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Chan AW, Simone Ii CB, van der Velden JM, van der Linden Y, Hoskin P, Detsky J, Choi JI, Lee SF, Wong HCY, Martin EJ, Raman S, Rades D, Willmann J, Rembielak A, Kazmierska J, Keit ER, Marta GN, Vassiliou V, Alcorn S, Bonomo P, Oldenburger E. A phase II trial on radiotherapy for high-risk asymptomatic bone metastases-creating more questions than answers? Ann Palliat Med 2024; 0:apm-23-595. [PMID: 38644554 DOI: 10.21037/apm-23-595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Affiliation(s)
- Adrian Wai Chan
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone Ii
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Emily J Martin
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Agata Rembielak
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Electroradiology Department, University of Medical Sciences, Poznan, Poland
| | - Emily R Keit
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus
| | - Sara Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
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Kennedy SKF, Goodall S, Lee SF, DeAngelis C, Jocko A, Charbonneau F, Wang K, Pasetka M, Ko YJ, Wong HCY, Chan AW, Rajeswaran T, Gojsevic M, Chow E, Gralla RJ, Ng TL, Jerzak KJ. 2020 ASCO, 2023 NCCN, 2023 MASCC/ESMO, and 2019 CCO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer 2024; 32:280. [PMID: 38594320 DOI: 10.1007/s00520-024-08462-x] [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: 08/22/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common toxicity that may impair the quality of life of patients with various malignancies ranging from early to end stages. In light of frequent changes to the guidelines for optimal management of CINV, we undertook this narrative review to compare the most recent guidelines published by ASCO (2020), NCCN (2023), MASCC/ESMO (2023), and CCO (2019). The processes undertaken by each organization to evaluate existing literature were also described. Although ASCO, NCCN, MASCC/ESMO, and CCO guidelines for the treatment and prevention of CINV share many fundamental similarities, the literature surrounding low and minimal emetic risk regimens is lacking. Current data regarding adherence to these guidelines is poor and warrants further investigation to improve care.
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Affiliation(s)
- Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Shannon Goodall
- Department of Internal Medicine, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Allison Jocko
- Scarborough Health Network, Oncology Pharmacy, Toronto, ON, Canada
| | - Flay Charbonneau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katie Wang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Pasetka
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Yoo-Joung Ko
- Oncology and Endoscopy, St Michael Hospital, Toronto, ON, Canada
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Adrian Wai Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Richard J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Terry L Ng
- Division of Medical Oncology, Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katarzyna J Jerzak
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Rades D, Simone CB, Wong HCY, Chow E, Lee SF, Johnstone PAS. Reirradiation of metastases of the central nervous system: part 2-metastatic epidural spinal cord compression. Ann Palliat Med 2024; 0:apm-23-594. [PMID: 38600819 DOI: 10.21037/apm-23-594] [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] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
An increasing number of patients irradiated for metastatic epidural spinal cord compression (MESCC) experience an in-field recurrence and require a second course of radiotherapy. Reirradiation can be performed with conventional radiotherapy or highly-conformal techniques such as intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT). When using conventional radiotherapy, a cumulative biologically effective dose (BED) ≤120 calculated with an α/β value of 2 Gy (Gy2) was not associated with radiation myelopathy in a retrospective study of 124 patients and is considered safe. In that study, conventional reirradiation led to improvements of motor deficits in 36% of patients and stopped further symptomatic progression in another 50% (overall response 86%). In four other studies, overall response rates were 82-89%. In addition to the cumulative BED or equivalent dose in 2 Gy fractions (EQD2), the interval between both radiotherapy courses <6 months and a BED per course ≥102 Gy2 (corresponding to an EQD2 ≥51 Gy2) were identified as risk factors for radiation myelopathy. Without these risk factors, a BED >120 Gy2 may be possible. Scoring tools have been developed that can assist physicians in estimating the risk of radiation myelopathy and selecting the appropriate dose-fractionation regimen of re-treatment. Reirradiation of MESCC may also be performed with highly-conformal radiotherapy. With IMRT or VMAT, rates of pain relief and improvement of neurologic symptoms of 60-93.5% and 42-73%, respectively, were achieved. One-year local control rates ranged between 55% and 88%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0% and 0-9.3%, respectively. With SBRT, rates of pain relief were 65-86%. Two studies reported improvements in neurologic symptoms of 0% and 82%, respectively. One-year local control rates were 74-83%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0-4.5% and 4.5-13.8%, respectively. For SBRT, a cumulative maximum EQD2 to thecal sac ≤70 Gy2, a maximum EQD2 of SBRT ≤25 Gy2, a ratio ≤0.5 of thecal sac maximum EQD2 of SBRT to maximum cumulative EQD2, and an interval between both courses ≥5 months were associated with a lower risk of myelopathy. Additional prospective trials are required to better define the options of reirradiation of MESCC.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | | | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Rades D, Simone CB, Wong HCY, Chow E, Lee SF, Johnstone PAS. Reirradiation of metastases of the central nervous system: part 1-brain metastasis. Ann Palliat Med 2024; 0:apm-23-593. [PMID: 38509654 DOI: 10.21037/apm-23-593] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Because of improved survival of cancer patients, more patients irradiated for brain metastases develop intracerebral recurrences requiring subsequent courses of radiotherapy. Five studies focused on reirradiation with whole-brain radiation therapy (WBRT) after initial WBRT for brain metastases. Following the second WBRT course, improvement of clinical symptoms was found in 31-68% of patients. Rates of neurotoxicity, such as encephalopathy or cognitive decline, were reported in two studies (1.4% and 32%). In another study, severe or unexpected adverse events were not observed. Survival following the second WBRT course was generally poor, with median survival times of 2.9-4.1 months. The survival prognosis of patients receiving two courses of WBRT can be estimated by a scoring tool considering five prognostic factors. Three studies investigated reirradiation with single-fraction stereotactic radiosurgery (SF-SRS) following primary WBRT. One-year local control rates were 74-91%, and median survival times ranged between 7.8 and 14 months. Rates of radiation necrosis (RN) after reirradiation were 0-6%. Seven studies were considered that investigated re-treatment with SF-SRS or fractionated stereotactic radiation therapy (FSRT) following initial SF-SRS or FSRT. One-year local control rates were 60-88%, and the median survival times ranged between 8.3 and 25 months. During follow-up after reirradiation, rates of overall (asymptomatic or symptomatic) RN ranged between 12.5% and 30.4%. Symptomatic RN occurred in 4.3% to 23.9% of cases (patients or lesions). The risk of RN associated with symptoms and/or requiring surgery or corticosteroids appears lower after reirradiation with FSRT when compared to SF-SRS. Other potential risk factors of RN include the volume of overlap of normal tissue receiving 12 Gy at the first course and 18 Gy at the second course of SF-SRS, maximum doses ≥40 Gy of the first or the second SF-SRS courses, V12 Gy >9 cm3 of the second course, initial treatment with SF-SRS, volume of normal brain receiving 5 Gy during reirradiation with FSRT, and systemic treatment. Cumulative EQD2 ≤100-120 Gy2 to brain, <100 Gy2 to brainstem, and <75 Gy2 to chiasm and optic nerves may be considered safe. Since most studies were retrospective in nature, prospective trials are required to better define safety and efficacy of reirradiation for recurrent or progressive brain metastases.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | | | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Rajeswaran T, Wong HCY, Zhang E, Kennedy SKF, Gojsevic M, Soliman H, Vassiliou V, Rades D, Bonomo P, Lee SF, Chan AW, Rembielak A, Oldenburger E, Maranzano E, Pergolizzi S, Finkelstein JA, Larouche J, Zhang N, Zhang X, Marta GN, Yee AJM, Yu S, van der Velden JM, van der Linden YM, Chow E. Quality of life issues in patients with bone metastases: A systematic review. Support Care Cancer 2023; 32:18. [PMID: 38091116 DOI: 10.1007/s00520-023-08241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Bones are frequent sites of metastatic disease, observed in 30-75% of advanced cancer patients. Quality of life (QoL) is an important endpoint in studies evaluating the treatments of bone metastases (BM), and many patient-reported outcome tools are available. The primary objective of this systematic review was to compile a list of QoL issues relevant to BM and its interventions. The secondary objective was to identify common tools used to assess QoL in patients with BM, and the QoL issues they fail to address. METHODS A search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and 27 January 2023 with the keywords "bone metastases", "quality of life", and "patient reported outcomes". Specific QoL issues in original research studies and the QoL tools used were extracted. RESULTS The review identified the QoL issues most prevalent to BM in the literature. Physical and functional issues observed in patients included pain, interference with ambulation and daily activities, and fatigue. Psychological symptoms, such as helplessness, depression, and anxiety were also common. These issues interfered with patients' relationships and social activities. Items not mentioned in existing QoL tools were related to newer treatments of BM, such as pain flare, flu-like symptoms, and jaw pain due to osteonecrosis. CONCLUSIONS This systematic review highlights that QoL issues for patients with BM have expanded over time due to advances in BM-directed treatments. If they are relevant, additional treatment-related QoL issues identified need to be validated prospectively by patients and added to current assessment tools.
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Affiliation(s)
- Thenugaa Rajeswaran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hospital Authority, Kowloon, Hong Kong
| | - Elwyn Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Samantha K F Kennedy
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Milena Gojsevic
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Shing-Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, New Territories, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, New Territories, Hong Kong
| | - Agata Rembielak
- The University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie HNS Foundation Trust, Manchester, UK
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Ernesto Maranzano
- Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Joel A Finkelstein
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jeremie Larouche
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Na Zhang
- Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Xiaojing Zhang
- Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Gustavo N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Albert J M Yee
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvette M van der Linden
- Department of Radiotherapy, Leiden University Medical Center, University of Leiden, Leiden, Holland
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Wong HCY, Lee SF, Chan AW, Caini S, Hoskin P, Simone CB, Johnstone P, van der Linden Y, van der Velden JM, Martin E, Alcorn S, Johnstone C, Isabelle Choi J, Nader Marta G, Oldenburger E, Raman S, Rembielak A, Vassiliou V, Bonomo P, Nguyen QN, Chow E, Ryu S. Stereotactic body radiation therapy versus conventional external beam radiotherapy for spinal metastases: A systematic review and meta-analysis of randomized controlled trials. Radiother Oncol 2023; 189:109914. [PMID: 37739318 DOI: 10.1016/j.radonc.2023.109914] [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: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS PubMed, EMBASE and Cochrane Library were searched up to 6 May 2023 for RCTs comparing SBRT and cEBRT for spinal metastases. Overall and complete pain response, local progression, overall survival, quality of life and adverse events were extracted. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) for dichotomous outcomes, and hazard ratios (HRs) for time-to-event outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic. RESULTS Three RCTs were identified involving 642 patients. No differences were seen in overall pain response comparing SBRT and cEBRT (RR at 3 months: 1.12, 95% CI, 0.74-1.70, p = 0.59; RR at 6 months: 1.29, 95% CI, 0.97-1.72, p = 0.08). Only two of three studies presented complete pain response data. SBRT demonstrated a statistically significant improvement in complete pain response compared to cEBRT (RR at 3 months: 2.52; 95% CI, 1.58-4.01; P < 0.0001; RR at 6 months: 2.48; 95% CI, 1.23-4.99; P = 0.01). There were no significant differences in local progression and overall survival. Adverse events were similar, except for any grade radiation dermatitis, which was significantly lower in SBRT arm (RR 0.17, 95% CI 0.03-0.96, P = 0.04). CONCLUSION SBRT is a safe treatment option for spine metastases. It may provide better complete pain response compared to cEBRT. Additional trials are needed to determine the potential benefits of SBRT in specific patient subsets.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China.
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, United Kingdom
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emily Martin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, LA, USA
| | - Sara Alcorn
- Department of Radiation Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Brazil
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Agata Rembielak
- Division of Cancer Sciences, University of Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Vassilios Vassiliou
- Bank of Cyprus Oncology Centre, Department of Radiation Oncology, Nicosia, Cyprus
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, New York, NY, USA
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Gojsevic M, Shariati S, Chan AW, Bonomo P, Zhang E, Kennedy SKF, Rajeswaran T, Rades D, Vassiliou V, Soliman H, Lee SF, Wong HCY, Rembielak A, Oldenburger E, Akkila S, Azevedo L, Chow E. Quality of life in patients with malignant spinal cord compression: a systematic review. Support Care Cancer 2023; 31:736. [PMID: 38055061 DOI: 10.1007/s00520-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature. METHODS A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC. RESULTS The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future. CONCLUSION This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elwyn Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing-Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Agata Rembielak
- The University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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8
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Chan AW, Wong HCY, Taphoorn M, Dirven L, Le Rhun E, Soliman H, Oldenburger E, Raman S, Vassiliou V, Bonomo P, Koller M, Marta GN, Rembielak A, Lee SF, Chow E, Simone CB. Latest clinical research in leptomeningeal disease (LMD)-a narrative review. Ann Palliat Med 2023; 12:1215-1231. [PMID: 37953219 DOI: 10.21037/apm-23-390] [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] [Received: 04/23/2023] [Accepted: 09/10/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Leptomeningeal disease (LMD) is associated with poor survival and health-related quality of life (HRQoL). There is an urgent need for clinical research in this area to improve the outcomes. The purpose of this study is to summarize the areas of active clinical research in LMD, identify the knowledge gap, and suggest future research directions. METHODS A narrative review of clinical trials in LMD was conducted based on a search in clinicatrials.gov using the search term "leptomeningeal" under "condition or disease". Clinical trials in patients with LMD arising from solid malignancy that were labelled as "not yet recruiting", "recruiting", "enrolling by invitation" or "active, not recruiting" were included. Studies which were deemed to have significant impact on future research direction in LMD were selected for discussion. KEY CONTENT AND FINDINGS A total of 38 clinical trials were included. Of these 38 trials, 19 are discussed in this review, with focus on their research questions and impact on future research directions. Most of the studies that were not selected for discussion focused on biomarker-driven interventions. Four key areas of research were identified, namely the (I) diagnosis, response assessment or molecular profiling of LMD (n=2); (II) advances in radiotherapy (n=3); (III) intrathecal treatment (n=13); (IV) novel drug carrier for systemic treatment (n=1). The research questions in the 19 discussed clinical trials included the tumour microenvironment of LMD, the role of novel molecular techniques in LMD, combination of radiotherapy with drugs, and cell-based immunotherapy. Among these 19 studies, 11 were phase 1 trials, 3 were phase 2 or phase 1/2 trials, 2 were phase 3 or phase 2/3 trials and the study phase was not reported in the remaining 3 studies. The existing knowledge gaps are discussed, including the lack of primary site-specific prognostic tools, cost-effectiveness studies, dedicated HRQoL assessment tools for LMD and sequencing of treatment. CONCLUSIONS The current clinical trials in LMD offer the promise to improve the diagnosis and treatment outcomes of patients with LMD. More research is needed to overcome the potential hurdles in the current treatment and bridge the knowledge gaps as identified in this review, to improve patients' quantity and quality of survival.
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Affiliation(s)
- Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China; Department of Radiation Oncology, National University Cancer Institute, National Univeresity Hospital, Singapore, Singapore
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
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9
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Wong HCY, Chan AW, Johnstone P, Simone CB, Navarro-Domenech I, Hoskin P, Johnstone C, Recht A, Menten J, van der Linden YM, van der Velden JM, Nguyen QN, Lutz S, Andratschke N, Wilmann J, Kazmierska J, Spalek M, Lim F, Yu HM, Perez B, Marta GN, Vassiliou V, Lee SF, Bonomo P, Rembielak A, Chow E, Oldenburger E, Raman S. A critical appraisal of the four systematic reviews and meta-analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here. Ann Palliat Med 2023; 12:1318-1330. [PMID: 37303218 DOI: 10.21037/apm-23-218] [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] [Received: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Radiotherapy is an important treatment modality for pain control in patients with bone metastases. Stereotactic body radiation therapy (SBRT), which allows delivering a much higher dose per fraction while sparing critical structures compared to conventional external beam radiotherapy (cEBRT), has become more widely used, especially in the oligometastatic setting. Randomized controlled trials (RCTs) comparing the pain response rate of SBRT and cEBRT for bone metastases have shown conflicting results, as have four recent systematic reviews with meta-analyses of these trials. Possible reasons for the different outcomes between these reviews include differences in methodology, which trials were included, and the endpoints examined and how they were defined. We suggest ways to improve analysis of these RCTs, particularly performing an individual patient-level meta-analysis since the trials included heterogeneous populations. The results of such studies will help guide future investigations needed to validate patient selection criteria, optimize SBRT dose schedules, include additional endpoints (such as the time to onset of pain response, durability of pain response, quality of life (QOL), and side effects of SBRT), and better assess the cost-effectiveness and trade-offs of SBRT compared to cEBRT. An international Delphi consensus to guide selection of optimal candidates for SBRT is warranted before more prospective data is available.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | | | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, The University of Manchester, UK
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johan Menten
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Yvette M van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Lutz
- Eastern Woods Radiation Oncology, Blanchard Valley Health Organization, Findlay, OH, USA
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Wilmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Department of Electroradiology, Poznań University of Medical Sciences, Poznan, Poland
| | - Mateusz Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Fiona Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - H Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brad Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China; Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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10
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Lee SF, Wong HCY, Chan AW, Caini S, Shariati S, Rades D, Chan RJ, Kennedy SKF, Wolf JR, van den Hurk C, Behroozian T, Bonomo P, Ho FCH, Chow E, Herst P. Mepitel Film for the prevention of acute radiation dermatitis in head and neck cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:527. [PMID: 37594538 DOI: 10.1007/s00520-023-07988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluates the efficacy of Mepitel Film in preventing acute radiation dermatitis (RD) in patients with head and neck cancer (HNC) across randomized controlled trials (RCTs). METHODS Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched on 5 March 2023 to identify relevant RCTs. RD assessment tools and outcomes were compared across studies. Pooled effect sizes and 95% confidence intervals (CI) were estimated based on random-effects analysis using RevMan 5.4. RESULTS Three RCTs conducted between 2018 and 2020 were included. Mepitel Film decreased RD severity when compared to Sorbolene or Biafine but not when compared to mometasone. A per-protocol analysis of two of the trials revealed that, overall, Mepitel Film significantly reduced the incidence of grade 2-3 RD (odds ratio (OR), 0.24; 95% CI, 0.09-0.65; p = 0.005) and moist desquamation (OR, 0.21; 95% CI, 0.10-0.46; p < 0.0001) and decreased average patient, researcher, and combined components of the Radiation-Induced Skin Reaction Assessment Scale (the standardized mean difference (SMD) for patient ratings, - 2.56; 95% CI, - 3.15 to - 1.96, p < 0.00001; SMD for researcher ratings, - 3.47; 95% CI, - 6.63 to - 0.31, p = 0.03; SMD for combined scores, - 3.68; 95% CI, - 6.43 to - 0.92, p = 0.009). Noted issues with Mepitel Film included itchiness and poor adherence. CONCLUSION While there were discrepancies across studies, Mepitel Film demonstrated a decrease in the incidence of grade 2-3 RD and moist desquamation. These findings emphasize the need for further examining Mepitel Film's efficacy across diverse patient groups and the importance of standardizing RD severity assessment methodologies and control arms.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore.
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong.
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francis C H Ho
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
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11
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Wong HCY, Chan AW, David E, Marta GN, Pan NY, Koller M, Lim F, Yeung R, Chow E, Simone CB. Should endovascular stenting be used routinely as first-line treatment for malignant superior vena cava syndrome?-a critical review in the context of recent advances in oncological treatments. Ann Palliat Med 2023; 12:803-815. [PMID: 37038079 DOI: 10.21037/apm-22-1293] [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] [Received: 11/14/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
Malignant superior vena cava syndrome (SVCS) is no longer considered a medical emergency in most cases because it rarely leads to life-threatening complications. However, it results in disturbing symptoms that can significantly affect patients' quality of life. Treating this condition effectively while minimising treatment-related morbidity is of increasing importance as cancer patients are living longer from advances in oncological treatments. This clinical practice review discusses the implications of these advances on the decision to consider stenting as the initial treatment for SVCS. Stenting is increasingly popular as it provides quick symptomatic relief with low rates of complications. Systemic treatments have evolved in the past two decades with the development of immunotherapy and targeted therapies that have different response patterns compared to conventional chemotherapy. Furthermore, major changes have also been seen in radiotherapy techniques that allow treatments to better conform to targets while sparing normal tissues. These advances have changed practice patterns for stent placement in SVCS patients in both the localised and metastatic settings. Prospective studies using standardised patient-reported outcome tools are needed to determine the optimal treatment sequence for SVCS patients, as current recommendations are mainly based on retrospective single-arm studies. An individualized approach with multidisciplinary input is therefore important to optimize patient outcomes before more robust evidence is available.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Elizabeth David
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Nin Yuan Pan
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Michael Koller
- University Hospital Regensburg, Center for Clinical Studies, Regensburg, Germany
| | - Fiona Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Rebecca Yeung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
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12
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Wong HCY, Lim FMY, Cheng ACK. Three-week Cycles of Paclitaxel-Carboplatin Administered Concurrently with Radiotherapy for Inoperable Stage III Non-small Cell Lung Cancer: 10-Year Single-Centre Experience. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- HCY Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong
| | - FMY Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong
| | - ACK Cheng
- Department of Oncology, Princess Margaret Hospital, Hong Kong
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13
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Mak WWS, Tsoi EWS, Wong HCY. Brief Wellness Recovery Action Planning (WRAP ®) as a mental health self-management tool for community adults in Hong Kong: A randomized controlled trial. J Ment Health 2022:1-8. [PMID: 35506470 DOI: 10.1080/09638237.2022.2069723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Wellness Recovery Action Planning (WRAP®) is a recovery-oriented program designed for people with mental illness to improve well-being and self-manage symptoms. AIMS This randomized controlled trial investigates the effectiveness of brief Wellness Recovery Action Planning (WRAP®) as a mental health self-management tool for adults without formal clinical diagnoses in Hong Kong. METHODS 182 adults were randomly assigned to WRAP® or waitlist control condition to investigate whether WRAP® can promote mental well-being and reduce psychological distress for community adults with no known diagnosable mental disorders. RESULTS Significant improvements were found in depressive (ηp2 = .11) and anxiety symptoms (ηp2 = .06), empowerment (ηp2 = .09), and personal recovery (ηp2 = .11) among WRAP® participants compared with waitlist control participants. Moreover, changes in anxiety symptoms, hope, empowerment, and reliance on others were found to sustain at 3-month follow-up. CONCLUSIONS Brief WRAP® is an effective self-management tool in enhancing mental health and alleviating psychological distress for millennials living in the community.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emily W S Tsoi
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Henry C Y Wong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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14
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Li PH, Chua GT, Leung ASY, Chan YC, Chan KKL, Cheung KH, Chong PCY, Ho PPK, Kwan MYW, Lai JCH, Lam KK, Lam TSK, Leung TF, Li TY, Duque JSR, So JLT, Wan KA, Wong HCY, Wu AYY, Lee TH, Ho MHK, Siu AYC. Hong Kong Anaphylaxis Consortium Consensus Statements on prescription of adrenaline autoinjectors in the acute care setting. Asia Pac Allergy 2021; 11:e1. [PMID: 33604271 PMCID: PMC7870372 DOI: 10.5415/apallergy.2021.11.e1] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background Adrenaline autoinjectors (AAInj) facilitates early administration of adrenaline and remains the first-line treatment for anaphylaxis. However, only a minority of anaphylaxis survivors in Hong Kong are prescribed AAInj and formal guidance do not exist. International anaphylaxis guidelines have been largely based on Western studies, which may not be as relevant for non-Western populations. Objective To formulate a set of consensus statements on the prescription of AAInj in Hong Kong. Methods Consensus statements were formulated by the Hong Kong Anaphylaxis Consortium by the Delphi method. Agreement was defined as greater than or equal to 80% consensus. Subgroup analysis was performed to investigate differences between allergy and emergency medicine physicians. Results A total of 7 statements met criteria for consensus with good overall agreement between allergy and emergency medicine physicians. AAInj should be used as first-line treatment and prescribed for all patients at risk of anaphylaxis. This should be prescribed prior to discharge from the Accident and Emergency Department together with an immediate referral to an allergy center. The decision for prescribing AAInj should be based on the severity of previous reactions; including objective signs of respiratory involvement, objective signs of cardiovascular involvement and multiorgan involvement (regardless of severity). Patient demographics and comorbidities, specifically history of asthma or chronic obstructive pulmonary disease, should also be considered. Patients deemed eligible for AAInj should be offered avoidance advice and prescribed one AAInj while awaiting review by allergists. AAInj technique should be demonstrated by a healthcare professional or instruction video, and a return demonstration by the patient is required. The patient should also be counseled that the decision on the continued need of AAInj prescription in the long-term should be reviewed by an allergist. Conclusion Consensus statements support the prescription of AAInj by front-line physicians with subsequent allergist review when treating patients at risk of anaphylaxis in Hong Kong.
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Affiliation(s)
- Philip H Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Gilbert T Chua
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Agnes S Y Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Yiu-Cheung Chan
- Accident & Emergency Department, United Christian Hospital, Hong Kong
| | - Karen K L Chan
- 24-Hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Hong Kong
| | - Koon-Ho Cheung
- Accident & Emergency Department, Prince of Wales Hospital, Hong Kong
| | | | - Polly P K Ho
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong
| | - Mike Y W Kwan
- Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - Jeffrey C H Lai
- Accident & Emergency Department, Tin Shui Wai Hospital, Hong Kong
| | - Kin-Kwai Lam
- Accident & Emergency Department, United Christian Hospital, Hong Kong
| | - Tommy S K Lam
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
| | - Ting-Fan Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tin-Yan Li
- Accident & Emergency Department, Queen Elizabeth Hospital, Hong Kong
| | - Jaime S Rosa Duque
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Jerome L T So
- Accident & Emergency Department, Tseung Kwan O Hospital, Hong Kong
| | - Kuang-An Wan
- Accident & Emergency Department, Ruttonjee Hospital, Hong Kong
| | - Henry C Y Wong
- Accident & Emergency Department, Pok Oi Hospital, Hong Kong
| | | | - Tak-Hong Lee
- Allergy Centre, Hong Kong Sanatorium and Hospital, Hong Kong
| | - Marco H K Ho
- Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Axel Y C Siu
- Accident & Emergency Department, Ruttonjee Hospital, Hong Kong
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15
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Abstract
Background: Weight loss is frequently observed in pancreatic cancer patients. We aimed to study the prognostic impacts of weight loss early during chemotherapy. Methods: A total of 72 patients of Chinese ethnicity with unresectable pancreatic cancer who underwent chemotherapy were reviewed. Critical weight loss (CWL) was defined as weight loss ≥ 5% within one month after treatment. The prognostic impact of weight loss and CWL were analyzed. Results: 47 patients (65.3%) had weight loss after one month of treatment, with 14 (19.4%) suffering from CWL. Baseline characteristics were similar between patients with and without CWL. The median OS and Time-to-treatment-failure (TTF) of patients with CWL were shorter than those without CWL (OS: 4.8 months [CWL] versus [vs.] OS 7.1 months [No CWL]; TTF 1.6 months [CWL] vs. 3.2 months [No CWL]; both P < 0.01). CWL was an independent adverse prognosticator for OS (Hazard Ratio [HR] = 2.50; P = 0.01) and TTF (HR = 2.71; P < 0.01). Other independent prognosticators for OS were serum albumin <35 mg/dl and CA19-9 ≥ 1000 IU/ml, while CWL was the only independent prognosticator for TTF (HR 2.71 [95% CI 1.33-5.52]; P < 0.01). Conclusions: Development of CWL in early course of chemotherapy was associated with worse prognosis in Chinese patients with unresectable pancreatic cancers.
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Affiliation(s)
- Henry C Y Wong
- a Department of Oncology , Princess Margaret Hospital , Hong Kong
| | - Kwan Y Lam
- b Department of Clinical Oncology , Sir YK Pao Center for Cancer, Prince of Wales Hospital , Hong Kong
| | - Charing C N Chong
- c Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery , The Chinese University of Hong Kong , Hong Kong
| | - Anthony W H Chan
- d Department of Anatomical and Cellular Pathology , Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong
- e State Key Laboratory in Oncology in South China , The Chinese University of Hong Kong , Hong Kong
| | - Stephen L Chan
- b Department of Clinical Oncology , Sir YK Pao Center for Cancer, Prince of Wales Hospital , Hong Kong
- e State Key Laboratory in Oncology in South China , The Chinese University of Hong Kong , Hong Kong
- f Institute of Digestive Disease , The Chinese University of Hong Kong , Hong Kong
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