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Meredith EG, Filion E, Faria S, Kundapur V, Thuc TVTT, Lok BH, Raman S, Bahig H, Laba JM, Lang P, Louie AV, Hope A, Rodrigues GB, Bezjak A, Campeau MP, Duclos M, Bratman S, Swaminath A, Salunkhe R, Warner A, Palma DA. Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00480-2. [PMID: 38614279 DOI: 10.1016/j.ijrobp.2024.03.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). METHODS Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. RESULTS Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. CONCLUSIONS 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.
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Affiliation(s)
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Sergio Faria
- McGill University Health Centre, Montréal, Canada
| | | | | | | | | | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | | | | | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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Palma DA, Bahig H, Hope A, Harrow S, Debenham BJ, Louie AV, Vu TTT(T, Filion E, Bezjak A, Campeau MP, Duimering A, Giuliani ME, Laba JM, Lang P, Lok BH, Qu XM, Raman S, Rodrigues GB, Goodman CD, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson CJ. Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial. JAMA Oncol 2024:2815670. [PMID: 38451491 PMCID: PMC10921346 DOI: 10.1001/jamaoncol.2023.7269] [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: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 03/08/2024]
Abstract
Importance Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects of SABR in this patient population. Design, Setting, and Participants This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Intervention Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. Main Outcomes and Measures The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Results Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). Conclusions and Relevance In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Trial Registration ClinicalTrials.gov Identifier: NCT03485378.
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Affiliation(s)
- David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Brock J. Debenham
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thi Trinh Thuc (Toni) Vu
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Adele Duimering
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Meredith E. Giuliani
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joanna M. Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin H. Lok
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - X. Melody Qu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - George B. Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher D. Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Physics, Western University, London, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Inderdeep Dhaliwal
- Department of Respirology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher J. Ryerson
- Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Gharzai LA, Morris E, Suresh K, Nguyen-Tân PF, Rosenthal DI, Gillison ML, Harari PM, Garden AS, Koyfman S, Caudell JJ, Jones CU, Mitchell DL, Krempl G, Ridge JA, Gensheimer MF, Bonner JA, Filion E, Dunlap NE, Stokes WA, Le QT, Torres-Saavedra P, Mierzwa M, Schipper MJ. Surrogate endpoints in clinical trials of p16-positive squamous cell carcinoma of the oropharynx: an individual patient data meta-analysis. Lancet Oncol 2024; 25:366-375. [PMID: 38423050 PMCID: PMC10962533 DOI: 10.1016/s1470-2045(24)00016-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The increased incidence of human papillomavirus (HPV)-related cancers has motivated efforts to optimise treatment for these patients with excellent prognosis. Validation of surrogates for overall survival could expedite the investigation of new therapies. We sought to evaluate candidate intermediate clinical endpoints in trials assessing definitive treatment of p16-positive oropharyngeal cancer with chemotherapy or radiotherapy. METHODS We did a retrospective review of five multicentre, randomised trials (NRG/RTOG 9003, 0129, 0234, 0522, and 1016) that tested radiotherapy with or without chemotherapy in patients (aged ≥18 years) with p16-positive localised head or neck squamous-cell carcinomas. Eight intermediate clinical endpoints were considered as potential surrogates for overall survival: freedom from local progression, freedom from regional progression, freedom from distant metastasis, freedom from locoregional progression, freedom from any progression, locoregional progression-free survival, progression-free survival, and distant metastasis-free survival. We used a two-stage meta-analytical framework, which requires high correlation between the intermediate clinical endpoint and overall survival at the patient level (condition 1), and high correlation between the treatment effect on the intermediate clinical endpoint and the treatment effect on overall survival (condition 2). For both, an r2 greater than 0·7 was used as criteria for clinically relevant surrogacy. FINDINGS We analysed 1373 patients with oropharyngeal cancer from May 9, 2020, to Nov 22, 2023. 1231 (90%) of patients were men, 142 (10%) were women, and 1207 (88%) were White, with a median age of 57 years (IQR 51-62). Median follow-up was 4·2 years (3·1-5·1). For the first condition, correlating the intermediate clinical endpoints with overall survival at the individual and trial level, the three composite endpoints of locoregional progression-free survival (Kendall's τ 0·91 and r2 0·72), distant metastasis-free survival (Kendall's τ 0·93 and r2 0·83), and progression-free survival (Kendall's τ 0·88 and r2 0·70) were highly correlated with overall survival at the patient level and at the trial-group level. For the second condition, correlating treatment effects of the intermediate clinical endpoints and overall survival, the composite endpoints of locoregional progression-free survival (r2 0·88), distant metastasis-free survival (r2 0·96), and progression-free survival (r2 0·92) remained strong surrogates. Treatment effects on the remaining intermediate clinical endpoints were less strongly correlated with overall survival. INTERPRETATION We identified locoregional progression-free survival, distant metastasis-free survival, and progression-free survival as surrogates for overall survival in p16-positive oropharyngeal cancers treated with chemotherapy or radiotherapy, which could serve as clinical trial endpoints. FUNDING NRG Oncology Operations, NRG Oncology SDMC, the National Cancer Institute, Eli Lilly, Aventis, and the University of Michigan.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, IL, USA
| | - Emily Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Krithika Suresh
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maura L Gillison
- Department of Thoracic and Head/Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Harari
- Department of Radiation Oncology, University of Wisconsin, Madison, WI, USA
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, University of Cleveland Medical Center, Cleveland, OH, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christopher U Jones
- Department of Radiation Oncology, Sutter Cancer Research Consortium, Novato, CA, USA
| | - Darrion L Mitchell
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Greg Krempl
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John A Ridge
- Department of Otolaryngology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - James A Bonner
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Neal E Dunlap
- Department of Radiation Oncology, The James Graham Brown Cancer Center at University of Louisville, Louisville, KY, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | | | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
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Tonneau M, Ng SP, Nguyen F, Filion E, Nelson K, Doucet R, Lahaie N, Bahig H. Agreement among Radiation Oncologists and Radiologist in Contouring GTV on Planning and Mid-Treatment MRI for Locally Advanced Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e727. [PMID: 37786115 DOI: 10.1016/j.ijrobp.2023.06.2242] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Over the 7-week radiotherapy course, patients with head and neck cancers undergo significant anatomical changes, including weight loss and tumor shrinkage (with complete response at mid-treatment in as high as 50% of patients). The current standard of care is to maintain the same plan for the entire treatment duration, unless major dosimetric deviations are suspected. The use of MRI for treatment adaptation has the advantage of increased soft tissue contrast and is being integrated into several clinical practices with the recent implementation of the MR-Linac technology. In this interim secondary analysis of a phase 2, randomized trial, we assessed inter-observer variability (IOV) in the delineation of GTV at planning and mid-treatment in locally advanced oropharynx cancer (OPC). MATERIALS/METHODS Three expert radiation oncologists (RO) and 1 expert radiologist, with a minimum of 5 years' experience in MRI contouring, blinded to each other's volumes, were provided with planning and mid-treatment MRI (T1 gadolinium, T2-weighted and DWI) of 9 patients with locally advanced OPC. Primary gross tumor volume (GTV) was independently contoured by all 3 ROs and the radiologist. Contouring agreement was analyzed using the dice similarity coefficient (DSC) index and the average Hausdorff distance. RESULTS Nine cases of locally advanced OPC were included. Fifty percent of the patients were stage 3 (AJCC 8th edition) and all were p16+ OPC. There was moderate IOV in the delineation of GTV on planning MRI as evidenced by mean DSC index and Hausdorff distance of 0.75 (range 0.53 - 0.87) and 0.30 cm (max 2.14 cm). At mid-treatment, the GTV IOV had a mean DSC index and Hausdorff distance of 0.30 (range 0.19 - 0.76) and 0.55 cm (max 2.83), respectively. The contours of the radiologist compared to RO shown a mean DSC index and Hausdorff distance on planning MRI 0.63 (range 0.53 - 0.69) and 0.41 cm (max 2.14 cm), and on mid-treatment MRI of 0.36 (range 0.19 - 0.59) and 0.68 cm (max 1.08 cm). CONCLUSION Although this study demonstrates the presence of moderate IOV between 3 experienced head and neck ROs and one radiologist in an academic institution for the delineation of GTV on planning MRI, we observed a higher IOV between the 4 experts on mid-treatment MRI. We also experienced a higher IOV between the radiologist and RO on planning and mid-treatment images. These results show high degree of GTV volume variability on mid-treatment MRI. Therefore, peer review of contours is important and guidelines for MR adaptive tumor delineation are needed.
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Affiliation(s)
- M Tonneau
- Centre Hospitalo-Universitaire de Montréal, Montréal, QC, Canada
| | - S P Ng
- Austin Health University Melbourne, Melbourne, Australia
| | - F Nguyen
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - E Filion
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - K Nelson
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - R Doucet
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - N Lahaie
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - H Bahig
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
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Bahig H, Nguyen-Tan PF, Yuan Y, Filion E, Ng SP, Soulières D, Christopoulos A, Fuller CD, Garden AS, Hutcheson KA, Lee A, Spiotto MT, Rosenthal DI, Phan J. Stereotactic Boost and Short-Course Radiotherapy for p16-Associated Oropharynx Cancer (SHORT-OPC): First Planned Interim Safety Analysis from a Randomized Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e564-e565. [PMID: 37785728 DOI: 10.1016/j.ijrobp.2023.06.1888] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is a need for safe treatment de-intensification in p16+ oropharynx cancer (OPC). The standard of care (SOC) radiotherapy (RT) regimen is cumbersome and associated with high toxicity. Stereotactic radiotherapy (SBRT) and multimodality image guidance is an opportunity to precisely target the gross tumor while safely reducing elective irradiation dose. We aim to assess the safety and efficacy of a short course RT for p16+ OPC, consisting of an SBRT boost to the gross tumor volume (GTV) followed by de-escalated elective irradiation. MATERIALS/METHODS In this randomized phase II trial, patients with p16-positive, stage I-II OPSCC with primary tumor <30 cc (8th Ed AJCC) are planned with combined CT, MRI and FDG-PET, and randomized to 1) SBRT boost (14 Gy in 2 fractions) to the GTV followed with de-escalated RT (+/- Cisplatin) to a dose of 40 Gy in 20 fractions, or 2) SOC RT (+/- Cisplatin) to a dose of 70 Gy in 33 fractions to the GTV and 59.4-54Gy (or equivalent) to the intermediate-to-low dose elective region. Patients are stratified by stage (I vs. II) and use of chemotherapy. The primary endpoint of the trial is locoregional control at 2 years, powered for a sample size of 100 patients. A Bayesian adaptive design includes 2 planned safety interim analysis using grade ≥ 3 subacute toxicities >40% as a stopping criterion, and 1 planned futility analysis. Acute adverse events (AE) are defined as those occurring ≤ 60 days from RT, subacute AE between 60-180 days after RT, and late AE >180 days from RT. This is the first planned toxicity analysis. RESULTS Twenty-one patients were randomly assigned and eligible (11 in SOC and 10 in experimental arm). Median age was 69 years (range 49-84); 29% and 71% had stage T1 and T2, while 10%, 85% and 1 patient had N0, N1 and N2 disease, respectively. RT alone and chemoradiation was administered in 67% and 33% of patients, respectively. At a median follow-up of 11 months (range 1.7-17.6), there was 1 local recurrence at the primary tumor site in the SOC arm (at 10 month) and no recurrence in the experimental arm. All enrolled patients remain alive at the time of analysis. There was a 54.5% rate of grade 3 acute AE in the SOC arm and 30.0% rate of grade 3 acute AE in the experimental arm. More specifically, 1, 5 (45%), 2 (18%), and 2 (18%) versus 0, 1, 1 and 1 patient developed acute grade 3 dysphagia, mucositis, pain and dermatitis in the SOC and experimental arm, respectively. There was no acute grade 4 or 5 toxicity. There was no grade ≥ 3 subacute toxicity or late toxicity in both arms. CONCLUSION This primary safety analysis showed that SBRT boost followed by a short course of de-escalated elective irradiation in p16+ OPC has limited early toxicity and meets criteria for study continuation.
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Affiliation(s)
- H Bahig
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - P F Nguyen-Tan
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Y Yuan
- MD Anderson Cancer Center, Houston, TX
| | - E Filion
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - S P Ng
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Department of Radiation Oncology, Melbourne, VIC, Australia
| | - D Soulières
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A Christopoulos
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - C D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - A Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M T Spiotto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bang C, Le W, Nguyen-Tan PF, Filion E, Soulières D, O'Sullivan B, Christopoulos A, Bissada E, Ayad T, Guertin L, Lalonde A, Markel D, Kadoury S, Bahig H. Dynamic Prediction of Toxicities in Head and Neck Cancer Radiotherapy by 3D Convolutional Neural Network Using Daily Cone-Beam CTs. Int J Radiat Oncol Biol Phys 2023; 117:S55. [PMID: 37784524 DOI: 10.1016/j.ijrobp.2023.06.346] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiotherapy (RT) is essential in head and neck cancer (HNC) treatments, but often causes significant toxicity. Different machine learning models have shown promise in predicting RT-induced toxicity, but none have yet integrated the fluctuating anatomical changes. By integrating daily cone-beam CTs (CBCT) allowing sequential anatomical views, our aim is to build a dynamic predictive model for three major HNC RT toxicities: reactive feeding tube placement, hospitalization and radionecrosis (RN). MATERIALS/METHODS 292 HNC cases treated with curative RT between 2017 and 2019 at our institution were retrospectively analyzed for clinical and radiological data. VoxelMorph, a deep deformable registration model, integrated the daily anatomical deformations between each CBCT and the planning CT, then converted them to Jacobian determinant matrix (Jf). Resnet, a convolutional neural network with multiple layers was trained using a 5-fold cross validation to integrate both radiological and clinical data. Each toxicity was classified as a binary decision using the cross-entropy loss to account for a class imbalance. Its predictive performance was compared to the baseline model using only clinical data. RESULTS The cohort included 78% men and 22% women, with a median age of 63 years (range 35-84). Primary cancer sites were 46% oropharynx, 19% larynx, 14% oral cavity, 7.5% nasopharynx, 5% hypopharynx, 4% unknown primary and 5% others; and stage ranged between Tx-4b N0 and 3b M0 (AJCC 8th Ed). Induction chemotherapy, concurrent chemotherapy, and adjuvant RT was used in 9%, 57% and 20% of patients, respectively. The incidence of feeding tube, hospitalization and RN was 19.9%, 7.2%, and 3.8%, respectively. Integrating Jf from the 10th RT CBCT showed better accuracy for each toxicity prediction: feeding tube (69.1% > 57.2%), hospitalization (75.3% > 63.1%) and RN (85.8% > 75.7%). Integrating both the raw CBCT and Jf improved hospitalization prediction (79.0% > 73.6%). Substituting Jf for the raw CBCT improved the prediction for RN (79.7% > 74.7%) and hospitalization (73.6% > 64.4%). For feeding tube, predictive performance of the Jf model trained against deformations showed a positive correlation between its performance and the RT received (r2 > 0.9) with increasing RT fractions, with a maximum accuracy of 83.1% at the 25th fraction. No such correlation was found for RN or hospitalization prediction. CONCLUSION To our knowledge, this is the first study showing promising results to predict HNC RT toxicities using daily per-treatment CBCT. Next steps involve integrating both the radiomic and the dosimetric inputs to build a more powerful model. This could expand to predict therapeutic outcomes and, ultimately, could guide decisions in individualized RT.
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Affiliation(s)
- C Bang
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - W Le
- Polytechnique Montreal, Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
| | - P F Nguyen-Tan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - E Filion
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - D Soulières
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - A Christopoulos
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - E Bissada
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - T Ayad
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - L Guertin
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - A Lalonde
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - D Markel
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - S Kadoury
- Polytechnique Montreal, Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
| | - H Bahig
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
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7
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Tonneau M, Richard C, Routy B, Campeau MP, Vu T, Filion E, Roberge D, Mathieu D, Doucet R, Beliveau-Nadeau D, Bahig H. A competing risk analysis of the patterns and risk factors of recurrence in early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy. Radiother Oncol 2023; 185:109697. [PMID: 37169303 DOI: 10.1016/j.radonc.2023.109697] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION To assess patterns of recurrence after stereotactic ablative radiotherapy (SABR) in patient ineligible to surgery with early-stage non-small cell lung cancer (ES-NSCLC), report survival and treatment after first recurrence. METHODS We performed a retrospective analysis on 1068 patients with ES-NSCLC and 1143 lesions. Between group differences were estimated using competing risk analysis and cause-specific hazard ratios were calculated. Overall survival (OS) after first recurrence was calculated. RESULTS Median follow-up was 37.6 months. Univariate analysis demonstrated that ultra-central location was associated with higher risk of regional recurrence (RR) and distant metastasis (DM) (p = 0.004 and 0.01). Central lesions were associated with higher risk of local recurrence (LR) and RR (p < 0.001). Ultra-central lesions were associated with shorter OS (p = 0.002) compared to peripheral lesions. In multivariate analysis, central location was the only factor associated with increased LR and RR risks (p = 0.016 and 0.005). Median OS after first recurrence was 14.8 months. There was no difference in OS after first recurrence between ultra-central, central, and peripheral lesions (p = 0.83). Patients who received a second SABR course had an OS of 51.3 months, compared to 19.5 months with systemic therapy and 8.1 months with supportive care (p < 0.0001). DISCUSSION The main prognostic factor for LR and RR risks was central location. Ultra-central and central tumors might benefit from treatment intensification strategies such as dose escalation and/or addition of systemic therapy to improve radiotherapy outcomes. After a first recurrence post SABR, patients with contralateral lung recurrences and those who were eligible to receive a second course of SABR had improved OS.
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Affiliation(s)
- Marion Tonneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Université de Médecine Henri Warembourg, Lille, France
| | - Corentin Richard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Bertrand Routy
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Pierre Campeau
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Toni Vu
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - David Roberge
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dominique Mathieu
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Robert Doucet
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dominic Beliveau-Nadeau
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Houda Bahig
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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8
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Lavigne D, De-Meric-de-Bellefon M, Nguyen-Tan FP, Landry D, Létourneau-Guillon L, Bélair M, O'Sullivan B, Filion E, Bahig H. Incidence and predictive factors of retropharyngeal lymph node metastases in patients with oropharyngeal cancer undergoing multimodality treatment planning imaging. Head Neck 2023; 45:1530-1538. [PMID: 37045788 DOI: 10.1002/hed.27368] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We investigated the incidence and predictive factors of retropharyngeal lymph node (RPLN) metastases in patients with oropharyngeal cancer (OPC) undergoing multimodality treatment planning imaging before radiotherapy. METHODS Consecutive patients with OPC treated with curative-intent radiotherapy from 2017 to 2019 were retrospectively analyzed. Treatment planning comprised contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) unless contraindicated. RESULTS Of 300 patients, 66 (22%) had radiological evidence of RPLN involvement on planning images, compared to 17 (6%) on diagnostic CT alone. On multivariate analysis, RPLN involvement was statistically (p < 0.05) associated with tonsil, soft palate, and posterior pharyngeal wall primaries, and with disease extension to the soft palate or vallecula. CONCLUSIONS Multimodality treatment planning imaging reveals a high rate of RPLN metastases from OPC compared to diagnostic CT alone. Patients with tonsil, soft palate, or posterior pharyngeal wall primaries or disease extending to the soft palate or vallecula appear at higher risk.
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Affiliation(s)
- Danny Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | | | - Felix-Phuc Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - David Landry
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Laurent Létourneau-Guillon
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Manon Bélair
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
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Lavigne D, Ng SP, O’Sullivan B, Nguyen-Tan PF, Filion E, Létourneau-Guillon L, Fuller CD, Bahig H. Magnetic Resonance-Guided Radiation Therapy for Head and Neck Cancers. Curr Oncol 2022; 29:8302-8315. [PMID: 36354715 PMCID: PMC9689607 DOI: 10.3390/curroncol29110655] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the significant evolution of radiation therapy (RT) techniques in recent years, many patients with head and neck cancer still experience significant toxicities during and after treatments. The increased soft tissue contrast and functional sequences of magnetic resonance imaging (MRI) are particularly attractive in head and neck cancer and have led to the increasing development of magnetic resonance-guided RT (MRgRT). This approach refers to the inclusion of the additional information acquired from a diagnostic or planning MRI in radiation treatment planning, and now extends to online high-quality daily imaging generated by the recently developed MR-Linac. MRgRT holds numerous potentials, including enhanced baseline and planning evaluations, anatomical and functional treatment adaptation, potential for hypofractionation, and multiparametric assessment of response. This article offers a structured review of the current literature on these established and upcoming roles of MRI for patients with head and neck cancer undergoing RT.
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Affiliation(s)
- Danny Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, VI 3084, Australia
| | - Brian O’Sullivan
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Laurent Létourneau-Guillon
- Department of Radiology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Clifton D. Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
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10
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Lavigne D, De-Meric-de-Bellefon M, Bahig H, Landry D, Belair M, Létourneau-Guillon L, Filion E, Nguyen-Tan FP. 180: Trimodality Imaging and Predictive Factors of Retropharyngeal Lymph Node Metastases in Oropharyngeal Cancers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04460-7] [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: 10/14/2022]
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11
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Tonneau M, Richard C, Routy B, Campeau MP, Vu T, Filion E, Roberge D, Mathieu D, Doucet R, Beliveau-Nadeau D, Bahig H. 42: A Competing Risk Analysis of Prognostic Factors for Local and Regional Recurrence and Survival Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Stereotactic Ablative Radiation Therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04321-3] [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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12
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Cardin GB, Bernard M, Bourbonnais J, Bahig H, Nguyen-Tan PF, Filion E, Soulieres D, Gologan O, Ayad T, Guertin L, Bissada E, Rodier F, Christopoulos A. The rs6942067 genotype is associated with a worse overall survival in young or non-smoking HPV-negative patients with positive nodal status in head and neck squamous cell carcinoma. Oral Oncol 2022; 125:105696. [PMID: 35026667 DOI: 10.1016/j.oraloncology.2021.105696] [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: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Guillaume B Cardin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Monique Bernard
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Jessica Bourbonnais
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Phuc Félix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Denis Soulieres
- Department of Medicine, Service of Hemato-Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Olguta Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Francis Rodier
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Otolaryngology-Head and Neck Surgery Service, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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Dal Fabbro C, Harris P, Dufresne E, Herrero Babiloni A, Mayer P, Bahig H, Filion E, Nguyen F, Ghannoum J, Schmittbuhl M, Lavigne G. Orofacial Pain and Snoring/Obstructive Sleep Apnea in Individuals with Head and Neck Cancer: A Critical Review. J Oral Facial Pain Headache 2022; 36:85-102. [PMID: 35943322 PMCID: PMC10586573 DOI: 10.11607/ofph.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2023]
Abstract
AIMS (1) To summarize current knowledge on the prevalence, intensity, and descriptors of orofacial pain and snoring/obstructive sleep apnea (OSA) before and after head and neck cancer (HNC) treatment; and (2) to propose future directions for research. METHODS The median prevalence for each condition was estimated from the most recent systematic reviews (SRs) and updated with new findings retrieved from the PubMed, Web of Science, Embase, and Cochrane databases up to December 2021. RESULTS The prevalence of HNC pain seems relatively stable over time, with a median of 31% before treatment in three studies to a median of 39% at 1 month to 16 years after treatment in six studies. HNC pain intensity remains mild to moderate. There was a threefold increase in temporomandibular pain prevalence after surgery (median 7.25% before to 21.3% after). The data for snoring prevalence are unreliable. The OSA/HNC prevalence seems relatively stable over time, with a median of 72% before treatment in three studies to 77% after treatment in 14 studies. CONCLUSION With the exception of temporomandibular pain, the prevalence of HNC pain and OSA seems to be stable over time. Future studies should: (1) compare the trajectory of change over time according to each treatment; (2) compare individuals with HNC to healthy subjects; (3) use a standardized and comparable method of data collection; and (4) assess tolerance to oral or breathing devices, since HNC individuals may have mucosal sensitivity or pain.
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Bahig H, Rosenthal DI, Nguyen-Tan FP, Fuller DC, Yuan Y, Hutcheson KA, Christopoulos A, Nichols AC, Fung K, Ballivy O, Filion E, Ng SP, Lambert L, Dorth J, Hu KS, Palma D. Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial. BMC Cancer 2021; 21:446. [PMID: 33888069 PMCID: PMC8061218 DOI: 10.1186/s12885-021-08195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
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Affiliation(s)
- Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David I. Rosenthal
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Félix-Phuc Nguyen-Tan
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David C. Fuller
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Ying Yuan
- grid.240145.60000 0001 2291 4776Biostatistics Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A. Hutcheson
- grid.240145.60000 0001 2291 4776Head and Neck Surgery Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Apostolos Christopoulos
- grid.410559.c0000 0001 0743 2111Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Anthony C. Nichols
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Kevin Fung
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Olivier Ballivy
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Edith Filion
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Sweet Ping Ng
- grid.1055.10000000403978434Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise Lambert
- Radiation Oncology Department, Centre Intégré de Cancérologie de Laval, Laval, Canada
| | - Jennifer Dorth
- grid.67105.350000 0001 2164 3847Radiation Oncology Department, Case Western Reserve University, Cleveland, USA
| | - Kenneth S. Hu
- Radiation Oncology Department, NYU Langone Health, Newyork, USA
| | - David Palma
- grid.39381.300000 0004 1936 8884Radiation Oncology Department, Western University, London, Ontario Canada
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Heng V, Diamant A, Chatterjee A, Faria S, Bahig H, Filion E, Doucet R, El Naqa I, Seuntjens J. PO-0995: Impact of the dose outside the PTV on distant recurrence in coplanar and non-coplanar lung SBRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01012-4] [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: 10/22/2022]
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16
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Bahig H, Lambert L, Filion E, Soulières D, Guertin L, Ayad T, Christopoulos A, Bissada E, Alizadeh M, Bélair M, Nguyen-Tan PF. Phase II study of de-intensified intensity-modulated radiotherapy and concurrent carboplatin/5-fluorouracil in lateralized p16-associated oropharyngeal carcinoma. Head Neck 2020; 42:3479-3489. [PMID: 32866313 DOI: 10.1002/hed.26401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess cancer control and patient-reported outcomes (PROs) after de-intensified intensity-modulated radiotherapy (IMRT) in lateralized p16-associated oropharyngeal cancer (p16-OPC). METHODS Lateralized p16-OPC treated with radiotherapy and concurrent Carboplatin/5-fluorouracil between 2011 and 2014 were enrolled. De-intensified IMRT consisted in elective neck dose of 43.2 Gy/24 fractions and omission of contralateral retropharyngeal/level IV nodes. PROs were assessed using the EORTC QLC-C30 and QLQ-HN35 scales. RESULTS Twenty-nine patients were included. Median follow-up was 44 months. As per AJCC 7th Ed, 7%, 83% and 10% of patients had stage III, IVa and IVb. 5-year locoregional control and overall survival rates were 100% and 100%, respectively. Rates of acute were 52% and 35%, respectively. At 2 years post-treatment, 50% and 14% of patients had grade 1 xerostomia and dysgueusia, respectively. Most PROs scores returned to baseline within 8 months post-treatment. CONCLUSION De-intensified IMRT was associated with excellent cancer outcomes, and rapid recovery of PROs in lateralized p16-OPC.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louise Lambert
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Denis Soulières
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louis Guertin
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Eric Bissada
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Moein Alizadeh
- Radiation Oncology Department, Centre Intégré de Cancérologie de la Cité de la Santé à Laval, Montreal, Québec, Canada
| | - Manon Bélair
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Phuc Felix Nguyen-Tan
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Bernard M, Cardin GB, Cahuzac M, Ayad T, Bissada E, Guertin L, Bahig H, Nguyen-Tan PF, Filion E, Ballivy O, Soulieres D, Rodier F, Christopoulos A. Dual Inhibition of Autophagy and PI3K/AKT/MTOR Pathway as a Therapeutic Strategy in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12092371. [PMID: 32825725 PMCID: PMC7563873 DOI: 10.3390/cancers12092371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/24/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
Genomic analyses of head and neck squamous cell carcinoma (HNSCC) have highlighted alterations in the phosphatidylinositol 3-kinase (PI3K) signaling pathway, presenting a therapeutic target for multiple ongoing clinical trials with PI3K or PI3K/MTOR inhibitors. However, these inhibitors can potentially increase autophagy in HNSCC and indirectly support cancer cell survival. Here, we sought to understand the relationship between the PI3K signaling pathway and autophagy during their dual inhibition in a panel of HNSCC cell lines. We used acridine orange staining, immunoblotting, and tandem sensor Red Fluorescent Protein- Green Fluorescent Protein-, microtubule-associated protein 1 light chain 3 beta (RFP-GFP-LC3B) expression analysis to show that PI3K inhibitors increase autophagosomes in HNSCC cells, but that chloroquine treatment effectively inhibits the autophagy that is induced by PI3K inhibitors. Using the Bliss independence model, we determined that the combination of chloroquine with PI3K inhibitors works in synergy to decrease cancer cell proliferation, independent of the PIK3CA status of the cell line. Our results indicate that a strategy focusing on autophagy inhibition enhances the efficacy of therapeutics already in clinical trials. Our results suggest a broader application for this combination therapy that can be promptly translated to in vivo studies.
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Affiliation(s)
- Monique Bernard
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Institut du Cancer de Montréal (ICM), Montreal, QC H2X 0A9, Canada
| | - Guillaume B. Cardin
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Institut du Cancer de Montréal (ICM), Montreal, QC H2X 0A9, Canada
| | - Maxime Cahuzac
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Institut du Cancer de Montréal (ICM), Montreal, QC H2X 0A9, Canada
| | - Tareck Ayad
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (E.B.); (L.G.)
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (E.B.); (L.G.)
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (E.B.); (L.G.)
| | - Houda Bahig
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (P.F.N.-T.); (E.F.); (O.B.)
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (P.F.N.-T.); (E.F.); (O.B.)
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (P.F.N.-T.); (E.F.); (O.B.)
| | - Olivier Ballivy
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (P.F.N.-T.); (E.F.); (O.B.)
| | - Denis Soulieres
- Department of Medicine, Service of Hemato-Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada;
| | - Francis Rodier
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Institut du Cancer de Montréal (ICM), Montreal, QC H2X 0A9, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Apostolos Christopoulos
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (M.B.); (G.B.C.); (M.C.); (T.A.); (H.B.); (F.R.)
- Institut du Cancer de Montréal (ICM), Montreal, QC H2X 0A9, Canada
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada; (E.B.); (L.G.)
- Correspondence: ; Tel.: +514-890-8000 (ext. 31292)
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Desilets A, Aubin F, Bahig H, Ballivy O, Charpentier D, Filion E, Jamal R, Lambert L, Vadnais C, Weng X, Soulieres D. Upfront DPYD genotyping and toxicity associated with fluoropyrimidine-based concurrent chemoradiotherapy for oropharyngeal carcinomas. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6580] [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: 11/20/2022] Open
Abstract
6580 Background: The combination of carboplatin and 5-fluorouracil (5-FU) is effective when used concurrently with radiotherapy for locoregionally advanced oropharyngeal carcinomas (Calais et al. 1999). DPYD polymorphisms can be associated with an increased risk of severe toxicity to fluoropyrimidines (Deenen et al. 2016). Upfront screening for the DPYD*2A allele is available in the province of Québec, Canada since March 2017. This study aimed to determine the effect of upfront genotyping on grade ≥3 toxicities. Methods: The studied population included all consecutive cases of oropharyngeal carcinomas treated with 5-FU based chemoradiotherapy one year before and after the implementation of upfront DPYD*2A genotyping. All patients were treated at the Centre Hospitalier de l’Université de Montréal (CHUM) between March 2016 and April 2018. Clinical data were extracted from chart review. Extended screening for 3 supplemental at-risk DPYD variants was also retrospectively performed in August 2019. Results: 181 patients were included in the analysis (87 patients before and 94 patients after DPYD*2A screening implementation). 91% of patients (n = 86) were prospectively genotyped for the DPYD*2A allele. Of those screened, 2% (n = 2/87) demonstrated a heterozygous DPYD*2A mutation. Those two patients received cisplatin-based treatment and thus avoided 5-FU toxicities. Extended genotyping of DPYD*2A-negative patients later allowed for the retrospective identification of 6 additional patients with alternative DPYD variants (two c.2846A > T and four c.1236G > A allele mutations). Conclusions: The DPYD*2A, c.2846A > T and c.1236G > A polymorphisms are associated with an increased risk of G3-4 toxicity to 5-FU, as well as higher hospitalization rates. Upfront DPYD genotyping can identify patients in whom fluoropyrimidine-related toxicity should be avoided. This represents an interesting addition in terms of pharmacovigilance. [Table: see text]
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Affiliation(s)
| | - Francine Aubin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Olivier Ballivy
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | | | - Edith Filion
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Rahima Jamal
- Centre Hospitalier De L'université De Montréal (CHUM), Montreal, QC, Canada
| | | | | | | | - Denis Soulieres
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Bahig H, Aubin F, Nguyen-Tan PF, Souliere D, Palma DA, Charpentier D, Debenham BJ, Jamal R, Sultanem K, Ballivy O, Filion E, Wong P. Initial analyses of a phase I/II trial of durvalumab (D) plus tremelimumab (T) and stereotactic body radiotherapy (SBRT) for oligometastatic head and neck carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6531] [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
6531 Background: PD-1/PD-L1 +/- CTLA-4 blockade in head-and-neck carcinoma (HNSCC) has shown signs of clinical activity. SBRT aims to reduce tumor burden and perhaps be immune-stimulatory. This analysis seeks to assess the safety and efficacy signal of the triple treatment combination (TTC) consisting of SBRT sandwiched between cycles of D (αPD-L1) and T (αCTLA-4) in oligometastatic (2-10) HNSCC. Methods: This is a single arm multi-institutional phase I/II trial (NCT03283605). D (1500 mg) and T (75 mg) were given for 4 monthly cycles, followed by monthly D. SBRT to 2-5 lesions was administered during cycle 2. The median prescribed and maximum SBRT doses were 40 Gy (range:18-50) and 49 Gy (range:28-61), respectively, given in 3-5 fractions. Global health status was derived from EORTC QLQ C30 questionnaires. Results: At data cut-off (Dec 31, 2019), 20 patients were recruited, of which 16 had a study treatment and were analyzed. Table describes the patient characteristics. There were 1 CTCAE V5.0 Grade 2 and 1 Grade 3 (both GI) serious adverse event (SAE) attributable to D and T. Two patients had unrelated SAEs (1 Grade 3-hypercalcemia and 1 Grade 5-GI). The Grade 5 SAE was a gastric hemorrhage that occurred the night of the first D + T infusion. There was no Grade 3+ AE secondary to SBRT. Thus, SBRT did not add to the 2/16 patients who had D + T related SAEs. Global health status scores did not differ statistically between baseline (75) and cycle 3 (73). Of the 14 patients that received SBRT, 7 patients had RECIST target lesions untreated by SBRT. The best responses for these 7 patients were: 1 CR, 3 PR, and 3 SD. When SBRT treated lesions are included and analyzed per RECIST (n = 14), there were 9 PR, 3 SD and 2 PD. The estimated median progression free survival was 7.2 months. Conclusions: The first 16 evaluable patients demonstrated tolerable profiles to the TTC (D + T + SBRT) for the treatment of oligometastatic (≤10 lesions) HNSCC. Best response rates were encouraging and could be due to the addition of SBRT during immunotherapy that served to either stimulate the immune system or annihilate slow responding or immunotherapy resistant lesions. Smaller overall tumor burden and 7/16 patients being treated in first line could also have contributed to better results. Clinical trial information: NCT03283605 . [Table: see text]
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Affiliation(s)
- Houda Bahig
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Francine Aubin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Denis Souliere
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | | | | | - Brock J Debenham
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Rahima Jamal
- Centre Hospitalier De L'université De Montréal (CHUM), Montreal, QC, Canada
| | - Khalil Sultanem
- Jewish General Hospital Room G-002 3755 Côte Ste., Montreal, QC, Canada
| | - Olivier Ballivy
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Edith Filion
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Philip Wong
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
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Diamant A, Heng VJ, Chatterjee A, Faria S, Bahig H, Filion E, Doucet R, Khosrow-Khavar F, Naqa IE, Seuntjens J. Comparing local control and distant metastasis in NSCLC patients between CyberKnife and conventional SBRT. Radiother Oncol 2020; 144:201-208. [PMID: 32044418 DOI: 10.1016/j.radonc.2020.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/01/2019] [Revised: 12/01/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Previous literature suggests that the dose proximally outside the PTV could have an impact on the incidence of distant metastasis (DM) after SBRT in stage I NSCLC patients. We investigated this observation (along with local failure) in deliveries made by different treatment modalities: robotic mounted linac SBRT (CyberKnife) vs conventional SBRT (VMAT/CRT). MATERIALS AND METHODS This study included 422 stage I NSCLC patients from 2 institutions who received SBRT: 217 treated conventionally and 205 with CyberKnife. The dose behavior outside the PTV of both sub-cohorts were compared by analyzing the mean dose in continuous shells extending 1, 2, 3, …, 100 mm from the PTV. Kaplan-Meier analysis was performed between the two sub-cohorts with respect to DM-free survival and local progression-free survival. A multivariable Cox proportional hazards model was fitted to the combined cohort (n = 422) with respect to DM incidence and local failure. RESULTS The shell-averaged dose fall-off beyond the PTV was found to be significantly more modest in CyberKnife plans than in conventional SBRT plans. In a 30 mm shell around the PTV, the mean dose delivered with CyberKnife (38.1 Gy) is significantly larger than with VMAT/CRT (22.8 Gy, p<10-8). For 95% of CyberKnife plans, this region receives a mean dose larger than the 21 Gy threshold dose discovered in our previous study. In contrast, this occurs for only 75% of VMAT/CRT plans. The DM-free survival of the entire CyberKnife cohort is superior to that of the 25% of VMAT/CRT patients receiving less than the threshold dose (VMAT/CRT<21Gy), with a hazard ratio of 5.3 (95% CI: 3.0-9.3, p<10-8). The 2 year DM-free survival rates were 87% (95% CI: 81%-91%) and 44% (95% CI: 28%-58%) for CyberKnife and the below-threshold dose conventional cohorts, respectively. A multivariable analysis of the combined cohort resulted in the confirmation that threshold dose was a significant predictor of DM(HR = 0.28, 95% CI: 0.15-0.55, p<10-3) when adjusted for other clinical factors. CyberKnife was also found to be superior to the entire VMAT/CRT with respect to local control (HR = 3.44, CI: 1.6-7.3). The 2-year local progression-free survival rates for the CyberKnife cohort and the VMAT/CRT cohort were 96% (95% CI: 92%-98%) and 88% (95% CI: 82%-92%) respectively. CONCLUSIONS In standard-of-care CyberKnife treatments, dose distributions that aid distant control are achieved 95% of the time. Although similar doses could be physically achieved by conventional SBRT, this is not always the case with current prescription practices, resulting in worse DM outcomes for 25% of conventional SBRT patients. Furthermore, CyberKnife was found to provide superior local control compared to VMAT/CRT.
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Affiliation(s)
- André Diamant
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada.
| | - Veng Jean Heng
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
| | - Avishek Chatterjee
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
| | - Sergio Faria
- Department of Radiation Oncology, McGill University Health Centre, Montréal, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Robert Doucet
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | | | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States
| | - Jan Seuntjens
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
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Dautruche A, Filion E, Mathieu D, Bahig H, Roberge D, Lambert L, Vu T, Campeau MP. To Biopsy or Not to Biopsy?: A Matched Cohort Analysis of Early-Stage Lung Cancer Treated with Stereotactic Radiation with or Without Histologic Confirmation. Int J Radiat Oncol Biol Phys 2020; 107:88-97. [PMID: 32004581 DOI: 10.1016/j.ijrobp.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/11/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE For nonoperable stage I non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has emerged as a standard treatment option. We aimed to compare the clinical outcomes of lung SBRT between patients with versus without pathologic cancer diagnosis. METHODS AND MATERIALS We included patients treated by SBRT for a single pulmonary lesion between July 2009 and July 2017. Patients in the clinical diagnosis group had a positron emission tomography/computed tomography scan showing hypermetabolism, growth of the mass on sequential computed tomography, and were not eligible for biopsy, refused biopsy, or had an inconclusive biopsy. For each of those patients, a matched pair in the pathologic diagnosis group was identified by matching for patient, treatment, and tumoral characteristics. We performed a power calculation to estimate the sample size required to detect a difference arising from a 5% or 15% rate of benign processes in the group without pathology. RESULTS A total of 924 lung SBRT treatments were performed among 878 patients from 2009 to 2017. Within this population, 131 patients were treated based on clinical findings. They were matched with 131 patients with a pathologic diagnosis who received treatment. At 3 years, no significant differences were observed in overall survival (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.7-2.1), local control (HR, 0.9; 95% CI, 0.4-2), or regional (HR, 0.5; 95% CI, 0.2-1.4) or distant recurrence (HR, 0.6; 95% CI, 0.3-1.1). CONCLUSIONS In our population, we found no clinically significant difference in patterns of recurrence or survival after lung SBRT for patients who had received clinical versus pathological diagnoses. There was, however, a trend toward more distant recurrences in the pathologic diagnosis group. Our power calculation suggests that data from multiple institutions would be required to rule out a difference in outcomes due to 5% to 15% of clinically diagnosed cases being treated for benign processes.
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Affiliation(s)
| | - Edith Filion
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | - Houda Bahig
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - David Roberge
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Louise Lambert
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Toni Vu
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
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Lenglet A, Campeau MP, Mathieu D, Bahig H, Lambert L, Vu T, Roberge D, Bilodeau L, Filion E. Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours. Radiother Oncol 2019; 134:178-184. [DOI: 10.1016/j.radonc.2019.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
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Bahig H, Aubin F, Stagg J, Gologan O, Ballivy O, Bissada E, Nguyen-Tan FP, Soulières D, Guertin L, Filion E, Christopoulos A, Lambert L, Tehfe M, Ayad T, Charpentier D, Jamal R, Wong P. Phase I/II trial of Durvalumab plus Tremelimumab and stereotactic body radiotherapy for metastatic head and neck carcinoma. BMC Cancer 2019; 19:68. [PMID: 30642290 PMCID: PMC6332607 DOI: 10.1186/s12885-019-5266-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 08/23/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The efficacy of immunotherapy targeting the PD-1/PD-L1 pathway has previously been demonstrated in metastatic head and neck squamous cell carcinoma (HNSCC). Stereotactic Body Radiotherapy (SBRT) aims at ablating metastatic lesions and may play a synergistic role with immunotherapy. The purpose of this study is to assess the safety and efficacy of triple treatment combination (TTC) consisting of the administration of durvalumab and tremelimumab in combination with SBRT in metastatic HNSCC. METHOD This is a phase I/II single arm study that will include 35 patients with 2-10 extracranial metastatic lesions. Patients will receive durvalumab (1500 mg IV every 4 weeks (Q4W)) and tremelimumab (75 mg IV Q4W for a total of 4 doses) until progression, unacceptable toxicity or patient withdrawal. SBRT to 2-5 metastases will be administered between cycles 2 and 3 of immunotherapy. The safety of the treatment combination will be evaluated through assessment of TTC-related toxicities, defined as grade 3-5 toxicities based on Common Terminology Criteria for Adverse Events (v 4.03), occurring within 6 weeks from SBRT start, and that are definitely, probably or possibly related to the combination of all treatments. We hypothesize that dual targeting of PD-L1 and CTLA-4 pathways combined with SBRT will lead to < 35% grade 3-5 acute toxicities related to TTC. Progression free survival (PFS) will be the primary endpoint of the phase II portion of this study and will be assessed with radiological exams every 8 weeks using the RECIST version 1.1 criteria. DISCUSSION The combination of synergistic dual checkpoints inhibition along with ablative radiation may significantly potentiate the local and systemic disease control. This study constitutes the first clinical trial combining effects of SBRT with dual checkpoint blockade with durvalumab and tremelimumab in the treatment of metastatic HNSCC. If positive, this study would lead to a phase III trial testing this treatment combination against standard of care in metastatic HNSCC. TRIAL REGISTRATION NCT03283605 . Registration date: September 14, 2017; version 1.
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Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Francine Aubin
- Department of Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - John Stagg
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Olguta Gologan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Pathology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Olivier Ballivy
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Eric Bissada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Otorhinolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Felix-Phuc Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Denis Soulières
- Department of Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Louis Guertin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Otorhinolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Apostolos Christopoulos
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Otorhinolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Louise Lambert
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Mustapha Tehfe
- Department of Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Tareck Ayad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Otorhinolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Danielle Charpentier
- Department of Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Rahima Jamal
- Department of Medical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Philip Wong
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada. .,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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Jumeau R, Nguyen-Tan PF, Bahig H, Liem X, Lambert L, Schmittbuhl M, Simard D, Filion E. Pre-irradiation dental care: Ready-to-use templates for oropharyngeal cancers. Rep Pract Oncol Radiother 2018; 23:270-275. [PMID: 30090026 DOI: 10.1016/j.rpor.2018.06.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 06/23/2018] [Indexed: 11/30/2022] Open
Abstract
Aim To develop a tool in order to guide pre-irradiation dental care (PIDC) for patients with oropharyngeal cancers. Background Osteoradionecrosis of the jaws is a potential complication of radiotherapy (RT) for head and neck cancers. To prevent this complication, PIDC can involve multiple dental extractions as a preventative measure to avoid post-RT complications. However, there is no standardized tool to guide PIDC. Materials and methods From January 2005 to October 2015, 120 head and neck cancer patients were prospectively included in a study investigating dysgeusia after RT. From this cohort, patients were enrolled according to the following inclusion criteria: histopathological confirmation of oropharyngeal squamous cell carcinoma; stage T1-4 N1-3 M0; ≤10 missing teeth. Individual teeth were retrospectively delineated on planning computed tomography and doses to dentition were assessed to generate templates. Results Thirty-three patients were included. Molars received highest doses with a mean dose of 50 Gy (range; 19-75 Gy). Ipsi-lateral and contralateral wisdom teeth received RT dose superior to 50 Gy in 92% and 56% of cases, respectively. Patients with advanced disease (T4 or N2c-3) received higher mean doses on inferior and ipsi-lateral dental arches compared to other patients (T1-3 N0-2b): 42 Gy vs. 39 Gy and 44 Gy vs. 39 Gy (p < 0.05), respectively. Conclusion Pre-RT dose distribution templates are an objective way to prepare PIDC. Further studies with a larger cohort are needed to validate these templates.
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Affiliation(s)
- Raphaël Jumeau
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Phuc Félix Nguyen-Tan
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Xavier Liem
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Louise Lambert
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Matthieu Schmittbuhl
- Faculty of Dentistry, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dany Simard
- Department of Radiation Physics, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Diamant A, Chatterjee A, Faria S, Naqa IE, Bahig H, Filion E, Robinson C, Al-Halabi H, Seuntjens J. Can dose outside the PTV influence the risk of distant metastases in stage I lung cancer patients treated with stereotactic body radiotherapy (SBRT)? Radiother Oncol 2018; 128:513-519. [PMID: 29801721 DOI: 10.1016/j.radonc.2018.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE In an era where little is known about the "abscopal" (out-of-the-field) effects of lung SBRT, we investigated correlations between the radiation dose proximally outside the PTV and the risk of cancer recurrence after SBRT in patients with primary stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This study included 217 stage I NSCLC patients across 2 institutions who received SBRT. Correlations between clinical and dosimetric factors were investigated. The clinical factors considered were distant metastasis (DM), loco-regional control (LRC) and radiation pneumonitis (RP). The dose (converted to EQD2) delivered to regions of varying size directly outside of the PTV was computed. For each feature, area under the curve (AUC) and odds ratios with respect to the outcome parameters DM, LRC and RP were estimated; Kaplan-Meier (KM) analysis was also performed. RESULTS Thirty-seven (17%) patients developed DM after a median follow-up of 24 months. It was found that the mean dose delivered to a shell-shaped region of thickness 30 mm outside the PTV had an AUC of 0.82. Two years after treatment completion, the rate of DM in patients where the mean dose delivered to this region was higher than 20.8 Gy2 was 5% compared to 60% in those who received a dose lower than 20.8 Gy2. KM analysis resulted in a hazard ratio of 24.2 (95% CI: 10.7, 54.4); p < 10-5. No correlations were found between any factor and either LRC or RP. CONCLUSIONS The results of this study suggest that the dose received by the region close to the PTV has a significant impact on the risk of distant metastases in stage I NSCLC patients treated with SBRT. If these results are independently confirmed, caution should be taken, particularly when a treatment plan results in a steep dose gradient extending outwards from the PTV.
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Affiliation(s)
- André Diamant
- Medical Physics Unit, McGill University Health Centre, Canada.
| | | | - Sergio Faria
- Department of Radiation Oncology, McGill University Health Centre, Canada
| | - Issam El Naqa
- Department of Radiation Oncology, Michigan University, United States
| | - Houda Bahig
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal, Canada
| | - Edith Filion
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal, Canada
| | - Cliff Robinson
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Hani Al-Halabi
- Department of Radiation Oncology, McGill University Health Centre, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University Health Centre, Canada
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Giuliani M, Mathew AS, Bahig H, Bratman SV, Filion E, Glick D, Louie AV, Raman S, Swaminath A, Warner A, Yau V, Palma D. SUNSET: Stereotactic Radiation for Ultracentral Non-Small-Cell Lung Cancer-A Safety and Efficacy Trial. Clin Lung Cancer 2018; 19:e529-e532. [PMID: 29759332 DOI: 10.1016/j.cllc.2018.04.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lung stereotactic body radiotherapy (SBRT) is considered a standard curative treatment for medically inoperable early stage non-small-cell lung cancer (NSCLC). Patients with ultracentral tumors (signifying tumors whose planning target volume touches or overlaps the central bronchial tree, esophagus, or pulmonary artery) may be at higher risk of serious toxicities such as bronchial stricture and collapse, esophageal strictures, tracheal-esophageal fistula, and hemorrhage. The primary objective of the study is to determine the maximum tolerated dose of radiotherapy for ultracentral NSCLC. METHODS This multicenter phase 1 dose-escalation study will use a time-to-event continual reassessment method (TITE-CRM). Accrual will start at level 1 (60 Gy in 8 fractions delivered daily). The model will use all available information from previously accrued patients to assign the highest dose with a predicted risk of grade 3-5 toxicity of 30% or less. All patients with newly diagnosed stage T1-3 N0M0 NSCLC (International Union Against Cancer, 8th edition) with tumor size ≤ 6 cm and meeting the criteria for ultracentral location (ie, tumors whose planning target volume touches or overlaps the central bronchial tree, esophagus, pulmonary vein, or pulmonary artery) will be eligible for this study. DISCUSSION It is important to identify a safe dose-fractionation regimen for treating ultracentral tumors with SBRT. In addition, the data from this study may be informative in guiding future studies on the use of SBRT in treating malignancies within the mediastinum-for example, for salvage treatment of mediastinal lymph nodes for recurrent NSCLC or mediastinal oligometastases.
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Affiliation(s)
- Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Ashwathy S Mathew
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM)-Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal (CHUM)-Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Daniel Glick
- BC Cancer-Victoria, Victoria, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Vivian Yau
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David Palma
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
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Diamant A, Chatterjee A, El Naqa I, Bahig H, Filion E, Robinson C, Faria S, Al-Halabi H, Adil K, Seuntjens J. PO-0755: Can dose proximal to the PTV influence the risk of distant metastases in SBRT lung cancer patients? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31065-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Mathieu D, Daoust VC, Bilodeau L, Bedwani S, Filion E, Lenglet A, Bahig H, Vu T, Roberge D, Campeau M. Central3D: A Clinical Tool for Robust Characterization of Centrally Located Non–small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1748] [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: 11/30/2022]
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29
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Bahig H, Campeau MP, Lapointe A, Bedwani S, Roberge D, de Guise J, Blais D, Vu T, Lambert L, Chartrand-Lefebvre C, Lord M, Filion E. Phase 1-2 Study of Dual-Energy Computed Tomography for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:334-343. [DOI: 10.1016/j.ijrobp.2017.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
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30
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Berania I, Cardin GB, Clément I, Guertin L, Ayad T, Bissada E, Nguyen-Tan PF, Filion E, Guilmette J, Gologan O, Soulieres D, Rodier F, Wong P, Christopoulos A. Four PTEN-targeting co-expressed miRNAs and ACTN4- targeting miR-548b are independent prognostic biomarkers in human squamous cell carcinoma of the oral tongue. Int J Cancer 2017; 141:2318-2328. [PMID: 28779483 DOI: 10.1002/ijc.30915] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/31/2017] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the prognostic value and oncogenic pathways associated to miRNA expression in squamous cell carcinoma of the oral tongue and to link these miRNA candidates with potential gene targets. We performed a miRNA screening within our institutional cohort (n = 58 patients) and reported five prognostic targets including a cluster of four co-expressed miRNAs (miR-18a, miR-92a, miR-103, and miR-205). Multivariate analysis showed that expression of miR-548b (p = 0.007) and miR-18a (p = 0.004, representative of co-expressed miRNAs) are independent prognostic markers for squamous cell carcinoma of the oral tongue. These findings were validated in The Cancer Genome Atlas (TCGA) cohort (n = 131) for both miRNAs (miR-548b: p = 0.027; miR-18a: p = 0.001). Bioinformatics analysis identified PTEN and ACTN4 as direct targets of the four co-expressed miRNAs and miR-548b, respectively. Correlations between the five identified miRNAs and their respective targeted genes were validated in the two merged cohorts and were concordantly significant (miR-18a/PTEN: p < 0.0001; miR-92a/PTEN: p = 0.0008; miR-103/PTEN: p = 0.008; miR-203/PTEN: p = 0.019; miR-548b/ACTN4: p = 0.009).
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Affiliation(s)
- Ilyes Berania
- CRCHUM and Institut du cancer de Montréal, Montreal, QC, Canada.,Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | | | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Julie Guilmette
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Department of Pathology, Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Olguta Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Denis Soulieres
- Department of Medicine, Service of Hemato-Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Francis Rodier
- CRCHUM and Institut du cancer de Montréal, Montreal, QC, Canada.,Département de radiologie, radio-oncologie et medicine nucléaire, Université de Montréal, Montreal, QC, Canada
| | - Philip Wong
- CRCHUM and Institut du cancer de Montréal, Montreal, QC, Canada.,Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- CRCHUM and Institut du cancer de Montréal, Montreal, QC, Canada.,Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Mathieu D, Campeau MP, Bedwani S, Roberge D, Doucet R, Zerouali K, Bahig H, Vu T, Lambert L, Masucci L, Filion E. The impacts of mid-treatment CBCT-guided patient repositioning on target coverage during lung VMAT. J Med Imaging Radiat Oncol 2017; 61:543-549. [DOI: 10.1111/1754-9485.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Dominique Mathieu
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Stéphane Bedwani
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - David Roberge
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Robert Doucet
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Karim Zerouali
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Houda Bahig
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Toni Vu
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Louise Lambert
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Laura Masucci
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Edith Filion
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
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Mongeon M, Thibault F, Chartrand-Lefebvre C, Gorgos AB, Soulez G, Filion E, Therasse E. Safety and Efficacy of Endovascular Fiducial Marker Insertion for CyberKnife Stereotactic Radiation Therapy Planning in Early-Stage Lung Cancer. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Swaminath A, Wierzbicki M, Parpia S, Wright JR, Tsakiridis TK, Okawara GS, Kundapur V, Bujold A, Ahmed N, Hirmiz K, Kurien E, Filion E, Gabos Z, Faria S, Louie AV, Owen T, Wai E, Ramchandar K, Chan EK, Julian J, Cline K, Whelan TJ. Canadian Phase III Randomized Trial of Stereotactic Body Radiotherapy Versus Conventionally Hypofractionated Radiotherapy for Stage I, Medically Inoperable Non–Small-Cell Lung Cancer – Rationale and Protocol Design for the Ontario Clinical Oncology Group (OCOG)-LUSTRE Trial. Clin Lung Cancer 2017; 18:250-254. [DOI: 10.1016/j.cllc.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022]
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34
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Jumeau R, Filion E, Bahig H, Vu T, Lambert L, Roberge D, Doucet R, Campeau M. Limiting Chest Wall Toxicity by Adapting the Dose Schedule and Dose Constraints in Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1778] [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: 11/25/2022]
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35
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Yao M, Zhang Q, Woods C, Nguyen-Tan P, Rosenthal D, Garden A, Thorstad W, Anne P, Schultz C, Caudell J, Filion E, Ridge J, Jones C, Kim H, Yom S, Raben D, Bonner J, Machtay M, Harris J, Le Q. Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy in Head and Neck Squamous Cell Carcinoma: A Pooled Analysis of NRG Oncology/RTOG 0129 and 0522. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.284] [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: 10/20/2022]
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36
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Bahig H, Campeau M, Roberge D, Lapointe A, Bedwani S, Vu T, Lambert L, de Guise J, Chartrand-Lefebvre C, Blais D, Lord M, Del Vecchio P, Filion E. Phase 1-2 Study on the Role of Dual-Energy Computed Tomography (DECT) for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.120] [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: 11/25/2022]
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37
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Jumeau R, Filion E, Bahig H, Vu T, Lambert L, Roberge D, Doucet R, Campeau MP. 160: Limiting Chest Wall Toxicity by Adapting the Dose Schedule and Dose Constraints in SBRT for Early-Stage Lung Cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33559-9] [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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38
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Jumeau R, Bahig H, Filion E, Campeau MP, Lambert L, Roberge D, Gorgos AB, Vu T. 161: Is it Time for Adjuvant ChemoTherapy after SBRT of Early-Stage Non-Small Cell Lung Cancer? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33560-5] [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: 11/30/2022]
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39
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Bahig H, Filion E, Vu T, Chalaoui J, Lambert L, Roberge D, Gagnon M, Fortin B, Béliveau-Nadeau D, Mathieu D, Campeau MP. Severe radiation pneumonitis after lung stereotactic ablative radiation therapy in patients with interstitial lung disease. Pract Radiat Oncol 2016; 6:367-374. [DOI: 10.1016/j.prro.2016.01.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/16/2022]
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Bahig H, Campeau MP, Roberge D, Lapointe A, Stephane B, Vu T, Lambert L, de Guise J, Blais D, Chartrand-Lefebvre C, Lord M, Del Vecchio P, Filion E. 43: Phase I-II on the use of Dual-Energy Computed Tomography (DECT) for Assessment of Differential Pulmonary Function in Radiotherapy Planning. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33442-9] [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: 11/25/2022]
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41
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Bahig H, Nguyen-Tan FP, Filion E, Roberge D, Thanomsack P, Doucet R, Blais D, Lambert L. 3: Laryngeal Motion Dynamics using 4D-Computed Tomography and Dynamic Magnetic Resonance Imaging. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33402-8] [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: 11/29/2022]
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Bahig H, Simard D, Létourneau L, Wong P, Roberge D, Filion E, Donath D, Sahgal A, Masucci L. A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 96:848-856. [PMID: 27788956 DOI: 10.1016/j.ijrobp.2016.07.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the incidence of pseudoprogression (PP) after spine stereotactic body radiation therapy based on a detailed and quantitative assessment of magnetic resonance imaging (MRI) morphologic tumor alterations, and to identify predictive factors distinguishing PP from local recurrence (LR). METHODS AND MATERIALS A retrospective analysis of 35 patients with 49 spinal segments treated with spine stereotactic body radiation therapy, from 2009 to 2014, was conducted. The median number of follow-up MRI studies was 4 (range, 2-7). The gross tumor volumes (GTVs) within each of the 49 spinal segments were contoured on the pretreatment and each subsequent follow-up T1- and T2-weighted MRI sagittal sequence. T2 signal intensity was reported as the mean intensity of voxels constituting each volume. LR was defined as persistent GTV enlargement on ≥2 serial MRI studies for ≥6 months or on pathologic confirmation. PP was defined as a GTV enlargement followed by stability or regression on subsequent imaging within 6 months. Kaplan-Meier analysis was used for estimation of actuarial local control, disease-free survival, and overall survival. RESULTS The median follow-up was 23 months (range, 1-39 months). PP was identified in 18% of treated segments (9 of 49) and LR in 29% (14 of 49). Earlier volume enlargement (5 months for PP vs 15 months for LR, P=.005), greater GTV to reference nonirradiated vertebral body T2 intensity ratio (+30% for PP vs -10% for LR, P=.005), and growth confined to 80% of the prescription isodose line (80% IDL) (8 of 9 PP cases vs 1 of 14 LR cases, P=.002) were associated with PP on univariate analysis. Multivariate analysis confirmed an earlier time to volume enlargement and growth within the 80% IDL as significant predictors of PP. LR involved the epidural space in all but 1 lesion, whereas PP was confined to the vertebral body in 7 of 9 cases. CONCLUSIONS PP was observed in 18% of treated spinal segments. Tumor growth confined to the 80% IDL and earlier time to tumor enlargement were predictive for PP.
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Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dany Simard
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Philip Wong
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - David Roberge
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - David Donath
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura Masucci
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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Bourque A, Bedwani S, Filion E, Carrier J. SU-C-BRA-02: A Lung Tumor Autocontouring Algorithm Based On Particle Filter for Dynamic Magnetic Resonance. Med Phys 2016. [DOI: 10.1118/1.4955563] [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: 11/07/2022] Open
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44
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Lapointe A, Bahig H, Zerouali K, Blais D, De Guise J, Carrier J, Filion E, Roberge D, Bedwani S. SU-F-J-91: Sparing Lung Function in Treatment Planning Using Dual Energy Tomography. Med Phys 2016. [DOI: 10.1118/1.4955999] [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: 11/07/2022] Open
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45
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Mathieu D, Campeau MP, Bahig H, Larrivée S, Vu T, Lambert L, Lavoie C, Roberge D, Doucet R, Carrier JF, Gorgos A, Fortin B, Filion E. Long-term quality of life in early-stage non-small cell lung cancer patients treated with robotic stereotactic ablative radiation therapy. Pract Radiat Oncol 2015; 5:e365-73. [DOI: 10.1016/j.prro.2014.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/02/2014] [Accepted: 12/12/2014] [Indexed: 12/25/2022]
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Bahig H, Fortin B, Alizadeh M, Lambert L, Filion E, Guertin L, Ayad T, Christopoulos A, Bissada E, Soulières D, Gaba Idiamey F, Nguyen-Tan PF. Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer. Oral Oncol 2015; 51:521-8. [DOI: 10.1016/j.oraloncology.2015.02.097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Moubayed SP, Sampalis JS, Ayad T, Guertin L, Bissada E, Gologan OE, Soulières D, Lambert L, Filion E, Nguyen-Tan PF, Christopoulos A. Predicting depression and quality of life among long-term head and neck cancer survivors. Otolaryngol Head Neck Surg 2014; 152:91-7. [PMID: 25395572 DOI: 10.1177/0194599814557772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study is to identify clinical factors that are predictive of depression and quality of life (QOL) among long-term survivors of head and neck squamous cell carcinoma and to develop predictive scores using these factors. STUDY DESIGN Cohort study SETTING Tertiary referral center. SUBJECTS AND METHODS A total of 209 posttreatment (median follow-up, 38.7 months) head and neck cancer patients were prospectively evaluated using the Hospital Anxiety Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, and the EORTC Quality of Life Questionnaire Head and Neck 35, and pretreatment patient-related, tumor-related, and treatment-related predictors were identified using chart review. Bivariate (χ(2) and t test) and multivariate (linear regression) analyses were used to construct predictive models. RESULTS Significant pretreatment predictors of depression were identified on multivariate analysis as smoking at diagnosis, >14 alcoholic drinks per week, T3 or T4 status, and >3 medications (P < .001). Two or more of these factors yielded an 82.3% sensitivity in detecting significant depressive symptoms (defined as a HADS cutoff score of 5). Significant predictors of fatigue, global health/QOL, social contact, speech, pain, swallowing, and xerostomia were also identified. CONCLUSION Pretreatment predictors of long-term depression and QOL have been defined using multivariate models, and an easily applicable predictive score of long-term depression is proposed. Potential eventual clinical applications include prophylactic intervention in at-risk patients.
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - John S Sampalis
- Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Olguta E Gologan
- Department of Pathology, Université de Montréal Hospital Center, Montreal, Canada
| | - Denis Soulières
- Medical Oncology Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louise Lambert
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Apostolos Christopoulos
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
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Fawaz Z, Mathieu D, Filion E, Lambert L, Masucci L. Intrafraction Cone Beam Computed Tomography Imaging Evaluation During Stereotactic Body Radiation Therapy for Lung Tumors and Metastatic Tumors to the Spine. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2522] [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: 10/24/2022]
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Bahig H, Simard D, Letourneau-Guillon L, Roberge D, Donath D, Wong P, Filion E, Beliveau-Nadeau D, Doucet R, Nicholson P, Masucci L. Quantitative MRI Changes Post–Stereotactic Ablative Radiation Therapy of the Spine. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2588] [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: 11/25/2022]
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Mongeon M, Filion E, Gilbert P, Béliveau-Nadeau D, Giroux M, Soulez G, Oliva V, Therasse E. Retrospective evaluation of endovascular fiducial markers insertion in cyberknife stereotactic radiotherapy treatment planning of lung neoplasms. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.519] [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: 10/25/2022] Open
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