin S. 122TiP Phase III study of durvalumab with SBRT for unresected stage I/II, lymph-node negative NSCLC (PACIFIC-4/RTOG 3515). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Robinson C, Kruser TJ, Owen D, Salama J, Daly ME. Fast and Furious: New Data Examining Accelerated Radiation Therapy for Limited-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 112:1067-1070. [PMID: 35286875 DOI: 10.1016/j.ijrobp.2021.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
| | | | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joseph Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
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18
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Samson P, Robinson C. Tempering Steel With Fire. Chest 2022; 161:603-604. [DOI: 10.1016/j.chest.2021.12.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 10/18/2022] Open
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19
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Waqar SN, Robinson C, Olszanski AJ, Spira A, Hackmaster M, Lucas L, Sponton L, Jin H, Hering U, Cronier D, Grinberg M, Seithel-Keuth A, Diaz-Padilla I, Berlin J. Phase I trial of ATM inhibitor M3541 in combination with palliative radiotherapy in patients with solid tumors. Invest New Drugs 2022; 40:596-605. [PMID: 35150356 PMCID: PMC9098584 DOI: 10.1007/s10637-022-01216-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ataxia telangiectasia mutated (ATM) kinase orchestrates DNA double strand break (DSB) repair; ATM inhibitors may therefore enhance the therapeutic effect of DSB-inducing treatments such as radiotherapy (RT). M3541 is an orally administered selective inhibitor of ATM. METHODS This phase I dose-escalation study evaluated the maximum-tolerated dose (MTD), recommended phase II dose(s) (RP2D), safety, pharmacokinetics (PK) and antitumor activity of M3541 in combination with fractionated palliative RT in patients with solid tumors. Fifteen patients received palliative RT (30 Gy in 10 fractions) and escalating doses of M3541 (50-300 mg administered on RT fraction days) guided by a Bayesian 2-parameter logistic regression model with overdose control. RESULTS Doses of M3541 up to 300 mg/fraction day were well tolerated. One patient (200 mg group) experienced two dose-limiting toxicities (urinary tract infection, febrile neutropenia) that resolved with antibiotics. All patients reported ≥ 1 treatment-emergent adverse event (TEAE) but none led to treatment discontinuation. No grade ≥ 4 TEAEs were reported and there was no indication of a dose effect for any TEAE. Three patients (20.0%; 95% confidence interval 4.3-48.1) had confirmed complete or partial response. M3541 total plasma levels did not increase with dose following single or repeated dosing. No relationship was observed between dose and changes in the ratio of phosphorylated to total ATM or in immune cell counts. CONCLUSIONS The MTD and RP2D could not be established as the study closed early due to the absence of a dose-response relationship and non-optimal PK profile. No further clinical development of M3541 was pursued. (Trial registration number ClinicalTrials.gov NCT03225105. Registration date July 21, 2017).
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Affiliation(s)
- Saiama N Waqar
- Division of Oncology, Washington University School of Medicine and Alvin J. Siteman Cancer Center, Saint Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Anthony J Olszanski
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Spira
- Medical Oncology, Virginia Cancer Specialists Research Institute and US Oncology Research, Fairfax, VA, USA
| | - Melissa Hackmaster
- Medical Oncology, Virginia Cancer Specialists Research Institute and US Oncology Research, Fairfax, VA, USA
| | - Luisa Lucas
- Merck S.L.U., Mollet del Valles, Spain, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Laura Sponton
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Hulin Jin
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Ursula Hering
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Damien Cronier
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | | | - Ivan Diaz-Padilla
- Oncology Global Clinical Development, Ares Trading SA, Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Jordan Berlin
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
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20
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Fullick E, Bidewell CA, Duff JP, Holmes JP, Howie F, Robinson C, Goodman G, Beckmann KM, Philbey AW, Daunt F. Mass mortality of seabirds in GB. Vet Rec 2022. [PMID: 35119735 DOI: 10.1002/vetr.1462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- E Fullick
- APHA Thirsk, North Yorkshire, YO7 1PZ
| | | | | | | | - F Howie
- SRUC Veterinary Services, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, EH26 0PZ
| | - C Robinson
- SRUC Veterinary Services, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, EH26 0PZ
| | | | | | - A W Philbey
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, EH26 9RG
| | - F Daunt
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB
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21
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Duriseti S, Kavanaugh JA, Szymanski J, Huang Y, Basarabescu F, Chaudhuri A, Henke L, Samson P, Lin A, Robinson C, Spraker MB. LITE SABR M1: A phase I trial of Lattice stereotactic body radiotherapy for large tumors. Radiother Oncol 2022; 167:317-322. [PMID: 34875286 DOI: 10.1016/j.radonc.2021.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is an attractive treatment option for patients with metastatic and/or unresectable tumors, however its use is limited to smaller tumors. Lattice is a form of spatially fractionated radiotherapy that may allow safe delivery of ablative doses to bulky tumors. We previously described Lattice SBRT, which delivers 20 Gy in 5 fractions with a simultaneous integrated boost to 66.7 Gy in a defined geometric arrangement (Lattice boost). The goal of this study was to prospectively evaluate the acute toxicity and quality of life (QoL) of patients with large tumors (>5 cm) treated with Lattice SBRT. METHODS This was a single-arm phase I trial conducted between October 2019 and August 2020. Patients with tumors > 4.5 cm were eligible. Lattice SBRT was delivered every other day. The primary outcome was the rate of 90-day treatment-associated (probably or definitely attributable) grade 3 + acute toxicity by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 criteria. Other outcomes included changes in patient reported toxicity and QoL inventories, GTV, and peripheral blood cytokines. RESULTS Twenty patients (22 tumors) were enrolled. Median GTV was 579.2 cc (range: 54.2-3713.5 cc) in volume and 11.1 cm (range: 5.6-21.4 cm) in greatest axial diameter. Fifty percent of tumors were in the thorax, 45% abdomen/pelvis, and 5% extremity. There was no likely treatment-associated grade 3 + toxicity in the 90-day period (acute and sub-acute). There was one case of grade 4 toxicity possibly associated with Lattice SBRT. CONCLUSIONS This phase I study met its primary endpoint of physician reported short-term safety. An ongoing phase II clinical trial of Lattice SBRT will evaluate late safety and efficacy of this novel technique.
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Affiliation(s)
- Sai Duriseti
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - James A Kavanaugh
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Jeff Szymanski
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Yi Huang
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Franco Basarabescu
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Aadel Chaudhuri
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Lauren Henke
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Alexander Lin
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Matthew B Spraker
- Department of Radiation Oncology, Washington University in St. Louis, United States.
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22
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Contreras J, Srivastava A, Samson P, DeWees T, Govindan R, Baggstrom MQ, Morgensztern D, Roach M, Badiyan SN, Bradley J, Waqar S, Robinson C. Phase I Study of Accelerated Hypofractionated Proton Therapy and Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022; 113:742-748. [PMID: 35074432 DOI: 10.1016/j.ijrobp.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the maximum tolerated dose (MTD) of hypofractionated proton beam radiation therapy (PBT) with concurrent weekly carboplatin/paclitaxel in patients with stage II-III non-small cell lung cancer (NSCLC). MATERIALS/METHODS A phase I trial was designed using the Time to Event-Continuous Reassessment Method (TITE-CRM). MTD was defined as the dose associated with a 20% probability of CTCAE protocol-specified serious adverse events (SAEs). Starting dose was 3.5 Gy/fx for 15 fractions with 2 potential escalation and de-escalation levels in 0.25 Gy/fx increments. Chemotherapy was weekly concurrent carboplatin/paclitaxel with 2 cycles of optional consolidation carboplatin/paclitaxel. RESULTS From 5/2015-9/2016, 23 patients enrolled at a single institution. Of 20 evaluable, median age was 66.5 years (range, 54-89) and 12 (60%) were male. Fourteen had squamous cell (70%), and 15 (75%) were stage IIIA. Nineteen (95%) completed all 3 cycles of concurrent chemotherapy, and 16 (80%) received at least one cycle of consolidation chemotherapy. Within the 6-month TITE-CRM assessment window, no SAEs were reported, and most patients were treated at the highest dose-level. Dose-level assignment was 52.5 Gy (n=2), 56.25 Gy (n=4), and 60 Gy (n=14). The posterior probability of dose limiting toxicity (DLT) for 60 Gy was 5.3% (95% CI, 1-18.1%). Acute, non-serious AEs included grade 2 esophagitis in 7 patients (35%) and grade 2 pneumonitis in 1 patient (5%). At a median follow-up of 20.3 months for all and 44.9 months for living patients, there were no grade 4 or 5 AEs, though there were three (21% at 24 months) SAEs outside of the dose-escalation window. The 2-year overall survival, local, regional, and distant control rates were 48%, 84%, 77%, and 79%, respectively. CONCLUSIONS Hypofractionated PBT and chemotherapy up to 60 Gy in 15 fractions is acutely well tolerated, with high rates of locoregional control and overall survival, though late SAEs were noted.
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Affiliation(s)
| | | | - Pamela Samson
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | | | | | - Saiama Waqar
- Washington University School of Medicine, St. Louis, Missouri
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23
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Dagra A, Barpujari A, Bauer SZ, Olowofela BO, Mohamed S, McGrath K, Robinson C, Robicsek S, Snyder A, Lucke-Wold B. Epigenetics of Neurotrauma. Neurology (Chic) 2022; 2:42-47. [PMID: 36507115 PMCID: PMC9732507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epigenetic changes have been linked to a host of disease states. Besides the physiological function of epigenetic changes in regulating cellular function, recent data indicates that key changes in epigenetic activity also play an important pathophysiologic role following neurotrauma specifically. Such manifestations occur through the activation or silencing of different genes. Histone methylation has emerged as a critical component of this process and can be selectively modulated after injury. Pre-clinical studies have resulted in key discoveries regarding specific methylation sites of interest. This focused review highlights some of these early findings and their relationship to clinical outcomes. These findings suggest areas of future investigation and discovery in the quest to develop ideal biomarkers and methods to utilize them in developing therapeutic interventions.
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Affiliation(s)
- A Dagra
- College of Medicine, University of Florida, USA
| | - A Barpujari
- College of Liberal Arts and Sciences, University of Florida, USA
| | - SZ Bauer
- College of Medicine, University of Nevada, USA
| | | | - S Mohamed
- College of Medicine, University of Florida, USA
| | - K McGrath
- College of Medicine, University of Florida, USA
| | - C Robinson
- Departments of Neurology and Neuroscience, McKnight Brain Institute, University of Florida, USA
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, and Brain Injury Rehabilitation and Neuroresilience Center, University of Florida, USA
| | - S Robicsek
- Department of Anesthesiology, University of Florida, USA
| | - A Snyder
- Department of Neuropsychology, University of Florida, USA
| | - B Lucke-Wold
- Department of Neurosurgery, University of Florida, USA
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24
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Daly ME, Singh N, Ismaila N, Antonoff MB, Arenberg DA, Bradley J, David E, Detterbeck F, Früh M, Gubens MA, Moore AC, Padda SK, Patel JD, Phillips T, Qin A, Robinson C, Simone CB. Management of Stage III Non-Small-Cell Lung Cancer: ASCO Guideline. J Clin Oncol 2021; 40:1356-1384. [PMID: 34936470 DOI: 10.1200/jco.21.02528] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on management of patients with stage III non-small-cell lung cancer (NSCLC). METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary oncology, community oncology, research methodology, and advocacy experts was convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 127 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address evaluation and staging workup of patients with suspected stage III NSCLC, surgical management, neoadjuvant and adjuvant approaches, and management of patients with unresectable stage III NSCLC.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Navneet Singh
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | | | | | - Martin Früh
- Department of Medical Oncology Cantonal Hospital of St Gallen, St Gallen, Switzerland.,University of Bern, Bern, Switzerland
| | | | | | - Sukhmani K Padda
- Department of Medicine, Division of Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jyoti D Patel
- Northwestern University-Feinberg School of Medicine, Chicago, IL
| | | | - Angel Qin
- University of Michigan, Ann Arbor, MI
| | | | - Charles B Simone
- New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, NY
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25
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Lee J, Bates M, Shepherd E, Riley S, Henshaw M, Metherall P, Daniel J, Blower A, Scoones D, Wilkinson M, Richmond N, Robinson C, Cuculich P, Hugo G, Seller N, McStay R, Child N, Thornley A, Kelland N, Atherton P, Peedell C, Hatton M. Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience. Open Heart 2021; 8:openhrt-2021-001770. [PMID: 34815300 PMCID: PMC8611439 DOI: 10.1136/openhrt-2021-001770] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Options for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option. Methods Seven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used. Results Acute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure. Conclusions Cardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.
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Affiliation(s)
- Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Matthew Bates
- Department of Cardiology, South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - Ewen Shepherd
- Department of Cardiology, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Riley
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Henshaw
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Peter Metherall
- 3D Lab, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim Daniel
- Department of Oncology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Alison Blower
- Department of Oncology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David Scoones
- Department of Pathology, South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - Michele Wilkinson
- Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Richmond
- Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Clifford Robinson
- Center for Noninvasive Cardiac Radioablation, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Phillip Cuculich
- Center for Noninvasive Cardiac Radioablation, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Geoffrey Hugo
- Center for Noninvasive Cardiac Radioablation, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Neil Seller
- Department of Cardiology, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McStay
- Department of Radiology, Newcastle NHS Hospitals Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas Child
- Department of Cardiology, South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - Andrew Thornley
- Department of Cardiology, South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - Nicholas Kelland
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philip Atherton
- Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Clive Peedell
- Department of Oncology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Matthew Hatton
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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26
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Hann MJ, Rocchigiani G, Verin R, Milner P, Robinson C, Castro Martins M. Advanced imaging of a histologically confirmed bone infarction of the distal tibia in a Warmblood mare. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. J. Hann
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst, Neston UK
| | - G. Rocchigiani
- Department of Veterinary Pathology, Infection and Public Health Institute of Veterinary Science University of Liverpool Leahurst, Neston UK
| | - R. Verin
- Department of Veterinary Pathology, Infection and Public Health Institute of Veterinary Science University of Liverpool Leahurst, Neston UK
| | - P. Milner
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst, Neston UK
- Department of Musculoskeletal Biology Institute of Ageing and Chronic Disease University of Liverpool Liverpool UK
| | - C. Robinson
- Nantwich Veterinary Group Equine Centre Nantwich, Cheshire UK
| | - M. Castro Martins
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst, Neston UK
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27
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Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol 2021; 3:343-359. [PMID: 34604796 PMCID: PMC8463722 DOI: 10.1016/j.jaccao.2021.06.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for many malignancies. With improvements in cardiac-sparing techniques, radiation-induced cardiac dysfunction has decreased but remains a continued concern. In this review, we provide an overview of the evolution of radiotherapy techniques in thoracic cancers and associated reductions in cardiac risk. We also highlight data demonstrating that in some cases radiation doses to specific cardiac substructures correlate with cardiac toxicities and/or survival beyond mean heart dose alone. Advanced cardiac imaging, cardiovascular risk assessment, and potentially even biomarkers can help guide post-radiotherapy patient care. In addition, treatment of ventricular arrhythmias with the use of ablative radiotherapy may inform knowledge of radiation-induced cardiac dysfunction. Future efforts should explore further personalization of radiotherapy to minimize cardiac dysfunction by coupling knowledge derived from enhanced dosimetry to cardiac substructures, post-radiation regional dysfunction seen on advanced cardiac imaging, and more complete cardiac toxicity data.
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Key Words
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CMRI, cardiac magnetic resonance imaging
- CT, computed tomography
- HL, Hodgkin lymphoma
- LAD, left anterior descending artery
- LV, left ventricular
- MHD, mean heart dose
- NSCLC, non–small cell lung cancer
- RICD, radiation-induced cardiovascular disease
- RT, radiation therapy
- SBRT, stereotactic body radiation therapy
- breast cancer
- cancer survivorship
- childhood cancer
- esophageal cancer
- imaging
- lung cancer
- lymphoma
- radiation physics
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
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28
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Henke LE, Stanley JA, Robinson C, Srivastava A, Contreras JA, Curcuru A, Green OL, Massad LS, Kuroki L, Fuh K, Hagemann A, Mutch D, McCourt C, Thaker P, Powell M, Markovina S, Grigsby PW, Schwarz JK, Chundury A. Phase I Trial of Stereotactic MRI-Guided Online Adaptive Radiation Therapy (SMART) for the Treatment of Oligometastatic Ovarian Cancer. Int J Radiat Oncol Biol Phys 2021; 112:379-389. [PMID: 34474109 DOI: 10.1016/j.ijrobp.2021.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/18/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy is increasingly used to treat a variety of oligometastatic histologies, but few data exist for ovarian cancer. Ablative stereotactic body radiation therapy dosing is challenging in sites like the abdomen, pelvis, and central thorax due to proximity and motion of organs at risk. A novel radiation delivery method, stereotactic magnetic-resonance-guided online-adaptive radiation therapy (SMART), may improve the therapeutic index of stereotactic body radiation therapy through enhanced soft-tissue visualization, real-time nonionizing imaging, and ability to adapt to the anatomy-of-the-day, with the goal of producing systemic-therapy-free intervals. This phase I trial assessed feasibility, safety, and dosimetric advantage of SMART to treat ovarian oligometastases. METHODS AND MATERIALS Ten patients with recurrent oligometastatic ovarian cancer underwent SMART for oligometastasis ablation. Initial plans prescribed 35 Gy/5 fractions with goal 95% planning target volume coverage by 95% of prescription, with dose escalation permitted, subject to strict organ-at-risk dose constraints. Daily adaptive planning was used to protect organs-at-risk and/or increase target dose. Feasibility (successful delivery of >80% of fractions in the first on-table attempt) and safety of this approach was evaluated, in addition to efficacy, survival metrics, quality-of-life, prospective timing and dosimetric outcomes. RESULTS Ten women with seventeen ovarian oligometastases were treated with SMART, and 100% of treatment fractions were successfully delivered. Online adaptive plans were selected at time of treatment for 58% of fractions, due to initial plan violation of organs-at-risk constraints (84% of adapted fractions) or observed opportunity for planning target volume dose escalation (16% of adapted fractions), with a median on-table time of 64 minutes. A single Grade ≥3 acute (within 6 months of SMART) treatment-related toxicity (duodenal ulcer) was observed. Local control at 3 months was 94%; median progression-free survival was 10.9 months. Median Kaplan-Meier estimated systemic-therapy-free survival after radiation completion was 11.5 months, with concomitant quality-of-life improvements. CONCLUSIONS SMART is feasible and safe for high-dose radiation therapy ablation of ovarian oligometastases of the abdomen, pelvis, and central thorax with minimal toxicity, high rates of local control, and prolonged systemic-therapy-free survival translating into improved quality-of-life.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer A Stanley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
| | - Amar Srivastava
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jessika A Contreras
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Austen Curcuru
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Katherine Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Andrea Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - David Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Premal Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers University, New Brunswick, New Jersey
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Kruser TJ, Robinson C, Owen D, Salama JK, Daly ME. Strike or Spare? A Review of Lung-Sparing Therapies for Malignant Pleural Mesothelioma. Int J Radiat Oncol Biol Phys 2021; 110:257-260. [PMID: 33989566 DOI: 10.1016/j.ijrobp.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tim J Kruser
- Department of Radiation Oncology, Turville Bay Radiation Oncology, SSM Health, Madison, Wisconsin.
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
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Squiers JJ, Ghamande S, Qiu T, Robinson C, Bertschy C, Arroliga AC, Peters W. Universal preprocedural SARS-CoV-2 testing protocol within a large healthcare system. Br J Surg 2021; 108:e326-e327. [PMID: 34370820 DOI: 10.1093/bjs/znab216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022]
Abstract
This research letter details the safety of a universal asymptomatic preprocedural SARS-CoV-2 testing protocol implemented within a large, integrated healthcare system. Among over 145 000 tests administered, fewer than 1 in 1000 patients had subsequent positive tests within 10 days of an initial negative SARS-CoV-2 test. Despite the infrequency of positive tests after negative screening tests, patient-to-provider transmission was documented in five instances.
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Affiliation(s)
- J J Squiers
- Baylor Scott & White Research Institute, Plano, Texas, USA
| | - S Ghamande
- Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
| | - T Qiu
- Baylor Scott & White Health, Dallas, Texas, USA
| | - C Robinson
- Baylor Scott & White Health, Dallas, Texas, USA
| | - C Bertschy
- Baylor Scott & White Medical Center-Temple, Temple, Texas, USA
| | - A C Arroliga
- Baylor Scott & White Medical Center-Temple, Temple, Texas, USA.,Baylor Scott & White Health, Dallas, Texas, USA
| | - W Peters
- Baylor Scott & White Health, Dallas, Texas, USA
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Cuculich P, Hugo G, Moore K, Samson P, Cooper DH, Robinson C. B-PO05-129 VIRTUAL EDUCATION AND PEER REVIEW PLATFORM ENABLES BEST PRACTICES FOR CARDIAC RADIOABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simcock IC, Reeve R, Burnett C, Costigan C, McNair H, Robinson C, Arthurs OJ. Clinical academic radiographers - A challenging but rewarding career. Radiography (Lond) 2021; 27 Suppl 1:S14-S19. [PMID: 34274226 DOI: 10.1016/j.radi.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To explain what a clinical academic career can be, what it can lead to for the individual, profession and most importantly the patient, and why these roles are so important to radiography. KEY FINDINGS Multiple challenges to the adoption of clinical academic careers exist, including achievable measurable outcomes, visibility & senior support, and balancing different time demands. Equally the rewards are wide ranging and can advance both the individual and profession through role extension opportunities, increased career progression, patient benefits, and academic and research skills. CONCLUSION Clinical academic careers can provide advantages for the individual, department, profession and most importantly the patient with advanced clinical practice through evidenced based research. IMPLICATIONS FOR PRACTICE Improving clinical academic careers within Radiography will promote research participation and increase radiographic roles in patient-centred research delivery and development. Combining evidenced based research with academic skills will lead to improved patient care and better clinical outcomes.
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Affiliation(s)
- I C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; National Institute of Health Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK.
| | - R Reeve
- Diagnostic Imaging Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; University of Southampton, Southampton, UK.
| | - C Burnett
- Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute of Medical Research, University of Leeds, UK; Leeds National Institute of Health Research Biomedical Research Centre, UK.
| | - C Costigan
- Nottingham University Hospitals NHS Trust, Nottingham, UK; National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
| | - H McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
| | - C Robinson
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.
| | - O J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; National Institute of Health Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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Choksi IN, Cox A, Robinson C, Bale A, Carpenter TO. Novel homozygous variant in BMP1 associated with a rare osteogenesis imperfecta phenotype. Osteoporos Int 2021; 32:1239-1244. [PMID: 33624138 DOI: 10.1007/s00198-021-05838-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 02/01/2023]
Abstract
Osteogenesis imperfecta (OI) is characterized by bone fragility and increased fracture susceptibility. BMP1 variants have been reported in the rare OI type XIII, specifically referred to herein as BMP1-associated autosomal recessive (AR) OI. We report the clinical presentation and diagnostic evaluation of a patient found to have a novel homozygous variant in BMP1. We also provide an overview of reported BMP1 variants to date, with discussion focusing on the use of bisphosphonate therapy in these patients. A 7-year-old male with speech and motor delay sustained five bilateral tibial fractures with minimal trauma since age 2.5 years. At age 6, he developed severe back pain after a fall. Diffuse spinal osteopenia and multiple vertebral compression fractures (VCF) at T9, L1, L3, and L5 were identified. Total hip BMD was generous (adjusted Z-score* = 1.76), and femoral neck BMD was high (adjusted Z-score* = 2.67). VCFs precluded assessment of lumbar spine BMD. Genetic analysis identified a homozygous missense variant in exon 4 of BMP1 (c.C505T; p.Arg169Cys). Unlike most forms of OI, patients with BMP1-associated AR OI may have normal or paradoxically increased BMD, making BMD and fracture risk correlation difficult. While bisphosphonates (BP) may help reduce recurrent fractures and provide symptomatic relief, the broad phenotypic spectrum and underlying bone pathology, often in the setting of increased BMD, complicate management. HR-pQCT assessment of bone microarchitecture and quality may aid in the decision of BP therapy and subsequent monitoring. Evidence is limited with respect to the effectiveness of BP in this rare form of OI. *Z-score was adjusted for height Z-score.
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Affiliation(s)
- I N Choksi
- Department of Pediatrics, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA.
| | - A Cox
- DNA Diagnostic Laboratory, Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - C Robinson
- Department of Pediatrics, Division of Endocrinology and Diabetes, Icahn School of Medicine, New York, NY, USA
| | - A Bale
- DNA Diagnostic Laboratory, Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - T O Carpenter
- Department of Pediatrics, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
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Chmura S, Winter KA, Robinson C, Pisansky TM, Borges V, Al-Hallaq H, Matuszak M, Park SS, Yi S, Hasan Y, Bazan J, Wong P, Yoon HA, Horton J, Gan G, Milano MT, Sigurdson ER, Moughan J, Salama JK, White J. Evaluation of Safety of Stereotactic Body Radiotherapy for the Treatment of Patients With Multiple Metastases: Findings From the NRG-BR001 Phase 1 Trial. JAMA Oncol 2021; 7:845-852. [PMID: 33885704 PMCID: PMC8063134 DOI: 10.1001/jamaoncol.2021.0687] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Stereotactic body radiotherapy (SBRT) for oligometastases is hypothesized to improve survival and is increasingly used. Little evidence supports its safe use to treat patients with multiple metastases. OBJECTIVE To establish safety of SBRT dose schedules in patients with 3 to 4 metastases or 2 metastases in close proximity to each other. DESIGN, SETTING, AND PARTICIPANTS This phase 1 trial opened on August 4, 2014, and closed to accrual on March 20, 2018. Metastases to 7 anatomic locations were included: bone/osseous (BO), spinal/paraspinal (SP), peripheral lung (PL), central lung (CL), abdominal-pelvic (AP), mediastinal/cervical lymph node (MC), and liver (L). Six patients could be enrolled per anatomic site. The setting was a consortium of North American academic and community practice cancer centers participating in NRG Oncology trials. Patients with breast, prostate, or non-small cell lung cancer with 3 to 4 metastases or 2 metastases in close proximity (≤5 cm) amenable to SBRT were eligible for this phase 1 study. Statistical analyses were performed from December 31, 2017, to September 19, 2019. INTERVENTIONS The starting dose was 50 Gy in 5 fractions (CL, MC), 45 Gy in 3 fractions (PL, AP, L), and 30 Gy in 3 fractions (BO, SP). MAIN OUTCOMES AND MEASURES The primary end point was dose-limiting toxicity (DLT) defined by the Common Terminology Criteria for Adverse Events, version 4.0, as specific adverse events (AEs) of grades 3 to 5 (definite or probable per the protocol DLT definition) related to SBRT within 180 days of treatment. Dose levels were considered safe if DLTs were observed in no more than 1 of 6 patients per location; otherwise, the dose at that location would be de-escalated. RESULTS A total of 42 patients enrolled, 39 were eligible, and 35 (mean [SD] age, 63.1 [14.2] years; 20 men [57.1%]; 30 White patients [85.7%]) were evaluable for DLT. Twelve patients (34.3%) had breast cancer, 10 (28.6%) had non-small cell lung cancer, and 13 (37.1%) had prostate cancer; there was a median of 3 metastases treated per patient. Median survival was not reached. No protocol-defined DLTs were observed. When examining all AEs, 8 instances of grade 3 AEs, most likely related to protocol therapy, occurred approximately 125 to 556 days from SBRT initiation in 7 patients. CONCLUSIONS AND RELEVANCE This phase 1 trial demonstrated the safety of SBRT for patients with 3 to 4 metastases or 2 metastases in close proximity. There were no treatment-related deaths. Late grade 3 AEs demonstrate the need for extended follow-up in long-surviving patients with oligometastatic disease. Treatment with SBRT for multiple metastases has been expanded into multiple ongoing randomized phase 2/3 National Cancer Institute-sponsored trials (NRG-BR002, NRG-LU002). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02206334.
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Affiliation(s)
- Steve Chmura
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Thomas M Pisansky
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Hania Al-Hallaq
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Sean S Park
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sun Yi
- Department of Radiation Oncology, University of Arizona Medical Center - University Campus, Tucson
| | - Yasmin Hasan
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Jose Bazan
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Philip Wong
- Centre Hospitalier de L'Universite de Montréal, Hotel Dieu de Montréal, Montréal, Quebec, Canada
| | - Harold A Yoon
- Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, Illinois
| | - Janet Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Gregory Gan
- New Mexico Minority Underserved National Cancer Institute Community Oncology Research Program, Albuquerque
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | | | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Julia White
- Ohio State University Comprehensive Cancer Center, Columbus
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Elsayed E, Robinson C. P.95 Trends in rocuronium use in obstetric anaesthesia and monitoring and documentation of neuromuscular block. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Crockett C, Chuter R, Cobben D, Dubec M, Green O, Hackett S, McDonald F, Robinson C, Samson P, Shiarli AM, Straza M, Verhoeff J, Vlacich G, Werner-Wasik M, Faivre-Finn C. Magnetic resonance-guided radiotherapy (MRgRT) for patients with lung cancer. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Singareddy A, Waqar SN, Devarakonda S, Ward JP, Govindan R, Robinson C, Morgensztern D, Samson PP. Cause of death among patients with non-small cell lung cancer treated with postoperative radiation therapy (PORT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20555 Background: The indications for post-operative radiation therapy (PORT) in locally advanced non-small cell lung cancer (NSCLC) remain undefined and a major concern is the perceived risk of increased mortality from cardiopulmonary causes. The purpose of this study was to quantify the rate of cardiopulmonary death in patients with resected NSCLC receiving PORT using a large national database. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database for lung cancer, patients with Stage IIIA or Stage IIIB NSCLC according to the 6th AJCC edition treated with surgery followed by PORT, who also received chemotherapy were identified. Cause of death was categorized as due to lung cancer, other cancer, cardiac, pulmonary, or other and reported as a percentage of total deaths at one and 2 years. Kaplan-Meier survival analysis was done to compare overall survival between Stage IIIA and IIIB patients. Results: From 2004 to 2015, 4387 patients with stage IIIA and IIIB meeting the eligibility criteria were identified. The median age at diagnosis was 65 years old, most patients were male (53%), Caucasian (83%), had adenocarcinoma (54.8%), stage IIIA disease (69%), and N2 disease (78%). The median overall survival for Stage IIIA and IIIB patients was 39 months and 27 months respectively (p < 0.001). Among the 2586 patients that died during the study period, the most common COD was lung cancer (81.3%). Cardiac and pulmonary COD occurred in 86 patients (3.3% of deaths) and 84 patients (3.2% of deaths) respectively, whereas 158 patients (6.1%) died from other cancers and 154 (5.9%) from other causes. There were 77 deaths from cardiopulmonary cause at 2 years (1.7% of patients and 2.9% of deaths). Cardiopulmonary COD was more common in patients with stage IIIB compared to IIIA disease (4.9% vs 3.3% of deaths, p < 0.001). Lung cancer was the most common COD both at 1 and 2 years (85%) whereas cardiopulmonary was the COD in 5.2% of patients at 1 year and 5.1% at 2 years. Conclusions: This analysis showed a low cardiopulmonary mortality from PORT in the first 2 years. The role for adjuvant radiotherapy remains undefined and treatment decisions for patients with resected stage III NSCLC should be guided by co-morbidities and the competing risk for death from lung cancer.
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Affiliation(s)
| | | | | | - Jeffrey P. Ward
- Barnes-Jewish Hospital/Washington University in St. Louis, St. Louis, MO
| | | | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, Saint Louis, MO
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38
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Crockett CB, Samson P, Chuter R, Dubec M, Faivre-Finn C, Green OL, Hackett SL, McDonald F, Robinson C, Shiarli AM, Straza MW, Verhoeff JJC, Werner-Wasik M, Vlacich G, Cobben D. Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer. Front Oncol 2021; 11:617681. [PMID: 33777759 PMCID: PMC7988221 DOI: 10.3389/fonc.2021.617681] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Curative-intent radiotherapy plays an integral role in the treatment of lung cancer and therefore improving its therapeutic index is vital. MR guided radiotherapy (MRgRT) systems are the latest technological advance which may help with achieving this aim. The majority of MRgRT treatments delivered to date have been stereotactic body radiation therapy (SBRT) based and include the treatment of (ultra-) central tumors. However, there is a move to also implement MRgRT as curative-intent treatment for patients with inoperable locally advanced NSCLC. This paper presents the initial clinical experience of using the two commercially available systems to date: the ViewRay MRIdian and Elekta Unity. The challenges and potential solutions associated with MRgRT in lung cancer will also be highlighted.
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Affiliation(s)
- Cathryn B. Crockett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Robert Chuter
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael Dubec
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Olga L. Green
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Sara L. Hackett
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Fiona McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Anna-Maria Shiarli
- Department of Radiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael W. Straza
- Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, United States
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - David Cobben
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Kong F, Hu C, Machtay M, Matuszak M, Xiao Y, Ten Haken R, Hirsh V, Pryma D, Siegel B, Gelblum D, Hayman J, Robinson C, Loo B, Videtic G, Faria S, Ferguson C, Dunlap N, Kundapu V, Paulus R, Curran W, Bradley J. OA02.04 Randomized Phase Ⅱ Trial (RTOG1106) on Midtreatment PET/CT Guided Adaptive Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Zarifkar P, Kamath A, Robinson C, Morgulchik N, Shah SFH, Cheng TKM, Dominic C, Fehintola AO, Bhalla G, Ahillan T, Mourgue d'Algue L, Lee J, Pareek A, Carey M, Hughes DJ, Miller M, Woodcock VK, Shrotri M. Clinical Characteristics and Outcomes in Patients with COVID-19 and Cancer: a Systematic Review and Meta-analysis. Clin Oncol (R Coll Radiol) 2021; 33:e180-e191. [PMID: 33261978 PMCID: PMC7674130 DOI: 10.1016/j.clon.2020.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/25/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
Much of routine cancer care has been disrupted due to the perceived susceptibility to SARS-CoV-2 infection in cancer patients. Here, we systematically review the current evidence base pertaining to the prevalence, presentation and outcome of COVID-19 in cancer patients, in order to inform policy and practice going forwards. A keyword-structured systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 in cancer patients. Studies were critically appraised using the NIH National Heart, Lung and Blood Institute's quality assessment tool set. The pooled prevalence of cancer as a co-morbidity in patients with COVID-19 and pooled in-hospital mortality risk of COVID-19 in cancer patients were derived by random-effects meta-analyses. In total, 110 studies from 10 countries were included. The pooled prevalence of cancer as a co-morbidity in hospitalised patients with COVID-19 was 2.6% (95% confidence interval 1.8%, 3.5%, I2: 92.0%). Specifically, 1.7% (95% confidence interval 1.3%, 2.3%, I2: 57.6.%) in China and 5.6% (95% confidence interval 4.5%, 6.7%, I2: 82.3%) in Western countries. Patients most commonly presented with non-specific symptoms of fever, dyspnoea and chest tightness in addition to decreased arterial oxygen saturation, ground glass opacities on computer tomography and non-specific changes in inflammatory markers. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%, I2: 52.3%). We identified impeding questions that need to be answered to provide the foundation for an iterative review of the developing evidence base, and inform policy and practice going forwards. Analyses of the available data corroborate an unfavourable outcome of hospitalised patients with COVID-19 and cancer. Our findings encourage future studies to report detailed social, demographic and clinical characteristics of cancer patients, including performance status, primary cancer type and stage, as well as a history of anti-cancer therapeutic interventions.
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Affiliation(s)
- P Zarifkar
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.
| | - A Kamath
- Faculty of Medicine, University of Oxford, Medical Sciences Divisional Office, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - C Robinson
- Faculty of Medicine, University of Oxford, Medical Sciences Divisional Office, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - N Morgulchik
- Imperial College London, Department of Chemistry, Molecular Sciences Research Hub, London, UK
| | - S F H Shah
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - T K M Cheng
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - C Dominic
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - A O Fehintola
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - G Bhalla
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - T Ahillan
- University College London Medical School, London, UK
| | | | - J Lee
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - A Pareek
- Department of Radiology Stanford University School of Medicine, Stanford, California, USA
| | - M Carey
- Department of Palliative Care Oxford University Hospitals NHS Foundation Trust, Sobell House Hospice, Churchill Hospital, Oxford, UK
| | - D J Hughes
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - M Miller
- Department of Palliative Care Oxford University Hospitals NHS Foundation Trust, Sobell House Hospice, Churchill Hospital, Oxford, UK
| | - V K Woodcock
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - M Shrotri
- London School of Hygiene & Tropical Medicine, London, UK
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Duriseti S, Kavanaugh J, Goddu S, Price A, Knutson N, Reynoso F, Michalski J, Mutic S, Robinson C, Spraker MB. Spatially fractionated stereotactic body radiation therapy (Lattice) for large tumors. Adv Radiat Oncol 2021; 6:100639. [PMID: 34195486 PMCID: PMC8233471 DOI: 10.1016/j.adro.2020.100639] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) has demonstrated clinical benefits for patients with metastatic and/or unresectable cancer. Technical considerations of treatment delivery and nearby organs at risk can limit the use of SBRT in large tumors or those in unfavorable locations. Spatially fractionated radiation therapy (SFRT) may address this limitation because this technique can deliver high-dose radiation to discrete subvolume vertices inside a tumor target while restricting the remainder of the target to a safer lower dose. Indeed, SFRT, such as GRID, has been used to treat large tumors with reported dramatic tumor response and minimal side effects. Lattice is a modern approach to SFRT delivered with arc-based therapy, which may allow for safe, high-quality SBRT for large and/or deep tumors. Methods and Materials Herein, we report the results of a dosimetry and quality assurance feasibility study of Lattice SBRT in 11 patients with 12 tumor targets, each ≥10 cm in an axial dimension. Prior computed tomography simulation scans were used to generate volumetric modulated arc therapy Lattice SBRT plans that were then delivered on clinically available Linacs. Quality assurance testing included external portal imaging device and ion chamber analyses. Results All generated plans met the standard SBRT dose constraints, such as those from the American Association of Physicists in Medicine Task Group 101. Additionally, we provide a step-by-step approach to generate and deliver Lattice SBRT plans using commercially available treatment technology. Conclusions Lattice SBRT is currently being tested in a prospective trial for patients with metastatic cancer who need palliation of large tumors (NCT04553471, NCT04133415).
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Affiliation(s)
- Sai Duriseti
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - James Kavanaugh
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Nels Knutson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew B Spraker
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
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Robinson C. SP-0723: Noninvasive cardiac radioablation for ventricular tachycardia. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hassanzadeh C, Sita T, Savoor R, Samson PP, Bradley J, Gentile M, Roach M, Mohindra N, Waqar S, Kruser TJ, Robinson C. Implications of pneumonitis after chemoradiation and durvalumab for locally advanced non-small cell lung cancer. J Thorac Dis 2020; 12:6690-6700. [PMID: 33282370 PMCID: PMC7711405 DOI: 10.21037/jtd-20-1792] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Consolidation durvalumab improved overall survival (OS) in locally advanced non-small cell lung cancer (LA-NSCLC) treated with chemoradiotherapy (CRT) in the PACIFIC trial; however, pneumonitis was increased with durvalumab. We sought to examine real-world outcomes with the PACIFIC paradigm, especially factors associated with pneumonitis, using a multi-institutional review. Methods Patients with LA-NSCLC treated with CRT followed by durvalumab from January 2017–February 2019 were identified at 2 institutions. We characterized demographics, tumor factors, radiotherapy, and duration of durvalumab. We examined pneumonitis outcomes including re-challenge success, with secondary endpoints of progression-free survival (PFS) and OS. Results Thirty-four patients were included with median follow-up of 12 months (range, 3 to 20 months); 94% had stage III disease. The cumulative grade >2 pneumonitis rate was 26.5% with 2 patients developing grade 3 pneumonitis and no grade 4/5 events. Median time to pneumonitis after RT was 2.4 months (range, 0 to 4.9 months). Pneumonitis management included median prednisone dose of 60 mg for median taper of 6 weeks with durvalumab held for median of 4.5 weeks (range, 2 to 8 weeks); 70% of pneumonitis patients received durvalumab re-challenge, with pneumonitis recurring in 14% of patients. 3-month and 6-month pneumonitis-free-survival were 76.9% and 73.6%, respectively; 9- and 12-month OS were 96% (75.1–99.8%), 86.6% (63.5–95.5%), respectively; 9- and 12-month PFS were 68% (47.5–82.5%), 48.7% (25.3–68.3%). Pneumonitis development did not significantly impact PFS or OS (P>0.05). Conclusions Among LA-NSCLC patients treated with CRT followed by consolidation durvalumab, more than 25% developed symptomatic pneumonitis. In this small case series, pneumonitis did not appear to negatively impact survival, and durvalumab re-challenge appeared feasible after pneumonitis treatment with steroids.
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Affiliation(s)
- Comron Hassanzadeh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy Sita
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Rohan Savoor
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Bradley
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Michelle Gentile
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Michael Roach
- Departmen of Radiation Oncology, Cancer Center of Hawaii, Honolulu, HI, USA
| | - Nisha Mohindra
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Saiama Waqar
- Department of Medicine, Oncology Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy J Kruser
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
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Ghimire P, Lavrador JP, Onyiriuka L, Robinson C, La J, Mullens L, Hurwitz V, Cikurel K, Al-Salihi O, Swampillai A, Brazil L, Bhangoo R, Vergani F, Gullan R, Ashkan K. Patient-reported Experience Measure for Neuro-oncology Telephone Clinics during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 33:e87. [PMID: 32828636 PMCID: PMC7438996 DOI: 10.1016/j.clon.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/05/2022]
Affiliation(s)
- P Ghimire
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - J P Lavrador
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - L Onyiriuka
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - C Robinson
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - J La
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - L Mullens
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - V Hurwitz
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - K Cikurel
- Department of Neurology, Kings College Hospital, London, UK
| | - O Al-Salihi
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - A Swampillai
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - L Brazil
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - R Bhangoo
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - F Vergani
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - R Gullan
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - K Ashkan
- Department of Neurosurgery, Kings College Hospital, London, UK
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Samson P, Ning MS, Shaverdian N, Shepherd AF, Gomez DR, McGinnis GJ, Nitsch PL, Chmura S, O’Reilly MS, Lee P, Chang JY, Robinson C, Lin SH. Clinical and Radiographic Presentations of COVID-19 Among Patients Receiving Radiation Therapy for Thoracic Malignancies. Adv Radiat Oncol 2020; 5:700-704. [PMID: 32395673 PMCID: PMC7212983 DOI: 10.1016/j.adro.2020.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Matthew S. Ning
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annemarie F. Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Paige L. Nitsch
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Steven Chmura
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | | | - Percy Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Joe Y. Chang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Steven H. Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
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Thor M, Deasy JO, Hu C, Gore E, Bar-Ad V, Robinson C, Wheatley M, Oh JH, Bogart J, Garces YI, Kavadi VS, Narayan S, Iyengar P, Witt JS, Welsh JW, Koprowski CD, Larner JM, Xiao Y, Bradley J. Modeling the Impact of Cardiopulmonary Irradiation on Overall Survival in NRG Oncology Trial RTOG 0617. Clin Cancer Res 2020; 26:4643-4650. [PMID: 32398326 DOI: 10.1158/1078-0432.ccr-19-2627] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/07/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To quantitatively predict the impact of cardiopulmonary dose on overall survival (OS) after radiotherapy for locally advanced non-small cell lung cancer. EXPERIMENTAL DESIGN We used the NRG Oncology/RTOG 0617 dataset. The model building procedure was preregistered on a public website. Patients were split between a training and a set-aside validation subset (N = 306/131). The 191 candidate variables covered disease, patient, treatment, and dose-volume characteristics from multiple cardiopulmonary substructures (atria, lung, pericardium, and ventricles), including the minimum dose to the hottest x% volume (Dx%[Gy]), mean dose of the hottest x% (MOHx%[Gy]), and minimum, mean (Mean[Gy]), and maximum dose. The model building was based on Cox regression and given 191 candidate variables; a Bonferroni-corrected P value threshold of 0.0003 was used to identify predictors. To reduce overreliance on the most highly correlated variables, stepwise multivariable analysis (MVA) was repeated on 1000 bootstrapped replicates. Multivariate sets selected in ≥10% of replicates were fit to the training subset and then averaged to generate a final model. In the validation subset, discrimination was assessed using Harrell c-index, and calibration was tested using risk group stratification. RESULTS Four MVA models were identified on bootstrap. The averaged model included atria D45%[Gy], lung Mean[Gy], pericardium MOH55%[Gy], and ventricles MOH5%[Gy]. This model had excellent performance predicting OS in the validation subset (c = 0.89). CONCLUSIONS The risk of death due to cardiopulmonary irradiation was accurately modeled, as demonstrated by predictions on the validation subset, and provides guidance on the delivery of safe thoracic radiotherapy.
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Affiliation(s)
- Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Elizabeth Gore
- Zablocki Veterans Administration Medical Center, Milwaukee, Wisconsin
| | - Voichita Bar-Ad
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Matthew Wheatley
- Mercy San Juan Medical Center Dignity Health, Carmichael, California
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey Bogart
- State University of New York Upstate Medical University, Syracuse, New York
| | | | - Vivek S Kavadi
- Texas Oncology Cancer Center Sugar Land, Sugar Land, Texas
| | | | | | - Jacob S Witt
- University of Wisconsin-Madison (accruals under Washington University), Madison, Wisconsin
| | - James W Welsh
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - James M Larner
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
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Kumar S, Chmura S, Robinson C, Lin SH, Gadgeel SM, Donington J, Feliciano J, Stinchcombe TE, Werner-Wasik M, Edelman MJ, Moghanaki D. Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic. J Thorac Oncol 2020; 15:1137-1146. [PMID: 32360578 PMCID: PMC7194660 DOI: 10.1016/j.jtho.2020.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome–coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually, cancer therapies may be withheld until symptoms have resolved with negative viral test results. The risk of severe treatment-related morbidity and mortality is increased for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary cancer team.
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Affiliation(s)
- Sameera Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Steven Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Steven H Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Shirish M Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Josephine Feliciano
- Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martin J Edelman
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Drew Moghanaki
- Department of Radiation Oncology, Emory University, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia
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Eswarakumar A, Robinson C, Carpenter TO. Response to report of rickets in twins occurring after maternal bisphosphonate exposure. Arch Pediatr 2020; 27:233-234. [PMID: 32280048 DOI: 10.1016/j.arcped.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Eswarakumar
- Department of Pediatrics (Endocrinology), Yale University School of Medicine, P.O Box 208064, 06520-8064 New Haven, CT, USA
| | - C Robinson
- Department of Pediatrics (Endocrinology), Yale University School of Medicine, P.O Box 208064, 06520-8064 New Haven, CT, USA
| | - T O Carpenter
- Department of Pediatrics (Endocrinology), Yale University School of Medicine, P.O Box 208064, 06520-8064 New Haven, CT, USA.
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Dendy Case M, Ghodadra A, Novelli P, Wu V, Ganguli S, Wildgruber M, Kohler M, Robinson C, Kim C, Wang D, Sze D, Kolbeck K, Russell L, Ludwig J, Uhlig J, Kim K. 3:45 PM Abstract No. 27 Neutrophil-lymphocyte ratio correlates with survival in MUlticenter Study of RAS Mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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