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Mutsaers A, Li G, Fernandes J, Ali S, Barnes E, Chen H, Czarnota G, Karam I, Moore-Palhares D, Poon I, Soliman H, Vesprini D, Cheung P, Louie A. Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases. Clin Transl Radiat Oncol 2024; 45:100730. [PMID: 38317679 PMCID: PMC10839264 DOI: 10.1016/j.ctro.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose/objectives The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process. Materials/methods Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF. Results We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5. Conclusion Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
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Affiliation(s)
- A. Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - J.S. Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - S. Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - E.A. Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - P. Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - A.V. Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
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Bishr MK, Banks J, Abdelaziz MS, Badawi M, Crane PW, Donigiewicz UJ, Elkorety M, Girgis M, Humphreys A, Isherwood J, Kahan J, Keelan S, Lindqvist EK, Nixon I, Sackey H, Sars C, Soliman H, Touqan N, Remoundos DD, Ahmed M. Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland. Clin Oncol (R Coll Radiol) 2024; 36:e31-e39. [PMID: 38294995 DOI: 10.1016/j.clon.2023.10.050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 02/02/2024]
Abstract
AIMS Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. MATERIALS AND METHODS An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. RESULTS Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. CONCLUSION The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.
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Affiliation(s)
- M K Bishr
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - J Banks
- The Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - M S Abdelaziz
- National Cancer Institute, Cairo University, Cairo, Egypt; University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Badawi
- East Sussex Healthcare Trust, Conquest Hospital, St Leonards-on-sea, UK
| | - P W Crane
- Queen Elizabeth II Hospital, Welwyn Garden City, UK
| | | | - M Elkorety
- West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - M Girgis
- West Suffolk NHS Hospital, Bury St Edmunds, UK
| | - A Humphreys
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - J Isherwood
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Kahan
- Velindre Cancer Centre, Cardiff, UK
| | - S Keelan
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - E K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - I Nixon
- Management Science, Business School, Strathclyde University, Glasgow, UK; The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Sackey
- Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - H Soliman
- Kings' College Hospital, Orpington, UK
| | - N Touqan
- Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK
| | - D D Remoundos
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
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Mutsaers A, Fernandes JS, Li GJ, Ali S, Palhares DM, Chen H, Cheung P, Czarnota GJ, Karam I, Poon I, Soliman H, Vesprini D, Sahgal A, Louie AV. Uncovering the Armpit of Axillary SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e195. [PMID: 37784836 DOI: 10.1016/j.ijrobp.2023.06.1064] [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) The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to applications in new and unique anatomic locations, highlighting the importance of effective, safe, reproducible treatment delivery. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes, safety and process. MATERIALS/METHODS In this ethics approved single-institution retrospective review, patients treated with SBRT to AM from 2014-2022 had tumor, treatment planning, and dosimetric variables abstracted. Toxicity was assessed per Common Terminology for Adverse Events V5.0. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). RESULTS We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60%), Eastern Cooperative Oncology Group performance status 0-1 (62%), and elderly (median age: 72), with a median follow-up of 14.6 months. Common primary sites included breast (n = 16, 43%), skin (n = 7, 19%), and lung (n = 5, 14%). Treatment indication included oligoprogression (n = 18, 46%), oligometastases (n = 14, 36%) and symptomatic progression (n = 7, 18%). A minority had prior overlapping radiation (n = 7, 18%) or regional surgery (n = 4, 11%), while most had prior systemic therapy (n = 26, 70%). Significant heterogeneity in simulation, planning and treatment was identified. Immobilization included 5-point thermoplastic mask (n = 12, 32%), Vacloc (n = 12, 32%) arms-up thorax bag (n = 11, 30%). 4-D CT scans were obtained in 46%, MR simulation in 21%, and intravenous contrast in 10%. Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy), over a median of 12 days (IQR: 9-14). Seventeen cases (44%) utilized a low-dose elective volume to cover remaining axilla; 14% used a high dose clinical target volume. Median planning target volume margin was 5mm (range: 3-10mm), and plans were generated with 5 different dose constraint protocols. At first radiographic assessment, 87% had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57% had complete symptom resolution and 21% had improvement. One and 2-year LF rate were 19% and 31%, respectively. Median OS was 21.0 months (95% [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95% [CI] 4.3-11.3). Acute and late toxicities were uncommon, with two grade 3 events (1 plexopathy in a case with tumor involving brachial plexus, 1 skin ulceration) identified, and no grade 4/5. CONCLUSION In this series of AM SBRT, low rates of toxicity, and good rates of LF and symptom improvement were observed. As treatment was delivered with a variety of individual treatment differences, an institutional protocol is under development to standardize technique, optimize efficiency and improve evaluability.
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Affiliation(s)
- A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J S Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G J Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G J Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Thomsen B, Vesprini D, Zeng L, Myrehaug SD, Tseng CL, Detsky J, Chen H, Zhang B, Jerzak K, Atenafu E, Maralani P, Soliman H, Sahgal A. Stereotactic Body Radiotherapy (SBRT) for Breast Cancer Spinal Metastases is Associated with Low Rates of Long-Term Local Failure (LF) and Vertebral Compression Fracture (VCF) Independent of Molecular Status. Int J Radiat Oncol Biol Phys 2023; 117:e153. [PMID: 37784740 DOI: 10.1016/j.ijrobp.2023.06.976] [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 limited outcome data specific to breast cancer spinal metastases following spine SBRT. This study aims to report outcomes specific to breast cancer spinal metastases receiving spine SBRT and determine the implication of biomarker status. MATERIALS/METHODS We have been maintaining a prospective database since the inception of the spine SBRT program. A retrospective review identified 168 breast cancer patients with 409 spinal segments treated with spine SBRT between January 2008 and January 2023. Molecular subtypes were grouped based on luminal A, luminal B, basal, and HER2 enriched. Patients were followed with q3-monthly full-spine MRI and a clinical assessment. The primary endpoint was MRI-based local failure (LF), and secondary endpoints were overall survival (OS) and vertebral compression fracture (VCF). RESULTS The median follow-up was 33 months (range, 3.3-123 months). Amongst the 168 patients, the majority were ECOG 0 or 1 (95%), neurologically intact (94%), polymetastatic (74%), and either luminal A (71%) or luminal B (8%). A total of 17% of patients were HER2+ve versus 83% HER2-ve. Of 409 treated segments the majority (76%) had no prior radiation or surgery (de novo), were SINS stable (60%), had either no or low-grade epidural disease (86%) and treated with 24-28 Gy in 2 fractions (73%). The LF and OS rates at 1, 3, and 5 years were 5%, 11%, and 14%, respectively, and 91%, 65%, and 45%, respectively, independent of molecular subtype on univariate analyses. The cumulative risk of VCF at 2 and 5 years was 7% and 10%, respectively. CONCLUSION We observe, in the largest breast cancer spine cohort to date, excellent long-term local control rates independent of molecular sub-group, and acceptable VCF rates.
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Affiliation(s)
- B Thomsen
- University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - K Jerzak
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ong WL, Zeng L, Soliman H, Myrehaug SD, Detsky J, Chen H, Ruschin ME, Atenafu E, Larouche J, Maralani P, Sahgal A, Tseng CL. Outcomes Specific to Spinal Metastases with Paraspinal Disease Extension Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e142-e143. [PMID: 37784717 DOI: 10.1016/j.ijrobp.2023.06.954] [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) Spinal metastases with paraspinal disease (PD) extension are known to have worse outcomes following stereotactic body radiotherapy (SBRT). Characteristics of the PD itself have not been investigated to determine the impact on outcomes such as local control, which is the purpose of this study. MATERIALS/METHODS We retrospectively reviewed those patients who had SBRT for spinal metastases with PD disease, identified from a prospectively maintained database. Spinal metastases previously irradiated or surgical resected were excluded. The extent of PD was classified as involving the rib, neuroforamina, and muscle invasion. The gross tumor volume of PD (GTV_PD) and the clinical target volume of PD (CTV_PD) were segregated from the bony compartments based on the treatment plan contours. The outcomes of interest included the cumulative risk of local failure (LF), re-irradiation rates (ReRT), and overall survival (OS). LF and ReRT were estimated for each treated sites using the competing risk model (death as the competing risk), while OS was evaluated per patient using the Kaplan Meier method. RESULTS A total of 86 patients with 96 spinal metastases sites with PD were included. Of the 96 treated sites, 65% (62/96), 29% (28/96) and 6% (6/96) of PD spanned 1, 2, and 3 vertebral levels respectively. The median follow-up was 12.4months (range: 0.6-100months). The 6- and 12-month OS for the cohort was 81% and 51%, respectively. 33/86 (38%) patients had radioresistant cancer (gastrointestinal, renal cell carcinoma, thyroid, sarcoma, or melanoma). Involvement of rib, neuroforamina and muscle invasion were observed in 39% (37/96), 65% (62/96) and 21% (20/96) of the treated sites, respectively. Epidural disease was present in 57% (55/96) of treated sites. The median GTV_PD volume was 7cc (range: 0.3-114cc), and the median CTV_PD volume was 24cc (range: 0.4-248cc). The prescribed doses were 24 Gy/2 fractions (fx) (80%), 28 Gy/2 fx (10%) and 30 Gy/4 fx (10%). There were 84 treated sites with at least one post-treatment MRI available for LF assessment. The crude LF risk was 32% (27/84), and the 6- and 12-month cumulative LF rates were 12% and 28%, respectively. There was a trend towards an increased risk of LF when PD involved the rib (35% vs 24% at 1 year respectively, P = 0.07) and muscle (67% vs 20% at 1 year respectively; P = 0.06), but no difference in LF for neuroforamina involvement (26% vs 34% at 1 year respectively, P = 0.5). There were no differences in LF based on cancer radioresistance (P = 0.6), GTV_PD volume (P = 0.3) or CTV_PD volume (P = 0.4). Of the 96 treated sites, 14% (14/96) were re-irradiated (9 with repeat SBRT and 5 with conventional EBRT) at a median of 15 months (range: 4.7-59 months) post initial SBRT. The cumulative incidence of ReRT at 6- and 12-months were 1.2% and 7.3%, respectively. CONCLUSION PD involving adjacent rib and muscle may be associated with worse LF following SBRT. Further expansion of the cohort and dosimetric analyses are ongoing.
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Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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6
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Burgess L, Zeng L, Myrehaug SD, Soliman H, Tseng CL, Detsky J, Chen H, Palhares DM, Witiw CD, Zhang B, Maralani P, Sahgal A. Stereotactic Body Radiotherapy for Posterior Element Only Spinal Metastases: Outcomes and Validation of Recommended Clinical Target Volume Delineation Practice. Int J Radiat Oncol Biol Phys 2023; 117:e91. [PMID: 37786212 DOI: 10.1016/j.ijrobp.2023.06.849] [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) Spine stereotactic body radiotherapy (SBRT) results in improved local control and pain response compared to conventional external beam radiotherapy. Consensus stipulates MRI-based delineation of the clinical target volume (CTV) is critical and is based on spine segment sector involvement. The applicability of these contouring guidelines to metastases confined to the posterior elements is unknown. The purpose of this study was to determine the patterns of failure, as well as the safety of treating posterior element metastases when the vertebral body was intentionally excluded from the CTV. MATERIALS/METHODS A retrospective review of a prospectively maintained database of 605 patients and 1412 spine segments treated with spine SBRT was performed. Only treated segments involving the posterior elements alone were included for the analyses. The primary outcome was local failure, as per SPINO recommendations, and secondary outcomes included patterns of failure, toxicities. Clinical and tumor factors were reported with descriptive statistics. The cumulative risk of local failure was estimated using the Fine-Gray method, accounting for death before local failure as a competing risk. RESULTS A total of 24/605 patients and 31/1412 segments within the database were treated to the posterior elements only. Local failure occurred in 11/31 segments. The cumulative rate of local recurrence was 9.7% at 12 months and 30.8% at 24 months. Amongst local failures, the most common histologies were renal cell carcinoma (36.4%) and non-small cell lung cancer (36.4%). At baseline, 4/11 (36.4%) segments with local failure (36.4%) had epidural disease and 8/11 (72.7%) had paraspinal disease. Most local failures were treated in the de novo setting (8/11, 72.7%). 6/11 (54.5%) failed exclusively within treated CTV sectors and 5/11 (45.5%) with both treated and adjacent untreated sectors. Of these five, four had disease progression within the untreated vertebral body. No failures occurred exclusively within the untreated vertebral body. One patient (4.2%) experienced a grade 4 skin toxicity and one patient (4.2%) developed an iatrogenic Grade 1 vertebral compression fracture. CONCLUSION Posterior element alone metastases are rare. Our analyses support SBRT consensus contouring guidelines such that the vertebral body can be excluded from CTV in spinal metastases confined to the posterior elements.
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Affiliation(s)
- L Burgess
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C D Witiw
- St. Michaels Hospital, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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7
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Zeng KL, Soliman H, Myrehaug SD, Tseng CL, Detsky J, Chen H, Lim-Fat MJ, Ruschin ME, Atenafu E, Keith J, Lipsman N, Heyn C, Maralani P, Das S, Pirouzmand F, Sahgal A. Outcomes Following Dose Escalated Radiotherapy for High Grade Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e161. [PMID: 37784757 DOI: 10.1016/j.ijrobp.2023.06.991] [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) Conventionally fractionated radiotherapy (RT) is a defined treatment following surgery for atypical and malignant meningioma. However, the optimal radiotherapeutic approach is not well defined. We present the results of our dose-escalation strategy. MATERIALS/METHODS Consecutive patients with a histopathologic grade 2 or 3 meningioma treated with RT were retrospectively reviewed. The primary outcome was progression-free survival (PFS), and secondary outcomes included cause-specific survival (CSS), overall survival (OS), local failure and incidence of radiation necrosis. We specifically compared the dose-escalation cohort, defined as those treated with ≥66 Gy EQD2 (equivalent dose in 2 Gy fractions, a/b = 10), to the standard dose cohort receiving <66 Gy EQD2. We defined adjuvant as RT delivered within 6 months of surgery otherwise the treatment was salvage. RESULTS A total of 118 patients with Grade 2 (111/118) or 3 (7/118) meningioma were identified. 54/118 (45.8%) received dose-escalation and 64/118 (54.2%) standard dosing. 34/54 (63.0%) dose-escalated and 45/64 (70.3%) standardly dosed were treated adjuvantly. The median follow-up was 45.4 months (IQR: 24.0-80.0 months) and median OS was 9.7 years. Post-operative residual disease was present in all dose-escalated patients, as compared to 65.6% in the standard dose cohort. PFS at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 78.9%, 72.2% and 64.6% vs. 57.2%, 49.1% and 40.8%, respectively, (p = 0.030). On multivariable (MVA) analysis, dose-escalation (HR: 0.544, 95% CI: 0.303-0.977, p = 0.042) was associated with improved PFS, whereas ≥2 surgeries (HR: 1.989, 95% CI: 1.049-3.773, p = 0.035) and older age (HR: 1.035, 95% CI:1.015-1.056, p<0.001) associated with worse PFS. The cumulative risk of local failure at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 16.9%, 23.8% and 31.8% vs. 39.6%, 45.6% and 53.9%, respectively, favoring dose-escalation (p = 0.016). MVA confirmed dose-escalation as predictive of a lower risk of LF (HR: 0.483, 95% CI: 0.263-0.887, p = 0.019), while ≥2 surgeries prior to RT predicted for greater LF rates (HR:2.145, 95% CI:1.220-3.771, p = 0.008). A trend was observed for prolonged CSS and OS in the dose escalation cohort (p = <0.1). Seven patients (5.9%) developed symptomatic radiation necrosis (RN) with no significant difference between the two cohorts. CONCLUSION Dose-escalated radiotherapy for high grade meningioma to at least 66 Gy is associated with significantly improved rates of local control and PFS with an acceptable risk of RN.
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Affiliation(s)
- K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M J Lim-Fat
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Keith
- Department of Neuropathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - C Heyn
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - F Pirouzmand
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Shor D, Zeng L, Holden L, Chen H, Maralani P, Heyn C, Zhang B, Myrehaug SD, Tseng CL, Detsky J, Soliman H, Sahgal A. Staged Stereotactic Radiosurgery as a Novel Adaptive Approach to Salvage Previously Irradiated Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e150. [PMID: 37784734 DOI: 10.1016/j.ijrobp.2023.06.969] [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) We report outcomes specific to a novel 3 fraction (frx) staged stereotactic radiosurgery (St-SRS) regimen designed to salvage metastases previously irradiated and considered to be at high risk of radiation necrosis (RN). MATERIALS/METHODS A total of 24 patients with 55 metastases treated with our 3 frx St-SRS approach were reviewed. Prior to each frx, patients were re-simulated and planned with a new MRI to allow for treatment adaption. The primary endpoint was the cumulative incidence of local failure (LF) and secondary endpoints included tumor dynamics and RN rates. RESULTS The median follow up was 9.0 months (range: 2.7-40.1 months) and median age was 59-years (range: 32-84). Primary cancers were of breast (44%), lung (33%), melanoma (22%), and gastro-intestinal (1%) origin. Individual metastases treated with St-SRS had initially failed surgery and post-op cavity hypofractionated SRS (HSRS) for 2/55 (4%), SRS alone for 19/55 (34%), whole brain radiation (WBRT) alone for 6/55 (11%), HSRS for 2/55 (4%), and prior SRS and WBRT exposure for 28/55 (51%). 46/55 (84%) were prescribed 8 Gy, 8 Gy, 4 Gy; 8/55 (14%) had 6 Gy, 6 Gy, 4 Gy and 1/55 (2%) had 8 Gy, 8 Gy, 6 Gy. The median number of weeks between frx was 2.6 (range: 1.0-6.8). The median of the mean and maximum target doses were 9.7 Gy (range: 5.4-11.7 Gy) and 12.4 Gy (range, 7.5-16.0 Gy) respectively. The median prescription isodose line was 62% (range: 50-85%). The mean lesion volume and diameter was 3.8cc (range: 0.05-24.8cc) and 1.6cm (range: 0.2-4.4cm), respectively. The mean percent target volume coverage, Paddick Conformality Index and Gradient Index were 100% (range: 97-100%), 0.7 (range: 0.1-0.9), and 3.2 (range: 2.5-6.7), respectively. The mean volume change between staged frxs was -4.2% (range: -69.3 to +63.1%), and based on the first and last St-SRS MRI was -10.8% (range: -86.6% to +68.7%). The crude LF rate was 27%. The median time to LF was 3.4 months (range: 1.2-7.4 months). Amongst those with a LF, 7/15 (46%) were melanoma, 6/15 (40%) HER2 positive breast cancer, 1/15 (7%) gastrointestinal and 1/15 (7%) non-small cell lung carcinoma. 8/15 (53%) had prior WBRT and SRS exposure, 1/16 (7%) surgery and cavity HSRS, 5/15 (33%) SRS alone and 1/15 (7%) WBRT alone. Only asymptomatic RN events were observed in 4/55 (7%). CONCLUSION St-SRS is a promising approach to salvage previously irradiated brain metastases, including prior SRS, with a favorable rate of RN. Tumor volume dynamics between stages can be significant warranting adaptive replanning.
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Affiliation(s)
- D Shor
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - L Holden
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C Heyn
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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9
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Shor D, Zeng KL, Chen H, Louie AV, Menjak I, Atenafu E, Tseng CL, Detsky J, Larouche J, Zhang B, Soliman H, Maralani P, Myrehaug SD, Sahgal A. Molecular Status Predicts for Local Control in Patients with Non-Small Cell Lung Cancer Spinal Metastases Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e57-e58. [PMID: 37785740 DOI: 10.1016/j.ijrobp.2023.06.773] [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) We report outcomes after spine stereotactic body radiotherapy (SBRT) in patients with metastatic non-small cell lung cancer (NSCLC), to determine the significance of programmed death-ligand 1 (PD-L1) status and epidermal growth factor (EGFR) mutation on local failure (LF) rate. MATERIALS/METHODS A total of 165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary outcomes included overall survival (OS) and vertebral compression fracture (VCF) rates. OS was estimated using the Kaplan-Meier method. Cumulative LF and VCF rates were calculated using competing risk analysis method. Multivariable analysis (MVA) evaluated factors predictive of LF and VCF. RESULTS Median follow-up was 13 months (range, 0.5-95 months). Median OS was 18.4 months (95% CI 11.4-24.6). Median age was 67 years (range, 28.2-89.9). 52% were female, 76% had an adenocarcinoma histology and 61% had a smoking history. 49/165 (29%) had an EGFR mutation. PD-L1 status was analyzed in 109/165 (66%) patients with 16% PD-L1 ≥ 50%, 20% PD-L1 1-49% and 35% PD-L1 <1%. Of 389 segments, 79% were de novo and 21% were previously radiated. At baseline, 35% had a VCF, 27% had epidural disease, 27% had paraspinal extension, and 49% were Spinal Instability in Neoplasia Score (SINS) stable. 239/389 (61%) were treated with either 24 or 28 Gy in 2 SBRT fractions. Within 1 month of SBRT, 39/165 (24%) had a tyrosine kinase inhibitor, 27/165 (16%) immunotherapy (IO) with or without chemotherapy, and 31/165 (19%) chemotherapy alone. LF cumulative incidence at 1- and 2-years was 16.3% (95% CI 12.8-20.3%) and 25.4% (95% CI 20.9%-30%), respectively. EGFR positivity (p<0.0001), PD-L1≥50% (p = 0.013) and treatment with IO within 1 month of SBRT (p = 0.004) predicted for improved local control on MVA. The 1- and 2-year LF rate in EGFR-positive vs. negative patients were 12.9% vs. 16.6% and 17.7% vs. 28.8%, respectively, and in those PD-L1 ≥50% vs PD-L1<50% were 7.8% vs. 19.6% and 7.8% vs. 38.1% respectively. Cumulative incidence of VCF at 1- and 2-years were 6.6% (95% CI 4.4-9.4%) and 8.8% (95% CI 6.1-12.0%). MVA identified prior SBRT to the same treated segment (P<0.0001) and a baseline VCF (p<0.0001) as significant predictors. 18/389 (4.6%) had radiation-induced radiculopathy and no radiation myelopathy events detected. CONCLUSION We identify the predictive utility of EGFR mutation and PD-L1 ≥50% status on local control in NSCLC patients with spinal metastases treated with spine SBRT, and a therapeutic benefit with peri-SBRT IO.
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Affiliation(s)
- D Shor
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Menjak
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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10
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Ong WL, Stewart J, Sahgal A, Soliman H, Tseng CL, Detsky J, Ho L, Das S, Maralani P, Lipsman N, Stanisz G, Perry J, Chen H, Atenafu E, Lau A, Ruschin ME, Myrehaug SD. Predictors of Tumor Dynamics during a 6-Week Course of Chemoradiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e142. [PMID: 37784716 DOI: 10.1016/j.ijrobp.2023.06.953] [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) Our prior imaging studies have shown geometrically meaningful inter-fraction tumor dynamics specific to glioblastoma (GBM). We aim to identify predictors associated with tumor dynamics during a 6-week course of concurrent chemoradiotherapy (CRT) for GBM. MATERIALS/METHODS Patients enrolled in a prospective serial magnetic resonance imaging (MRI) study were reviewed. All patients were treated with 54-60 Gy in 30 fractions. The gross tumor volume (GTV) included the surgical cavity and T1c enhanced residual tumor; clinical tumor volume (CTV) included GTV with a 15mm isotropic expansion, respecting anatomical boundaries; planning target volume (PTV) was 4mm expansion. MRIs were obtained at RT planning (F0), fraction 10 (F10), and fraction 20 (F20). Tumor dynamic metrics (relative to F0) assessed included the GTV volume (Vrel), Hausdorff distance (dH) and migration distance (dM). dH is the average distance between two datasets in metric space. dM is the maximum linear displacement of the GTV in any direction. Factors to be determined associated with tumor dynamics included: age, sex, corpus callosum (CC) involvement, extent of surgery (gross total resection (GTR), subtotal resection (STR) or biopsy alone (Bx)), MGMT methylation and IDH mutation status. RESULTS A total of 129 patients were reviewed. Median GTV was 20.9cc at F0, 17.6cc at F10 (Vrel 0.85), and 16.1cc at F20 (Vrel 0.78). Patients without CC involvement had more marked GTV volume reduction: Vrel 0.82 vs 1.02 with CC involvement at F10 (P = 0.05), and Vrel 0.77 vs 0.88 with CC involvement at F20 (P = 0.03). Patients with GTR (vs STR vs Bx) had more marked GTV volume reduction across all time points: Vrel 0.78, 0.85 and 1.07 respectively at F10 (P = 0.001), and Vrel 0.69, 0.80, 1.04 respectively at F20 (P = 0.001). The median dH was 8.1mm at F10 and 9.2mm at F20. Patients with CC involvement (vs without CC involvement) had a larger dH: 54% vs 25% had dH>10mm respectively at F10 (P = 0.03), and 73% vs 28% had dH>10mm respectively at F20 (P<0.005). Patients with a GTR had smaller dH at both F10 (P = 0.02) and F20 (P = 0.006). At F20, 20%, 47% and 37% of patients with GTR, STR and Bx had dH>10mm (P = 0.04). The median dM were 4.7mm at F10 and 4.7mm at F20. Patients with CC involvement (vs without CC involvement) had larger dM: 41% vs 12% had dM >10mm respectively at F10 (P = 0.01), and 45% vs 9% had dM >10mm respectively at F20 (P<0.001). Patients with GTR had smaller dM at F10 (P = 0.03) and F20 (P0.002). At F20, 0%, 25% and 19% of patients with GTR, STR and Bx had dM>10mm (P = 0.002). Age, sex, MGMT methylation and IDH mutation status were not associated with Vrel, dH and dM at F10 and F20. CONCLUSION We identified CC involvement and extent of surgery to be associated with tumor dynamics at F10 and F20 over the course of CRT for GBM. This offers opportunities to better select patients who may benefit from earlier/ more frequent RT replan/ adaptation to ensure adequate tumor coverage, or to reduce RT toxicities.
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Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - J Stewart
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Ho
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - G Stanisz
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - J Perry
- Department of Neurooncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - A Lau
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Palhares DM, Zeng KL, Myrehaug SD, Tseng CL, Soliman H, Chen H, Maralani P, Larouche J, Wilson J, Ruschin ME, Zhang B, Atenafu E, Sahgal A, Detsky J. Stereotactic Body Radiotherapy (SBRT) for Sacral Metastases: Deviation from Recommended Target Volume Delineation Predicts Higher Risk of Local Failure. Int J Radiat Oncol Biol Phys 2023; 117:e143-e144. [PMID: 37784719 DOI: 10.1016/j.ijrobp.2023.06.956] [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) A international consensus recommendation was published to guide target volume delineation specific to sacral stereotactic body radiotherapy (SBRT). We report outcomes after sacrum SBRT, focusing on the impact of contouring deviation on local failure (LF) risk, with an aim to validate this guideline. MATERIALS/METHODS All patients who underwent SBRT to any level between S1 and S5 from 2010 to 2021 were identified from a prospectively maintained institutional database. The primary outcome was magnetic resonance-based LF. Secondary outcomes included vertebral compression fracture (VCF) and overall survival (OS). Cumulative LF and VCF rates were calculated per segment using the competing risk analysis method. Kaplan Meier analysis was used to estimate OS per patient. Cox proportional hazards model was used to assess predictive factors of LF, VCF, and OS. RESULTS A total of 215 treated sacral segments in 112 patients were retrospectively reviewed. The median follow-up was 13 months (range, 0.4-116.9). The median age was 64 years (range, 18-86), and 56% were male. Most patients (52%) had treatment to a single segment. The median clinical target volume (CTV) was 129.2 cc (range, 5.8-753.5). Most segments were treated with 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Thirty-one percent of segments were of radioresistant histology (gastrointestinal, kidney, melanoma, sarcoma, or thyroid primary), and 51% had extraosseous disease. Sixteen percent of segments were under-contoured per consensus guidelines, with incomplete coverage of the involved sector (71%), omission of the adjacent uninvolved sector (17%), or both (11%) as the causes for deviation. The cumulative incidence of LF was 18.4% (95% CI 13.5-24.0) at 12-months and 23.1% (95% CI 17.6-29.0) at 24-months. On multivariate analysis (MVA), under-contouring (HR 2.4, 95% CI 1.3-4.7, p = 0.008), radioresistant histology (HR 2.4, 95% CI 1,4-4.1, p = 0.001), and extraosseous extension (HR 2.5, 95% CI 1.3-4.7, p = 0.005) were predictors of increased risk of LF. The LF rates at 12/24-months were 15.1%/18.8% for segments contoured per guideline versus 31.4%/40.0% for those under-contoured. The cumulative incidence of VCF was 7.1% (95% CI 4.1-11.1) at 12-months and 12.3% (95% CI 8.2-17.2) at 24-months. On MVA, female gender was the only risk factor for VCF (HR 2.3, 95% CI 1.1-5.2, p = 0.04). The median OS was 29.5 months (95% CI 17.5-59.2). On MVA, primary kidney (HR 4.7, 95% CI 1.7-12.5, p = 0.002) or lung histology (HR 3.4, 95% CI 1.3-8.5, p = 0.010), the presence of liver (HR 2.8, 95% CI 1.2-6.4, p = 0.016) or lung (HR 2.5, 95% CI 1.3-5.1, p = 0.008) metastases, ECOG performance status 2 or 3 (HR 3.3, 95% CI 1.2-8.2, p = 0.013), and the presence of sensory or motor deficit (HR 2.6, 95% CI 1.2-5.4, p = 0.012) were prognostic for worse OS. CONCLUSION Sacral SBRT is associated with high rates of efficacy and an acceptable VCF risk. Adherence to target volume delineation consensus guidelines reduces the risk of LF.
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Affiliation(s)
- D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Wilson
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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12
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Palhares DM, Dasgupta A, Saifuddin M, Ho L, Lu L, Prasla S, Pena MLA, Karam I, Soliman H, Szumacher E, Chow E, Chen H, Vesprini D, Sahgal A, Czarnota GJ. A Novel Strategy to Enhance Radiotherapy Efficacy: Results from the Prospective Phase I Clinical Trial of MR-Guided Focused Ultrasound-Stimulated Microbubbles (MRgFUS+MB) Treatment for Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e197. [PMID: 37784840 DOI: 10.1016/j.ijrobp.2023.06.1068] [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) Preclinical in vitro and in vivo studies have demonstrated that tumor cell death can be enhanced 10- to 40-fold when radiotherapy (RT) is combined with focused-ultrasound (FUS)-stimulated microbubbles (MB) treatment. MBs are gas microspheres used as intravascular contrast agents. The acoustic exposure of MBs within the target volume causes bubbles cavitation that induces perturbation of tumor vasculature. This activates apoptotic pathways responsible for the ablative effect of stereotactic body radiotherapy, which would otherwise require high-dose radiotherapy (>8-10 Gy/fraction) to be activated. Subsequent irradiation of an MB-sensitized tumor causes increased anoxic tumor killing, which occurs in addition to canonical RT-induced DNA damage. Given the compelling results of preclinical data, we conducted a phase I clinical trial of magnetic resonance (MR)-guided FUS-stimulated MBs (MRgFUS+MB) treatment for breast cancer patients (pts). We report the safety and efficacy results of this new radio enhancement treatment. MATERIALS/METHODS This is a single-center, single-arm, investigator-initiated phase 1 clinical trial (NCT04431674). We included pts with stage I-IV breast cancer with tumor in situ for whom breast or chest wall RT was deemed adequate by a multidisciplinary team. Pts were excluded if they had contraindications for contrast-enhanced MR or MB administration. Pts underwent 2-3 MRgFUS+MB treatments throughout the RT course. We used an MR-coupled FUS-device operating at 500 KHz and 540 kPa peak negative pressure to deliver the treatment. The FUS sonicated intravenously administrated MB within the MR-guided target volume. Pts were monitored for 30-min post-procedure and subsequently treated with RT. The primary outcome was acute toxicity per Common Terminology for Adverse Events V5.0. Secondary outcomes were radiological response at 3 months and local control (LC) at 1 year. Kaplan-Meier method was used to estimate local control. All pts signed a written consent form before study participation. RESULTS We enrolled 18 females with 20 primary breast cancer treated with MRgFUS+MB therapy. The median age was 60 years (range, 44-90). The molecular subtypes consisted of basal-like (n = 3/20), luminal (n = 11/20), and HER2-enriched (n = 6/20). The prescribed dose was 20 Gy/5 fractions (n = 8/20), 30-35 Gy/5 fractions (n = 7/20), 30-40 Gy/10 fractions (n = 3/20), and 66 Gy/33 fractions (n = 2/20). The median follow-up was 9 months (range, 0.3-29). All pts completed the planned MRgFUS+MB treatments. The only MRgFUS+MB treatment-related toxicity consisted of Grade 1 allergic reaction (mild cough) 30 minutes after the last MB injection. All worst acute toxicities were radiation dermatitis (Grade 3 = 2/20, Grade 2 = 2/20, Grade 1 = 14/20). At 3 months, 75% had partial (n = 6/20) or complete (n = 9/20) response, with a single progression. The LC rate at 1 year was 86%. CONCLUSION MRgFUS+MB was a safe and efficient treatment that provided durable responses.
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Affiliation(s)
- D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Dasgupta
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M Saifuddin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Ho
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Lu
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Prasla
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M L A Pena
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G J Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ruschin ME, Stewart J, Hudson JM, Myrehaug SD, Tseng CL, Soliman H, Chen H, Maralani P, Sahgal A, Detsky J. Dosimetric Implications of Weekly On-Line MR-Guided Adaptive Radiotherapy (RT) for Glioblastomas (GBM) Growing during RT. Int J Radiat Oncol Biol Phys 2023; 117:e713-e714. [PMID: 37786085 DOI: 10.1016/j.ijrobp.2023.06.2214] [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) The UNITED trial (NCT04726397) involves once-weekly on-line adaptive RT for patients with GBM on a 1.5T MRI-Linac (MRL). For tumors that continue to enlarge during the course of RT, we hypothesize that the adaptive strategy improves the dosimetric coverage of the target relative to a non-adaptive strategy. MATERIALS/METHODS As per the trial protocol, T1+contrast (T1c) and FLAIR MRI sequences were acquired once per week during RT to re-define and adapt the gross tumor volume (GTV) as the contrast enhanced volume, the clinical target volume (CTV) as a 5mm expansion around the GTV plus adjacent FLAIR hyperintense regions considered at-risk by the radiation oncologist, and a 3 mm PTV around the CTV. Nine UNITED patients with tumors that grew throughout RT (GTV and/or CTV) were identified. 5/9 patients were treated with 60 Gy in 30 fractions (6 weekly adaptions) and 4/9 with 40 Gy in 15 fractions (3 weekly adaptions). For the final week's GTV and CTV (GTVfinal and CTVfinal), the dosimetric outcomes of the delivered and adaptive summative plans (Dsum) were compared to dose of the baseline plan (Dbaseline) generated on Fraction 1 of treatment, the latter being indicative of the theoretical situation where no further adaption was taken. We measured the dose to 99% of the GTVfinal and CTVfinal: Dsum99 and Dbaseline99. RESULTS For each adaptive fraction, the plan was optimized to achieve an objective of D99 greater than 95% of the prescription (D99>95%) for both the GTV and CTV. The relative increase in GTVfinal and CTVfinal from baseline was on average 119% (range: 98% to 144.7%) and 128% (range: 109% to 176%), respectively. The proportion of CTVfinal that was outside the baseline plan's PTV was on average 11.5% (range: 0% to 32%). The GTVfinal did not extend beyond the baseline PTV for any of the 9 cases. GTVfinal Dsum99 was >95% for all cases while CTVfinal Dsum99 was < 95% in 2 of 9 cases (74%, and 87%). By contrast, the baseline plan, if given for all fractions with no further adaptation, yielded a D99 for CTVfinal of <95% in 5 of 9 cases (28%, 52%, 75%, 84%, and 87%). In general, coverage of the CTVfinal decreased with increasing levels of CTVfinal outside of the baseline PTV. For all 5 cases where CTVfinal D99<95% on the baseline plan, more than 10% of CTVfinal was outside of the baseline PTV. Small margin, weekly adaptive RT on an MRL for GBM maintains coverage of the GTV in the presence of tumor growth while minimizing the degree of normal brain tissue irradiated. Dosimetric impact on non-GTV/CTV brain is outside the scope of the present study. CONCLUSION Preliminary results indicate that a once weekly adaptive approach for small margin MR-guided RT improves tumor coverage for progressive tumors compared to a static (baseline) plan without adaptation.
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Affiliation(s)
- M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Stewart
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J M Hudson
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Palhares D, Chen H, Wang M, Myrehaug S, Detsky J, Tseng C, Husain Z, Perry J, Lim-Fat M, Lipsman N, Das S, Keith J, Sahgal A, Soliman H. Predictive Factors for Survival and Radiation Necrosis in Patients with Recurrent High-Grade Glioma Treated with Re-Irradiation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.843] [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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Zeng K, Abugarib A, Soliman H, Myrehaug S, Husain Z, Detsky J, Ruschin M, Karotki A, Atenafu E, Maralani P, Sahgal A, Tseng C. Dose-Escalated Two-Fraction Spine Stereotactic Body Radiotherapy: 28 Gy vs. 24 Gy in 2 Daily Fractions. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.663] [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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Hudson J, Stewart J, Zeng K, Chen H, Ruschin M, Soliman H, Tseng C, Myrehaug S, Husain Z, Sahgal A, Detsky J. Impact of MGMT Promoter Methylation Status on Tumor Dynamics during Weekly Adaptive Radiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Zeng K, Myrehaug S, Soliman H, Husain Z, Tseng C, Detsky J, Ruschin M, Atenafu E, Witiw C, Larouche J, da Costa L, Maralani P, Parulekar W, Sahgal A. Mature Local Control and Reirradiation Rates Comparing Spine Stereotactic Body Radiotherapy to Conventional Palliative External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.345] [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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18
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Patin EC, Dillon MT, Nenclares P, Grove L, Soliman H, Leslie I, Northcote D, Bozhanova G, Crespo-Rodriguez E, Baldock H, Whittock H, Baker G, Kyula J, Guevara J, Melcher AA, Harper J, Ghadially H, Smith S, Pedersen M, McLaughlin M, Harrington KJ. Harnessing radiotherapy-induced NK-cell activity by combining DNA damage-response inhibition and immune checkpoint blockade. J Immunother Cancer 2022; 10:e004306. [PMID: 35314434 PMCID: PMC8938703 DOI: 10.1136/jitc-2021-004306] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite therapeutic gains from immune checkpoint inhibitors (ICI) in many tumor types, new strategies are needed to extend treatment benefits, especially in patients failing to mount effective antitumor T-cell responses. Radiation and drug therapies can profoundly affect the tumor immune microenvironment. Here, we aimed to identify immunotherapies to increase the antitumor response conferred by combined ataxia telangiectasia and Rad3-related kinase inhibition and radiotherapy. METHODS Using the human papillomavirus (HPV)-negative murine oral squamous cell carcinoma model, MOC2, we assessed the nature of the antitumor response following ataxia telangiectasia and Rad3-related inhibitor (ATRi)/radiotherapy (RT) by performing RNA sequencing and detailed flow cytometry analyses in tumors. The benefit of immunotherapies based on T cell immunoreceptor with Ig and ITIM domains (TIGIT) and Programmed cell death protein 1 (PD-1) immune checkpoint blockade following ATRi/RT treatment was assessed in the MOC2 model and confirmed in another HPV-negative murine oral squamous cell carcinoma model called SCC7. Finally, immune profiling was performed by flow cytometry on blood samples in patients with head and neck squamous cell carcinoma enrolled in the PATRIOT clinical trial of combined ATRi/RT. RESULTS ATRi enhances radiotherapy-induced inflammation in the tumor microenvironment, with natural killer (NK) cells playing a central role in maximizing treatment efficacy. We demonstrated that antitumor activity of NK cells can be further boosted with ICI targeting TIGIT and PD-1. Analyses of clinical samples from patients receiving ATRi (ceralasertib) confirm the translational potential of our preclinical studies. CONCLUSION This work delineates a previously unrecognized role for NK cells in the antitumor immune response to radiotherapy that can be augmented by small-molecule DNA damage-response inhibitors and immune checkpoint blockade.
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Affiliation(s)
- Emmanuel C Patin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Magnus T Dillon
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Pablo Nenclares
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Lorna Grove
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Heba Soliman
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Davina Northcote
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Galabina Bozhanova
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Eva Crespo-Rodriguez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Holly Baldock
- Biological Services Unit, The Institute of Cancer Research, London, UK
| | - Harriet Whittock
- Biological Services Unit, The Institute of Cancer Research, London, UK
| | - Gabriella Baker
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Joan Kyula
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Jeane Guevara
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Alan A Melcher
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | | | | | - Simon Smith
- Early Oncology R&D, AstraZeneca, Cambridge, UK
| | - Malin Pedersen
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Martin McLaughlin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kevin J Harrington
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
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Soliman H, Mariano G, Duboc H, Giovinazzo D, Coffin B, Gourcerol G, Moszkowicz D. Gastric motility disorders and their endoscopic and surgical treatments other than bariatric surgery. J Visc Surg 2022; 159:S8-S15. [DOI: 10.1016/j.jviscsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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White I, Hunt A, Bird T, Settatree S, Soliman H, Mcquaid D, Dearnaley D, Lalondrelle S, Bhide S. Interobserver variability in target volume delineation for CT/MRI simulation and MRI-guided adaptive radiotherapy in rectal cancer. Br J Radiol 2021; 94:20210350. [PMID: 34723622 PMCID: PMC8631009 DOI: 10.1259/bjr.20210350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Quantify target volume delineation uncertainty for CT/MRI simulation and MRI-guided adaptive radiotherapy in rectal cancer. Define optimal imaging sequences for target delineation. METHODS Six experienced radiation oncologists delineated clinical target volumes (CTVs) on CT and 2D and 3D-MRI in three patients with rectal cancer, using consensus contouring guidelines. Tumour GTV (GTVp) was also contoured on MRI acquired week 0 and 3 of radiotherapy. A STAPLE contour was created and volume and interobserver variability metrics were analysed. RESULTS There were statistically significant differences in volume between observers for CT and 2D-MRI-defined CTVs (p < 0.05). There was no significant difference between observers on 3D-MRI. Significant differences in volume were seen between observers for both 2D and 3D-MRI-defined GTVp at weeks 0 and 3 (p < 0.05). Good interobserver agreement (IOA) was seen for CTVs delineated on all imaging modalities with best IOA on 3D-MRI; median Conformity index (CI) 0.74 for CT, 0.75 for 2D-MRI and 0.77 for 3D-MRI. IOA of MRI-defined GTVp week 0 was better compared to CT; CI 0.58 for CT, 0.62 for 2D-MRI and 0.7 for 3D-MRI. MRI-defined GTVp IOA week three was worse compared to week 0. CONCLUSION Delineation on MRI results in smaller volumes and better IOA week 0 compared to CT. 3D-MRI provides the best IOA in CTV and GTVp. MRI-defined GTVp on images acquired week 3 showed worse IOA compared to week 0. This highlights the need for consensus guidelines in GTVp delineation on MRI during treatment course in the context of dose escalation MRI-guided rectal boost studies. ADVANCES IN KNOWLEDGE Optimal MRI sequences for CT/MRI simulation and MRI-guided adaptive radiotherapy in rectal cancer have been defined.
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Affiliation(s)
| | - Arabella Hunt
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Thomas Bird
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Settatree
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Heba Soliman
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Dualta Mcquaid
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - David Dearnaley
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Susan Lalondrelle
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Shree Bhide
- The Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
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Tan H, Stewart J, Ruschin M, Wang M, Myrehaug S, Tseng C, Detsky J, Husain Z, Sahgal A, Soliman H. Inter Fraction Target Dynamics and Variability Between T1 and T2-Weighted MRI During Surgical Cavity Hypofractionated Stereotactic Radiotherapy: Prospective Serial Imaging Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.610] [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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Tseng C, Chen H, Stewart J, Lau A, Chan R, Lawrence L, Campbell M, Myrehaug S, Soliman H, Husain Z, Detsky J, Maralani P, Keller B, Ruschin M, Sahgal A. Glioma Radiation Therapy on a High Field 1.5 MR-Linac: Workflow and Initial Experience. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1608] [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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Wang M, Kim A, Ruschin M, Tan H, Soliman H, Myrehaug S, Detsky J, Husain Z, Atenafu E, Keller B, Sahgal A, Tseng C. Dosimetric Comparison in Malignant Glioma Patients Clinically Treated on Hybrid Magnetic Resonance Imaging (MRI)-Linac (MRL) vs. Conventional Linac. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1416] [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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Cheung P, Tseng C, Chung H, Chu W, Vesprini D, Liu S, Morton G, Sahgal A, Soliman H, Myrehaug S, Detsky J, Szumacher E, Chung P, Helou J, Emmenegger U, Mamedov A, Shahid A, Zhang L, Loblaw D. Intermittent Androgen Deprivation Therapy Plus Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.873] [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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Stewart J, Maralani P, Mahtab M, Moazen B, Soliman H, Tseng C, Detsky J, Husain Z, Campbell M, Keller B, Myrehaug S, Sahgal A, Ruschin M. Planning Target Volume Implications of Residual Setup Uncertainty and Intrafraction Motion During MRI Guided Brain Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1603] [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: 11/28/2022]
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Soliman H, Abdel-Aal A, Elsabbagh A, Hamed M, Underwood E, Saddekni S. 581 Renal Arteriovenous Fistula Percutaneous Embolization Using the Amplatzer Vascular Plug II. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.302] [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: 11/12/2022]
Abstract
Abstract
Introduction
Renal arteriovenous fistula (AVF) is not considered a common condition; however, it can occasionally complicate with renal impairment and heart failure secondary to high cardiac output. Recently, percutaneous embolization has overcome traditional surgery as the first line of its management, because of better success rates as well as less morbidity and mortality.
Case report
A 68-year-old male who presented with a renal AVF post left partial nephrectomy associated with a large pseudoaneurysm. This was found on a computed tomography angiography (CTA) scan, a routine follows up for his endovascular aortic aneurysm repair. Due to the patient’s co-morbidities and to avoid the potentially fatal pseudoaneurysm rupture, a minimal invasive approach was agreed in the multidisciplinary meeting. He was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug II (AVP-II) through a right femoral arterial access. The patient recovery was uneventful, following an overnight stay he was discharged home. CTA done four and ten months later showed the AVP-II device inside the left renal artery branch feeder with no artifacts seen. There was absence of recanalization of the AVF. In the literature, adopting the transarterial route for the renal AVF treatment with AVP-II device as a single embolotherapy device has not been reported before.
Conclusions
Our report display the feasibleness of AVP-II in renal AVF treatment by arterial feeder embolization, specifically in fistulas with high flow and short communication as our case in which it showed offered multiple advantages over coils and is more cost effective.
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Affiliation(s)
- H Soliman
- King's College Hospital, London, United Kingdom
- University of Birmingham at Alabama, Alabama, USA
| | - A Abdel-Aal
- University of Birmingham at Alabama, Alabama, USA
| | - A Elsabbagh
- University of Birmingham at Alabama, Alabama, USA
| | - M Hamed
- University of Birmingham at Alabama, Alabama, USA
| | - E Underwood
- University of Birmingham at Alabama, Alabama, USA
| | - S Saddekni
- University of Birmingham at Alabama, Alabama, USA
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Soliman H, Halawa M, Awad R, Tan J. 580 Vascular Distal Bypass Early Surveillance Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.070] [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: 11/12/2022]
Abstract
Abstract
Introduction
Due to inconsistency in Duplex surveillance following distal bypass for peripheral arterial disease at our district general hospital. We planned an audit aiming to assess our current early surveillance of distal vascular bypass.
Method
The latest twenty patients who underwent distal bypass were collected retrospectively from the theatre’s records. Their clinical and imaging records were analysed to ascertain the timing of 1st duplex after the procedure. We also examined the discharge medications. We chose the standard advised by Society for Vascular Surgery that every patient following the procedure ideally should have (Clinical examination + ABPI + Duplex) at 1, 3, 6 and 12 months then annually.
Results
8 patients (40%) had a Duplex within 1 month, while 10% did not have a scan at all. Time range between the procedure and first Duplex was 1-11 months with a mean of 4 months. All patients were discharged on at least a single antiplatelet agent while only 70% were prescribed statins. Six patients needed an intervention for blocked graft but eventually failed, only one patient had a Duplex in a timely fashion, the stenosed graft was salvaged by angioplasty.
Conclusions
There was no clear standardized surveillance protocol for vascular team juniors to follow. In addition, discharge of distal bypass patients sometimes is carried by general surgery team during weekends and unlikely that a Duplex is booked. We suggested booking the Duplex in theaters soon after performing the procedure to ensure inclusion in the surveillance protocol, education of junior doctors and re-auditing in 1 year.
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Affiliation(s)
- H Soliman
- King's College Hospital, London, United Kingdom
- West Hertfordshire NHS Trust, Watford, United Kingdom
| | - M Halawa
- West Hertfordshire NHS Trust, Watford, United Kingdom
| | - R Awad
- West Hertfordshire NHS Trust, Watford, United Kingdom
| | - J Tan
- West Hertfordshire NHS Trust, Watford, United Kingdom
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Soliman H, Hussain A, Manejwala O, Ghosh A, Shauib S, Hafeez R, El-Hasani S. 579 Emergency Surgical Admissions During The COVID-19 Pandemic; Comparative Study of Emergency Surgery Outcome Before and During The COVID-19. Br J Surg 2021. [PMCID: PMC8524547 DOI: 10.1093/bjs/znab259.470] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction There are relatively few studies on emergency surgical practice in the COVID-19 pandemic. Our aim is to analyse the outcomes of emergency surgery before against those during COVID-19. Method Retrospectively we collected the emergency admissions to the general surgery department at a district general hospital during November 2019, which is a representative of our regular activity, and April 2020, the height of the COVID-19. The primary endpoint was the number and nature of surgical admissions and procedures. The secondary endpoints were morbidities and mortalities, laparoscopic and procedure approach (laparoscopic vs open), inflammatory markers (white cell count and C-reactive protein), hospital stay, gender and age. Results During the two months a total of 332 patients were admitted; 177 during November 2019 and 146 patients during April 2020. The mean age was 51 years in the November group and 49 years in the April group. 146 operations were conducted in November, while 117 procedures were performed in April. Hospital stay average was 5.87 days and 5.43 days for November and April groups, respectively. In the April group, seven patients tested positive for COVID-19. Mortality was slightly higher during April (2.05%) than November (1.6%). Postoperative complications, C-reactive protein level and prevalence of acute cholecystitis were much higher during April, while abscess and diverticulitis prevalence were significantly lower. Conclusions Morbidity, mortality and acute cholecystitis were significantly higher during the COVID-19 pandemic, while abscess and diverticulitis were significantly less prevalent likely due to and tendency by patients to avoid hospitals and hence late clinical presentation.
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Affiliation(s)
- H Soliman
- King's College Hospital, London, United Kingdom
| | - A Hussain
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - O Manejwala
- King's College Hospital, London, United Kingdom
| | - A Ghosh
- King's College Hospital, London, United Kingdom
| | - S Shauib
- King's College Hospital, London, United Kingdom
| | - R Hafeez
- King's College Hospital, London, United Kingdom
| | - S El-Hasani
- King's College Hospital, London, United Kingdom
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Chehade R, Wang X, Rosen M, Sahgal A, Das S, Saskin R, Zhang B, Soliman H, Chan KW, Jerzak K. 312P Survival of breast cancer patients with brain metastases treated with radiotherapy in Ontario, Canada: A population-based study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.595] [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: 11/28/2022] Open
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30
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Nenclares P, Gunn L, Soliman H, Bover M, Trinh A, Leslie I, Wong KH, Melcher A, Newbold K, Nutting CM, Ap Dafydd D, Bhide SA, Harrington K. On-treatment immune prognostic score for patients with relapsed and/or metastatic head and neck squamous cell carcinoma treated with immunotherapy. J Immunother Cancer 2021; 9:e002718. [PMID: 34103355 PMCID: PMC8190047 DOI: 10.1136/jitc-2021-002718] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have suggested that inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and fibrinogen) are prognostic biomarkers in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors (ICIs). We aimed to develop a model that predicts response and survival in patients with relapsed and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy. METHODS Analysis of 100 consecutive patients with unresectable R/M HNSCC who were treated with ICI. Baseline and on-treatment (day 28) NLR, fibrinogen and LDH were calculated and correlated with response, progression-free survival (PFS) and overall survival (OS) using univariate and multivariate analyses. The optimal cut-off values were derived using maximally selected log-rank statistics. RESULTS Low baseline NLR and fibrinogen levels were associated with response. There was a statistically significant correlation between on-treatment NLR and fibrinogen and best overall response. On-treatment high NLR and raised fibrinogen were significantly associated with poorer outcome. In multivariate analysis, on-treatment NLR (≥4) and on-treatment fibrinogen (≥4 ng/mL) showed a significant negative correlation with OS and PFS. Using these cut-off points, we generated an on-treatment score for OS and PFS (0-2 points). The derived scoring system shows appropriate discrimination and suitability for OS (HR 2.4, 95% CI 1.7 to 3.4, p<0.0001, Harrell's C 0.67) and PFS (HR 1.8, 95% CI 1.4 to 2.3, p<0.0001, Harrell's C 0.68). In the absence of an external validation cohort, results of fivefold cross-validation of the score and evaluation of median OS and PFS on the Kaplan-Meier survival distribution between trained and test data exhibited appropriate accuracy and concordance of the model. CONCLUSIONS NLR and fibrinogen levels are simple, inexpensive and readily available biomarkers that could be incorporated into an on-treatment scoring system and used to help predict survival and response to ICI in patients with R/M HNSCC.
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Affiliation(s)
- Pablo Nenclares
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Lucinda Gunn
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Heba Soliman
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Mateo Bover
- Head and Neck Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amy Trinh
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Alan Melcher
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Chris M Nutting
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Derfel Ap Dafydd
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Shreerang A Bhide
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Teama N, Elsharabasy R, Soliman H, ElSharkawy M. MO856IMPACT OF HEMODIALYSIS TIME PROLONGATION ON BLOOD PRESSURE CONTROL IN PREVALENT HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab098.0048] [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: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Hypertension prevalence among ESRD patients range from 76% to 90%. Sodium & volume overload is among the main mechanisms. Increasing theduration of dialysis time, either by longer session hours or increased sessions, aiming at reducing the dry weight to achieve euvolemia, may be beneficial for individuals who failed to achieve target BP or ideal volume status during standard HD prescription hours.We aim to study the effect of increasing hemodialysis session time on blood pressure control.
Method
This observational study was conducted on 50 adult clinically stable hypertensive prevalent HD patients on thrice weekly maintenance HD. Patients with secondary causes of hypertension and Patients with decompensated medical conditions were excluded from our study.Patients were divided into 2 groups:(A) 25 patients who received longer session hemodialysis session (4.5hour) and (B) 25 patients HD who received the usual 4 hours session.
Revision of antihypertensive medications&dosages,dry weight was reassessed regularly, andthey were instructed to restrict their salt intake as much as possible aiming at BP <140/90mmHg.they werefollowed up for a period of 6 months assess changes of pre-dialysis blood pressure to monitor response.
Results
Patients in both groups were age matched, with male sex predominance (64%in groupA&56% in groupB). Patients in both groups underwent their HD sessions mostly through AVF (68% and 92% for group A and B respectively). Ultrafiltration volume declined significantly with longer HD sessions compared to conventional sessions (p-value <0.001 vs 0.523).
Longer HD session time session was associated with highly significant decline in mean SBP, (p-value <0.001). Longer HD session time session was associated with highly statistically significant decline in mean DBP, (p-value <0.001). The decline in mean perdialysis SBP & DBP was -17.27 &-9 mmHg, respectively and the rate of decline of postdialysis SBP & DBP was -6.45 & -12.38 mmHg, respectively at 6th month compared to values in 1st month of follow up period.
Conclusion
Longer HD session duration is associated with better improvement in UF volume, mean SBP&DBP, pre-dialysis SBP&DBP and post-dialysis SBP&DBP as well.
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Affiliation(s)
- Nahla Teama
- Ain Shams University, Faculty of Medicine, Nephrology, Cairo, Egypt
| | - Reem Elsharabasy
- Ain Shams University, Faculty of Medicine, Nephrology, Cairo, Egypt
| | - Heba Soliman
- Mansheit El Bakry Hospital, Nephrology, Cairo, Egypt
| | - Magdy ElSharkawy
- Ain Shams University, Faculty of Medicine, Nephrology, Cairo, Egypt
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Soliman H, Girish G, Shahed S. 419 Endovascular Aortic Repair of Abdominal Aortic Aneurysm Early Re-Intervention Outcome, A District General Hospital Experience. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.277] [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: 11/12/2022]
Abstract
Abstract
Introduction
Endovascular repair (EVAR) transformed abdominal aortic aneurysm (AAA) management. However, it is associated with higher re-intervention rate compared with open repair. This audit evaluates the early re-intervention rate at Watford General Hospital relative to the 4-yearly average rate in the draft evidence review by NICE (16.89%).
Method
EVAR procedures performed in 2015 and 2016 were retrieved. The follow up was analysed to identify re-intervention procedures performed to address complications related to the initial EVAR or sac expansion.
Results
108 patients underwent EVAR during the 2-year inclusion period. 21 re-interventions (19.4%) were recorded, irrespective of type or cause of re-intervention. 30 patients (28.6%) developed endoleak but only 17 (56.7%) had a re-intervention. Type 1 endoleak was the main cause for re-intervention (28.6%). The majority of re-interventions were executed endovascularly (57%). 47.6% of the re-interventions were done during the first year following EVAR.
Conclusions
Even though our re-intervention rate was relatively above the international average, EVAR is still considered safe for AAA repair with low morbidity and mortality. As re-interventions are frequently required, long-term surveillance is essential. Conversely, most of re-interventions can be performed with minimal morbidity. We recommend discussing all cases in a formal MDT before surgery and any re-intervention.
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Affiliation(s)
- H Soliman
- West Hertfordshire NHS Trust, Watford, United Kingdom
| | - G Girish
- West Hertfordshire NHS Trust, Watford, United Kingdom
| | - S Shahed
- West Hertfordshire NHS Trust, Watford, United Kingdom
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Gunn L, Gilbert J, Nenclares P, Soliman H, Newbold K, Bhide S, Wong KH, Harrington K, Nutting C. Taste dysfunction following radiotherapy to the head and neck: A systematic review. Radiother Oncol 2021; 157:130-140. [PMID: 33545253 DOI: 10.1016/j.radonc.2021.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND An intact sense of taste provides pleasure, supports sustenance and alerts the body to toxins. Head and neck cancer (HNC) patients who receive radiotherapy (RT) are high-risk for developing radiation-induced taste dysfunction. Advances in RT offer opportunities for taste-preserving strategies by reducing dose to the gustatory organs-at-risk. METHODS PubMed, Medline and EMBASE were searched for publications reporting on taste, RT and HNC. Randomised trials, cohort studies and cross-sectional studies were included. RESULTS 31 studies were included in this review. Meta-analysed prevalence of acute taste dysfunction following RT was approximately 96% (95% CI 64 to 100%) by objective measures and 79% (95% CI 65 to 88%) by subjective measures, with the majority of patients showing at least partial recovery. Long-term dysfunction was seen in ~25% of patients. Taste dysfunction was associated with sequalae including weight loss and reduced quality-of-life (QoL). Taste dysfunction was more common when the oral cavity, and specifically the anterior two-thirds of the tongue, was irradiated, suggesting a dose constraint for taste preservation might be feasible. Proton beam therapy and customised bite blocks reduced dose to the gustatory field and subsequent loss of taste. CONCLUSIONS Taste dysfunction following RT is common and negatively affects patients' nutritional status and QoL. Decisions about treatment strategies, including choice of RT modality, dose distribution across the gustatory field and the use of adjuncts like bite blocks may be beneficial. However, evidence is limited. There is a pressing need for randomised studies or large prospective cohort studies with sufficient adjustment for confounders.
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Affiliation(s)
- Lucinda Gunn
- Head and Neck Unit, The Royal Marsden London, London, UK.
| | | | | | - Heba Soliman
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Shree Bhide
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Elmougy F, Elsharkawy M, Hafez M, Atty SA, Baz H, Ibrahim A, Soliman H, Ekladious S, Abdullatif M, Thabet G, Rady N, Afif A, Tolba A, Zaki Z, Musa N. Genetic profiling of CAH Egyptian children: rapid guide to clinical interpretation of common mutations. J Endocrinol Invest 2021; 44:83-93. [PMID: 32358738 DOI: 10.1007/s40618-020-01271-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The prevalence of CAH in Egypt is reported to be ten times more than that of the worldwide prevalence. The study aimed at genetic screening of children diagnosed with 21-alpha hydroxylase deficiency congenital adrenal hyperplasia (21OHD-CAH). In addition, the study offers a rapid and easy guide for clinical reporting of common mutations for endocrinologists. METHODS A cohort of 174 unrelated Egyptian children with 21OHD-CAH were screened for 11 common CYP21A2 gene mutations using a strip hybridization assay, and then, bioinformatics analysis was done to report the pathogenicity of the common mutations for clinical classification. RESULTS The most common mutations were I2 splice and p.Q318X. Deletions/conversions comprised 45.9% of the cohort, whereas 7.4% of the cases were negative for all mutations. The least positively detected point mutations were p.P453S, cluster E6, p.R483P, and p.L307FS, which were detected in fewer than 5% of cases. CONCLUSION Strip hybridization assay is a rapid screening tool for the diagnosis of CAH. The authors hypothesized an easy and rapid scheme for clinical interpretation of the strip results to gain the highest value of the strip in diagnosis.
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Affiliation(s)
- F Elmougy
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - M Elsharkawy
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt.
| | - M Hafez
- Diabetes, Endocrine and Metabolism Pediatric Unit, Cairo University, Cairo, Egypt
| | - S A Atty
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - H Baz
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - A Ibrahim
- Diabetes, Endocrine and Metabolism Pediatric Unit, Cairo University, Cairo, Egypt
| | - H Soliman
- Diabetes, Endocrine and Metabolism Pediatric Unit, Cairo University, Cairo, Egypt
| | - S Ekladious
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - M Abdullatif
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - G Thabet
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - N Rady
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - A Afif
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - A Tolba
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Aini Hospital, Cairo University, Cairo, 11562, Egypt
| | - Z Zaki
- Clinical and Chemical Pathology Department, Minia University, El Minya, Egypt
| | - N Musa
- Diabetes, Endocrine and Metabolism Pediatric Unit, Cairo University, Cairo, Egypt
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Zeng K, Husain Z, Soliman H, Myrehaug S, Tseng C, Detsky J, Lee Y, Campbell M, Foster M, Atenafu E, Maralani P, Sahgal A. Imaging-Based Local Control Rates For “Radioresistant” Spinal Metastases Following Spine Stereotactic Body Radiotherapy Using Prostate Cancer As The “Radiosensitive” Reference. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.132] [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: 10/23/2022]
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Cheung P, Patel S, North S, Sahgal A, Chu W, Soliman H, Ahmad B, Winquist E, Niazi T, Pantenaude F, Lim G, Heng D, Dubey A, Czaykowsky P, Wong R, Swaminath A, Morgan S, White J, Keshavarzi S, Bjarnason G. Stereotactic Radiotherapy for Oligoprogression in Metastatic Kidney Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Prospective Phase II Multi-Centre Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mehrabian H, Lam W, Myrehaug S, Ruschin M, Tseng C, Detsky J, Husain Z, Stanisz G, Sahgal A, Soliman H. Quantitative MRI Metrics Differentiating Radioresistant from Radiosensitive Brain Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2192] [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: 11/28/2022]
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Potluri T, Fahey M, Kawahara Y, Mills M, Figura N, Washington I, Diaz R, Robinson T, Yu H, Etame A, Czerniecki B, Arrington J, Forsyth P, Soliman H, Han H, Ahmed K. Brain Metastases Outcomes In Patients With Melanoma, Non-Small Cell Lung Cancer, And Breast Cancer And Implications For Screening Brain MRIs. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.057] [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: 10/23/2022]
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39
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Mehrabian H, Lam W, Myrehaug S, Ruschin M, Tseng C, Detsky J, Husain Z, Stanisz G, Sahgal A, Soliman H. Quantitative MRI (qMRI) Metrics of Response to Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2084] [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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Lee M, Tseng C, Detsky J, Husain Z, Ruschin M, Lee Y, Myrehaug S, Sahgal A, Soliman H. Rates Of Radionecrosis In Re-Irradiation Of Brain Metastases Using Hypofractionated Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.100] [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: 10/23/2022]
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Angelis V, Tippu Z, Joshi K, Reis S, Gronthoud F, Fribbens C, Okines A, Stanway S, Cottier E, McGrath S, Watkins D, Noble J, Bhosle J, Gerlinger M, Hamid I, Soliman H, Nenclares P, Jones R, Harrington K, Gennatas S. Defining the true impact of coronavirus disease 2019 in the at-risk population of patients with cancer. Eur J Cancer 2020; 136:99-106. [PMID: 32659475 PMCID: PMC7340059 DOI: 10.1016/j.ejca.2020.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In light of the coronavirus disease 2019 (COVID-19) pandemic, cancer centres in the United Kingdom and Europe re-organised their services at an unprecedented pace, and many patients with cancer have had their treatments severely disrupted. Patients with cancer were considered at high risk on sparse evidence, and despite a small number of emerging observational studies, the true incidence and impact of COVID-19 in the 'at-risk' population of patients with cancer is yet to be defined. METHODS Epidemiological and clinical data were collected prospectively for patients attending the Royal Marsden Hospital and three network hospitals between March 1st and April 30th 2020 that were confirmed to have Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Significance of clinical and pathological characteristics was assessed using the Fisher's exact test and Wilcoxon rank sum test, whilst univariate and multivariate logistic regression models were used to further assess risk. The number of patients attending in March/April 2020 for face-to-face attendances was also extracted. FINDINGS During the 2-month study period, 867 of 13,489 (6.4%) patients met the criteria leading to swab testing. Of the total at-risk population, only 113 of 13,489 (0.84%) were swab positive, 101 of 13,489 (0.75%) required hospital admission and 29 of 13,489 (0.21%) died of COVID-19. Of the patients that attended the hospital to receive cytotoxic chemotherapy alone or in combination with other therapy, 59 of 2001 (2.9%) were admitted to the hospital for COVID-19-related issues and 20 of 2001 (1%) died. Of the patients that collected targeted treatments, 16 of 1126 (1.4%) were admitted and 1 of 1126 (0.1%) died. Of the 11 patients that had received radiotherapy, 6 of 1042 (0.6%) required inpatient admission and 2 of 1042 (0.2%) died. INTERPRETATIONS Administration of systemic anticancer therapy appears to be associated with a modest risk of severe COVID-19 infection. Based on this snapshot taken as the first wave of COVID-19 hit our practice, we conclude that continuation of active cancer treatment, even in the palliative setting, is appropriate.
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Affiliation(s)
| | - Zayd Tippu
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Kroopa Joshi
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Sara Reis
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Firza Gronthoud
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - Alicia Okines
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Susannah Stanway
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK; Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Emma Cottier
- Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Sophie McGrath
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - David Watkins
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Jillian Noble
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK; Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Jaishree Bhosle
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Marco Gerlinger
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Intan Hamid
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Heba Soliman
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Pablo Nenclares
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Robin Jones
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Kevin Harrington
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
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Schachner O, Dinhopl N, Friedl A, Soliman H, El-Matbouli M. Advanced vacuolation indicates propagation of various salmonid alphavirus type 2 isolates in Acholeplasma-infected BF-2 cells. Dis Aquat Organ 2020; 139:189-197. [PMID: 32495745 DOI: 10.3354/dao03481] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During previous routine inspections of bluegill fry (BF-2) and rainbow trout gonad (RTG-2) cells incubated with organ samples from asymptomatic Arctic char Salvelinus alpinus, brook trout Salvelinus fontinalis, and rainbow trout Oncorhynchus mykiss, a distinctive, reproducible cytopathic effect (CPE) appeared. The striking CPE, involving progressive vacuolation turning into slowly proceeding pyknotic degeneration, was originally attributed exclusively to enhanced growth of Acholeplasma sp. However, at a recent re-examination of re-infected BF-2 cells using electron microscopy (EM), conventional PCR, and quantitative PCR (qPCR), a virus was also detected. Two days post inoculation (dpi), EM revealed characteristic virions inside cytoplasmic vacuoles and next to bacteria outside the cells. The nucleotide sequences of the viral nsP3 gene fragment obtained from supernatants of infected cells were 100% identical and representative for salmonid alphavirus type 2 (SAV 2). The 16S RNA gene (16S rDNA) fragment sequences of the Mollicutes-specific PCR product obtained from SAV-infected as well as virus-free BF-2 control cells were identical with Acholeplasma laidlawii. In addition, qPCR results indicated enhanced propagation of virus and bacteria increasing with vacuolation between 5 and 8 dpi. Advanced vacuolation can be regarded as a CPE of both SAV and A. laidlawii, suggesting a viral impact on the bacterial infection that turns a latent intracellular stage into an apparent degenerative condition.
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Affiliation(s)
- O Schachner
- Clinical Division of Fish Medicine, University of Veterinary Medicine, 1210 Vienna, Austria
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Erler D, Poon I, Cheung P, Sahgal A, Soliman H, Korol R. Evaluating Respiratory Motion of the Bony Thorax in the Context of Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.860] [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: 11/17/2022]
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Detsky J, Nguyen T, Soliman H, Myrehaug S, Tseng C, Sahgal A, Heyn C, Maralani P. Fat-Saturated Dixon-Based Magnetic Resonance Imaging for Improved Detection of Brain Metastases for Radiosurgery Planning. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2330] [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: 11/15/2022]
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Zeng K, Tseng C, Myrehaug S, Soliman H, Husain Z, Sahgal A. Features of Patients Living Less Than 3 Months Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2252] [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: 10/26/2022]
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Stewart J, Myrehaug S, Lee Y, Tseng C, Soliman H, Xie J, Campbell M, Lau A, Sahgal A, Ruschin M. Machine Learning-Based Tumor Contour Propagation for MRI Adaptive Radiotherapy of Gliobastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.747] [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: 10/26/2022]
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Potluri T, Figura N, Oliver D, Robinson T, Etame A, Tran N, Liu J, Soliman H, Forsyth P, Sahebjam S, Yu M, Han H, Ahmed K. CDK 4/6 Inhibitors and Stereotactic Radiation in the Management of Hormone Receptor-Positive Breast Cancer Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Faruqi S, Soliman H, Myrehaug S, Zeng K, Husain Z, Atenafu E, Tseng C, Das S, Perry J, Maralani P, Heyn C, Mainprize T, Ruschin M, Sahgal A. Radiation Necrosis Following Five Daily Fractions of Stereotactic Radiotherapy for Surgical Cavities and Intact Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2333] [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: 11/28/2022]
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Stewart J, Myrehaug S, Lee Y, Tseng C, Soliman H, Xie J, Campbell M, Lau A, Sahgal A, Ruschin M. Quantitative Assessment of Tumor Dynamics using Serial MRIs during Post-Operative Radiotherapy of Glioblastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2313] [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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Nguyen T, Sahgal A, Detsky J, Atenafu E, Myrehaug S, Tseng C, Husain Z, Ruschin M, Lee Y, Heyn C, Soliman H. Predictors of Leptomeningeal Disease after Hypofractionated Stereotactic Radiotherapy for Intact and Resected Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2351] [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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