1
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Guckenberger M, Billiet C, Schnell D, Franzese C, Spałek M, Rogers S, Stelmes JJ, Aebersold DM, Hemmatazad H, Zimmermann F, Zimmer J, Zilli T, Bruni A, Baumert BG, Nägler F, Gut P, Förster R, Madani I. Dose-intensified stereotactic body radiotherapy for painful vertebral metastases: A randomized phase 3 trial. Cancer 2024. [PMID: 38581694 DOI: 10.1002/cncr.35310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The purpose of this randomised study was to determine whether dose-intensified stereotactic body radiotherapy (SBRT) for painful vertebral metastases results in increased rates of pain improvement compared with conventional external beam radiotherapy (cEBRT) (control) 6 months after treatment. METHODS This randomized, controlled phase 3 trial was conducted between November 2016 and January 2023, when it was stopped early. Patients were eligible if they were aged 18 years or older; had one or two painful, stable, or potentially unstable vertebral metastases; and had a life expectancy of 1 year or longer according to the investigator's estimates. Patients received 48.5 grays (Gy) in 10 fractions (with epidural involvement) or 40 Gy in five fractions (without epidural involvement) in the SBRT group and 30 Gy in 10 fractions or 20 Gy in five fractions in the cEBRT group, respectively. The primary end point was an improvement in the pain score at the treated site by at least 2 points (on a visual analog scale from 0 to 10 points) at 6-month follow-up. Data were analyzed on an intention-to-treat and per-protocol basis. RESULTS Of 214 patients who were screened for eligibility, 63 were randomized 1:1 between SBRT (33 patients with 36 metastases) and cEBRT (30 patients with 31 metastases). The median age of all patients was 66 years, and 40 patients were men (63.5%). In the intention-to-treat analysis, the 6-month proportion of patients who had metastases with pain reduction by 2 or more points was significantly higher in the SBRT group versus the control group (69.4% vs. 41.9%, respectively; two-sided p = .02). Changes in opioid medication intake relative to baseline were nonsignificant between the groups. No differences were observed in vertebral compression fracture or adverse event rates between the groups. CONCLUSIONS Dose-intensified SBRT improved pain score more effectively than cEBRT at 6 months.
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Affiliation(s)
- Matthias Guckenberger
- University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Ciro Franzese
- Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Mateusz Spałek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jean-Jacques Stelmes
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Luxemburg Health Directorate, Luxemburg, Luxemburg
| | - Daniel M Aebersold
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hossein Hemmatazad
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Jörg Zimmer
- Städtisches Klinikum Dresden, Dresden, Germany
| | - Thomas Zilli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Robert Förster
- University Hospital Zurich, Zurich, Switzerland
- Kantonsspital Winterthur, Winterthur, Switzerland
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2
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Haas R, Stelmes JJ, Zaffaroni F, Sauvé N, Clementel E, Bar-Deroma R, Le Péchoux C, Litière S, Marreaud S, Alyamani N, Andratschke NHJ, Sangalli C, Chung PW, Miah A, Hurkmans C, Gronchi A, Bovée JVMG, Gelderblom H, Kasper B, Weber DC, Bonvalot S. Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092-22092 STRASS trial. Cancer 2022; 128:2796-2805. [PMID: 35536104 DOI: 10.1002/cncr.34239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The European Organization for Research and Treatment of Cancer 22092-62092 STRASS trial failed to demonstrate the superiority of neoadjuvant radiotherapy (RT) over surgery alone in patients with retroperitoneal sarcoma. Therefore, an RT quality-assurance program was added to the study protocol to detect and correct RT deviations. The authors report results from the trial RT quality-assurance program and its potential effect on patient outcomes. METHODS To evaluate the effect of RT compliance on survival outcomes, a composite end point was created. It combined the information related to planning target volume coverage, target delineation, total dose received, and overall treatment time into 2 groups: non-RT-compliant (NRC) for patients who had unacceptable deviation(s) in any of the previous categories and RT-compliant (RC) otherwise. Abdominal recurrence-free survival (ARFS) and overall survival were compared between the 2 groups using a Cox proportional hazard model adjusted for known prognostic factors. RESULTS Thirty-six of 125 patients (28.8%) were classified as NRC, and the remaining 89 patients (71.2%) were classified as RC. The 3-year ARFS rate was 66.8% (95% confidence interval [CI], 55.8%-75.7%) and 49.8% (95% CI, 32.7%-64.8%) for the RC and NRC groups, respectively (adjusted hazard ratio, 2.32; 95% CI, 1.25-4.32; P = .008). Local recurrence after macroscopic complete resection occurred in 13 of 89 patients (14.6%) versus 2 of 36 patients (5.6%) in the RC and NRC groups, respectively. CONCLUSIONS The current analysis suggests a significant benefit in terms of ARFS in favor of the RC group. This association did not translate into less local relapses after complete resection in the RC group. Multidisciplinary collaboration and review of cases are critical to avoid geographic misses, especially for rare tumors like retroperitoneal sarcoma.
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Affiliation(s)
- Rick Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Jacques Stelmes
- Ente Ospedliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Facundo Zaffaroni
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Nicolas Sauvé
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Enrico Clementel
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Institute, Paris, France
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Sandrine Marreaud
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Najlaa Alyamani
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - Claudia Sangalli
- Department of Radiation Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Peter W Chung
- Department of Radiation Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Aisha Miah
- Department of Radiation Oncology, The Royal Marsden National Health Service Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Alessandro Gronchi
- Department of Surgery, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bernd Kasper
- Sarcoma Unit of the Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland.,Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland
| | - Sylvie Bonvalot
- Department of Surgery, Curie Institute, University of Paris, Paris, France
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3
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Gamper EM, Musoro JZ, Coens C, Stelmes JJ, Falato C, Groenvold M, Velikova G, Cocks K, Flechtner HH, King MT, Bottomley A. Minimally important differences for the EORTC QLQ-C30 in prostate cancer clinical trials. BMC Cancer 2021; 21:1083. [PMID: 34620124 PMCID: PMC8496068 DOI: 10.1186/s12885-021-08609-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The aim of the study was to estimate the minimally important difference (MID) for interpreting group-level change over time, both within a group and between groups, for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores in patients with prostate cancer. Methods We used data from two published EORTC trials. Clinical anchors were selected by strength of correlations with QLQ-C30 scales. In addition, clinicians’ input was obtained with regard to plausibility of the selected anchors. The mean change method was applied for interpreting change over time within a group of patients and linear regression models were fitted to estimate MIDs for between-group differences in change over time. Distribution-based estimates were also evaluated. Results Two clinical anchors were eligible for MID estimation; performance status and the CTCAE diarrhoea domain. MIDs were developed for 7 scales (physical functioning, role functioning, social functioning, pain, fatigue, global quality of life, diarrhoea) and varied by scale and direction (improvement vs deterioration). Within-group MIDs ranged from 4 to 14 points for improvement and − 13 to − 5 points for deterioration and MIDs for between-group differences in change scores ranged from 3 to 13 for improvement and − 10 to − 5 for deterioration. Conclusions Our findings aid the meaningful interpretation of changes on a set of EORTC QLQ-C30 scale scores over time, both within and between groups, and for performing more accurate sample size calculations for clinical trials in prostate cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08609-7.
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Affiliation(s)
- Eva M Gamper
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria.
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Claudette Falato
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, and Bispebjerg Hospital, Copenhagen, Denmark
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK
| | - Kim Cocks
- Adelphi Value, Bollington, Cheshire, UK
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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4
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Vu E, Schröder C, Dülk J, Stelmes JJ, Vu J, Schilling J, Förster FG, Förster R. Nationwide Survey of German Outpatient Gynecologic Oncology Practices during the Coronavirus Disease 2019 Pandemic: Reactions to the First Wave and Future Perspectives. Breast Care (Basel) 2021; 382:1-7. [PMID: 34580581 PMCID: PMC8450854 DOI: 10.1159/000518858] [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: 04/08/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In the spring of 2020, coronavirus disease 2019 posed a substantial challenge for countries and their healthcare systems. In Germany, over 70% of all cancer patients are treated in an outpatient setting, so gynecologic oncology practices are the guarantors of optimal patient care. We developed a survey to evaluate the management of gynecologic oncology patients. Methods The survey consisted of 38 questions and was sent to the members of the Berufsverband Niedergelassener Gynäkologischer Onkologen in Deutschland e.V. (BNGO), a professional association of gynecologic oncologists in the outpatient sector in Germany. Results The survey was completed by 54 out of 133 (41%) gynecologic oncologists from 14 out of 15 (93%) federal states where the BNGO is represented. Facing the pandemic, popular measures were mask requirements (100%), restriction of access to practices (94%), increased number of disinfectant dispensers (85%), installment of panes of acrylic glass (76%), or spatial alterations (67%). For most patients the pandemic had no influence on prioritization of therapies (82%) or prescribed systemic treatments (87%). Despite an increase in perceived psychological burden among the staff (72%), 85% (45/54) of the practices were not offered any additional psychological support. Discussion and Conclusion As most cancer patients in Germany are treated in an outpatient setting, a suitable reaction of oncology centers to the new circumstances was crucial to secure optimal treatment and patient care. Nevertheless, the low prioritization of mental health or distress of healthcare workers poses a serious threat to the maintenance of optimal medical care in further waves of the pandemic.
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Affiliation(s)
- Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christina Schröder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jonas Dülk
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland, Cantonal Hospitals, Bellinzona, Switzerland
| | - Jennifer Vu
- Friedrich Alexander University Erlangen, Erlangen, Germany
| | - Jörg Schilling
- Gemeinschaftspraxis Dres. med. Schilling, Till and Kohn, Berlin, Germany
| | - Frank Gerhard Förster
- MVZ Flemmingstraße, Poliklinik GmbH, Chemnitz, Germany.,Faculty of Business and Economics, University of Applied Sciences Zwickau, Zwickau, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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5
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Fassbind S, Ferraro DA, Stelmes JJ, Fankhauser CD, Guckenberger M, Kaufmann PA, Eberli D, Burger IA, Kranzbühler B. 68Ga-PSMA-11 PET imaging in patients with ongoing androgen deprivation therapy for advanced prostate cancer. Ann Nucl Med 2021; 35:1109-1116. [PMID: 34185262 PMCID: PMC8408087 DOI: 10.1007/s12149-021-01646-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 12/28/2022]
Abstract
Purpose Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) imaging significantly improved the detection of recurrent prostate cancer (PCa). However, the value of PSMA PET imaging in patients with advanced hormone-sensitive or hormone-resistant PCa is still largely unknown. The aim of this study was to analyze the detection rate and distribution of lesions using PSMA PET imaging in patients with advanced PCa and ongoing androgen deprivation therapy (ADT). Methods A total of 84 patients diagnosed with hormone-sensitive or hormone-resistant PCa who underwent 68Ga-PSMA-11 PET/magnetic resonance imaging (MRI) or computer tomography (CT) under ongoing ADT were retrospectively analyzed. We assessed the detection of PSMA-positive lesions overall and for three PSA subgroups (0 to < 1 ng/mL, 1 to < 20 ng/mL and > 20 ng/mL). In addition, PSMA-positive findings were stratified by localization (prostatic fossa, pelvic, para-aortic, mediastinal/supraclavicular and axillary lymph nodes, bone lesions and visceral lesions) and hormone status (hormone-sensitive vs. hormone-resistant). Furthermore, we assessed how many patients would be classified as having oligometastatic disease (≤ 3 lesions) and theoretically qualify for metastasis-directed radiotherapy (MDRT) in a personalized patient management. Results We detected PSMA-positive lesions in 94.0% (79 of 84) of all patients. In the three PSA subgroups detection rates of 85.2% (0 to < 1 ng/mL, n = 27), 97.3% (1 to < 20 ng/mL, n = 37) and 100% (> 20 ng/mL, n = 20) were observed, respectively. PSMA-positive visceral metastases were observed only in patients with a PSA > 1 ng/mL. Detection of PSMA-positive lesions did not significantly differ between patients with hormone-sensitive and hormone-resistant PCa. Oligometastatic PCa was detected in 19 of 84 patients (22.6%). Almost all patients, 94.7% (n = 18) would have been eligible for MDRT. Conclusions In this study, we observed an overall very high detection rate of 94% using PSMA PET imaging in patients with advanced PCa and ongoing ADT. Even in a majority of patients with very low PSA values < 1 ng/ml PSMA-positive lesions were found.
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Affiliation(s)
- Saskia Fassbind
- Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland
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6
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Haas RL, Stelmes JJ, Zaffaroni F, Clementel E, Bar Deroma R, Le Pechoux C, Litiere S, Marreaud S, Alyamani N, Andratschke N, Sangalli C, Chung PWM, Miah A, Hurkmans C, Gronchi A, Bovée JV, Gelderblom H, Kasper B, Weber D, Bonvalot S. Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the 62092-22092 STRASS trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11566 Background: The EORTC 22092-62092 STRASS trial failed to detect a superiority of neoadjuvant radiotherapy in patients with retroperitoneal sarcoma as compared to surgery alone. As radiotherapy (RT) was the experimental treatment, a comprehensive quality assurance program (RTQA) has been included in the study protocol in order to detect and correct potential RT deviations. We report here the overall trial RTQA results and its potential impact on patient’s outcomes in this international phase III trial. Methods: Plans from all patients randomized to the experimental preoperative RT arm were submitted to a multidisciplinary RTQA team, consisting of medical physicists and radiation-oncologists. Target volume parameters and tumor dose coverage were prospectively reviewed by the RTQA team but not all plans were made compliant. In order to evaluate the impact on oncological outcomes, a composite endpoint, overall RT compliance status, was created; patients were classified into two major groups: RT compliant (RC) group and non-compliant (NRC) group, defining whether RT was as concisely per protocol or not. This composite endpoint combined the information related to PTV coverage, target delineation, total dose received and overall treatment time. Both abdominal recurrence-free survival (ARFS) and OS were compared between RC and NRC patients using Cox’s proportional hazard model adjusted for age, sex, WHO performance status, tumor grade, histological subtype and tumor size at baseline (millimeters). Results: After final review, 75.2% (94 out of 125) of patients had compliant RT plans (65.6% were already compliant at first submission to RTQA team and 9.6% were made compliant after review). Most patients in the NRC (77.4%) had deviations linked to incorrect target volume delineations. 3-year ARFS was 67.2% (95% Confidence interval (CI): 58.0 – 77.8%) and 48.4% (34.3 – 68.2%) for RC and NRC group, respectively (adjusted HR: 2.64, 95% CI: 1.38 – 5.07, p = 0.003). Corresponding OS at 3 years was 89.9% (95% CI: 83.6 – 96.3%) and 75.4% (95% CI: 61.9 – 91.8%) in the RC and NRC group with a trend in favor of RC (adjusted HR: 2.76, 95% CI: 0.91 – 8.43, p = 0.074). Conclusions: To our knowledge, this is the first RTQA evaluation of a phase III sarcoma trial. The data suggests a significant benefit in terms of ARFS and a trend for OS in favor of the RT compliant group. RTQA in prospective clinical trials, investigating new RT techniques, dose levels and indications, continues to be an important and integral part of trial designing. Funding Source: EORTC, EORTC Cancer Research Fund, EUROSARC FP7 278472 and Kom op tegen Kanker (Stand up to Cancer), the Flemish Cancer Society.
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Affiliation(s)
- Rick L.M. Haas
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Facundo Zaffaroni
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Enrico Clementel
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | | | - Saskia Litiere
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Najlaa Alyamani
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Sangalli
- Department of Radiation Oncology, Istituto Nazionale Dei Tumori, Milan, Italy
| | - Peter W. M. Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Aisha Miah
- The Royal Marsden Hospital, London, United Kingdom
| | - Coen Hurkmans
- Department of Radiation Oncology, Catherina Hospital, Eindhoven, Netherlands
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Istituto Nazionale Dei Tumori, Milan, Italy
| | - Judith V.M.G. Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Bernd Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - Damien Weber
- Radiation Oncology Department, University Hospital of Bern, Bern, Swaziland
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7
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Foerster R, Zwahlen DR, Buchali A, Tang H, Schroeder C, Windisch P, Vu E, Akbaba S, Bostel T, Sprave T, Zamboglou C, Zilli T, Stelmes JJ, Telkhade T, Murthy V. Stereotactic Body Radiotherapy for High-Risk Prostate Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13040759. [PMID: 33673077 PMCID: PMC7918664 DOI: 10.3390/cancers13040759] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is an established, potentially curative treatment option for all risk constellations of localized prostate cancer (PCA). Androgen deprivation therapy (ADT) and dose-escalated RT can further improve outcome in high-risk (HR) PCA. In recent years, shorter RT schedules based on hypofractionated RT have shown equal outcome. Stereotactic body radiotherapy (SBRT) is a highly conformal RT technique enabling ultra-hypofractionation which has been shown to be safe and efficient in patients with low- and intermediate-risk PCA. There is a paucity of data on the role of SBRT in HR PCA. In particular, the need for pelvic elective nodal irradiation (ENI) needs to be addressed. Therefore, we conducted a systematic review to analyze the available data on observed toxicities, ADT prescription practice, and oncological outcome to shed more light on the value of SBRT in HR PCA. METHODS We searched the PubMed and Embase electronic databases for the terms "prostate cancer" AND "stereotactic" AND "radiotherapy" in June 2020. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. RESULTS After a rigorous selection process, we identified 18 individual studies meeting all selection criteria for further analyses. Five additional studies were included because their content was judged as relevant. Three trials have reported on prostate SBRT including pelvic nodes; 2 with ENI and 1 with positive pelvic nodes only. The remaining studies investigated SBRT of the prostate only. Grade 2+ acute genitourinary (GU) toxicity was between 12% and 46.7% in the studies investigating pelvic nodes irradiation and ranged from 0% to 89% in the prostate only studies. Grade 2+ chronic GU toxicity was between 7% and 60% vs. 2% and 56.7%. Acute gastrointestinal (GI) grade 2+ toxicity was between 0% to 4% and 0% to 18% for studies with and without pelvic nodes irradiation, respectively. Chronic GI grade 2+ toxicity rates were between 4% and 50.1% vs. 0% and 40%. SBRT of prostate and positive pelvic nodes only showed similar toxicity rates as SBRT for the prostate only. Among the trials that reported on ADT use, the majority of HR PCA patients underwent ADT for at least 2 months; mostly neoadjuvant and concurrent. Biochemical control rates ranged from 82% to 100% after 2 years and 56% to 100% after 3 years. Only a few studies reported longer follow-up data. CONCLUSION At this point, SBRT with or without pelvic ENI cannot be considered the standard of care in HR PCA, due to missing level 1 evidence. Treatment may be offered to selected patients at specialized centers with access to high-precision RT. While concomitant ADT is the current standard of care, the necessary duration of ADT in combination with SBRT remains unclear. Ideally, all eligible patients should be enrolled in clinical trials.
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Affiliation(s)
- Robert Foerster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-52-266-31-40
| | - Daniel Rudolf Zwahlen
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Medical Faculty, University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Andre Buchali
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
| | - Hongjian Tang
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Christina Schroeder
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
- Department of Radiation Oncology, Ruppiner Kliniken GmbH, Brandenburg Medical School (MHB), 16816 Neuruppin, Germany;
- Center for Proton Therapy, Paul Scherrer Institute (PSI), ETH Domain, 5232 Villingen, Switzerland
| | - Paul Windisch
- Institute for Radiation Oncology, Cantonal Hospital Winterthur (KSW), 8401 Winterthur, Switzerland; (D.R.Z.); (H.T.); (C.S.); (P.W.)
| | - Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen (KSSG), 9007 St. Gallen, Switzerland;
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Mainz, 55131 Mainz, Germany; (S.A.); (T.B.)
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany; (T.S.); (C.Z.)
| | - Thomas Zilli
- Department of Radiation Oncology, University Hospital Geneva (HUG), 1205 Geneva, Switzerland;
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland (IOSI), Cantonal Hospitals (EOC), 6500 Bellinzona, Switzerland;
| | - Tejshri Telkhade
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai 400012, India; (T.T.); (V.M.)
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8
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Bonvalot S, Gronchi A, Le Péchoux C, Swallow CJ, Strauss D, Meeus P, van Coevorden F, Stoldt S, Stoeckle E, Rutkowski P, Rastrelli M, Raut CP, Hompes D, De Paoli A, Sangalli C, Honoré C, Chung P, Miah A, Blay JY, Fiore M, Stelmes JJ, Dei Tos AP, Baldini EH, Litière S, Marreaud S, Gelderblom H, Haas RL. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2020; 21:1366-1377. [PMID: 32941794 DOI: 10.1016/s1470-2045(20)30446-0] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Unlike for extremity sarcomas, the efficacy of radiotherapy for retroperitoneal sarcoma is not established. The aim of this study was to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone on abdominal recurrence-free survival. METHODS EORTC-62092 is an open-label, randomised, phase 3 study done in 31 research institutions, hospitals, and cancer centres in 13 countries in Europe and North America. Adults (aged ≥18 years) with histologically documented, localised, primary retroperitoneal sarcoma that was operable and suitable for radiotherapy, who had not been previously treated and had a WHO performance status and American Society of Anesthesiologists score of 2 or lower, were centrally randomly assigned (1:1), using an interactive web response system and a minimisation algorithm, to receive either surgery alone or preoperative radiotherapy followed by surgery. Randomisation was stratified by hospital and performance status. Radiotherapy was delivered as 50·4 Gy (in 28 daily fractions of 1·8 Gy) in either 3D conformal radiotherapy or intensity modulated radiotherapy, and the objective of surgery was a macroscopically complete resection of the tumour mass with en-bloc organ resection as necessary. The primary endpoint was abdominal recurrence-free survival, as assessed by the investigator, and was analysed in the intention-to-treat population. Safety was analysed in all patients who started their allocated treatment. This trial is registered with ClinicalTrials.gov, NCT01344018. FINDINGS Between Jan 18, 2012 and April 10, 2017, 266 patients were enrolled, of whom 133 were randomly assigned to each group. The median follow-up was 43·1 months (IQR 28·8-59·2). 128 (96%) patients from the surgery alone group had surgery, and 119 (89%) patients in the radiotherapy and surgery group had both radiotherapy and surgery. Median abdominal recurrence-free survival was 4·5 years (95% CI 3·9 to not estimable) in the radiotherapy plus surgery group and 5·0 years (3·4 to not estimable) in the surgery only group (hazard ratio 1·01, 95% CI 0·71-1·44; log rank p=0·95). The most common grade 3-4 adverse events were lymphopenia (98 [77%] of 127 patients in the radiotherapy plus surgery group vs one [1%] of 128 patients in the surgery alone group), anaemia (15 [12%] vs ten [8%]), and hypoalbuminaemia (15 [12%] vs five [4%]). Serious adverse events were reported in 30 (24%) of 127 patients in the radiotherapy plus surgery group, and in 13 (10%) of 128 patients in the surgery alone group. One (1%) of 127 patients in the radiotherapy plus surgery group died due to treatment-related serious adverse events (gastropleural fistula), and no patients in the surgery alone group died due to treatment-related serious adverse events. INTERPRETATION Preoperative radiotherapy should not be considered as standard of care treatment for retroperitoneal sarcoma. FUNDING European Organisation for Research and Treatment of Cancer, and European Clinical Trials in Rare Sarcomas.
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Affiliation(s)
- Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France.
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Dirk Strauss
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Frits van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stephan Stoldt
- Department of Surgical Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Eberhard Stoeckle
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marco Rastrelli
- Department of Surgery, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | | | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aisha Miah
- Department of Radiation Oncology, Royal Marsden Hospital, London, UK
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jean-Jacques Stelmes
- Quality Assurance in Radiotherapy, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Angelo P Dei Tos
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Saskia Litière
- Department of Statistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Sandrine Marreaud
- Headquarters, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rick L Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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Maillet D, Corbaux P, Stelmes JJ, Dalle S, Locatelli-Sanchez M, Perier-Muzet M, Duruisseaux M, Kiakouama-Maleka L, Freyer G, Boespflug A, Péron J. Association between immune-related adverse events and long-term survival outcomes in patients treated with immune checkpoint inhibitors. Eur J Cancer 2020; 132:61-70. [PMID: 32334337 DOI: 10.1016/j.ejca.2020.03.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The impact of immune-related adverse events (irAE) on survival outcomes after single-agent immune checkpoint inhibitors (ICIs) remains unclear. We aimed to evaluate the association between irAEs and ICI efficacy in various malignancies. METHODS All patients treated with a single-agent ICI for any advanced cancer were included in this retrospective multicentric series. The primary objective was to assess the impact of all type grade ≥II irAEs on progression-free survival (PFS) and overall survival (OS). IrAEs were first considered as a fixed covariate and included in Cox-regression models. In addition, as irAEs are time-related events and can occur at any point during follow-up, we analysed the occurrence of irAEs as a time-varying covariate. RESULTS In this cohort of 410 patients, the majority of patients (70%) were treated for non-small cell lung cancer. The ICI was an anti-PD(L)1 for 356 patients (82%) and an anti-CTLA4 for 79 patients (18%). In total 126 (29%) of the patients presented at least one grade ≥II irAEs. The first occurrence of a grade ≥II irAE had a positive impact on PFS and OS when considered as a fixed or as a time-varying covariate (hazard ratio [HR] for PFS = 0.63, 95% confidence interval [CI] 0.50-0.81; P = 0.00022; HR for OS = 0.57, 95% CI 0.43-0.74, P < 0.0001). This overall finding was confirmed in patients treated with an anti-PD(L)1 and among patients with lung cancer. CONCLUSION In this pooled multi-institutional cohort, the incidence of irAEs was associated with better long-term survival across different malignancies treated with ICI monotherapy.
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Affiliation(s)
- Denis Maillet
- Hospices Civils de Lyon, Oncology Department, Pierre-Bénite, France; Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.
| | - Pauline Corbaux
- Hospices Civils de Lyon, Oncology Department, Pierre-Bénite, France; Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | | | - Stéphane Dalle
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Cancer Research Center of Lyon, Dermatology Department, Pierre-Bénite, France
| | - Myriam Locatelli-Sanchez
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Cancer Research Center of Lyon, Department of Respiratory Medicine, Pierre-Bénite, France
| | - Marie Perier-Muzet
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Cancer Research Center of Lyon, Dermatology Department, Pierre-Bénite, France
| | - Michaël Duruisseaux
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Department of Respiratory Medicine, Groupement Hospitalier Est, Hôpital Louis-Pradel, Lyon, France
| | - Lize Kiakouama-Maleka
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Department of Respiratory Medicine, Croix-rousse Hospital, Lyon, France
| | - Gilles Freyer
- Hospices Civils de Lyon, Oncology Department, Pierre-Bénite, France; Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France
| | - Amélie Boespflug
- Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; Hospices Civils de Lyon, Cancer Research Center of Lyon, Dermatology Department, Pierre-Bénite, France
| | - Julien Péron
- Hospices Civils de Lyon, Oncology Department, Pierre-Bénite, France; Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France
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10
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Stelmes JJ, Gregoire V, Poorten VV, Golusiñski W, Szewczyk M, Jones T, Ansarin M, Broglie MA, Giger R, Klussmann JP, Evans M, Bourhis J, Leemans CR, Spriano G, Dietz A, Hunter K, Zimmermann F, Tinhofer I, Patterson JM, Quaglini S, Govaerts AS, Fortpied C, Simon C. Organ Preservation and Late Functional Outcome in Oropharyngeal Carcinoma: Rationale of EORTC 1420, the "Best of" Trial. Front Oncol 2019; 9:999. [PMID: 31696052 PMCID: PMC6817682 DOI: 10.3389/fonc.2019.00999] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/17/2019] [Indexed: 01/25/2023] Open
Abstract
Dysphagia represents one of the most serious adverse events after curative-intent treatments with a tremendous impact on quality of life in patients with head and neck cancers. Novel surgical and radiation therapy techniques have been developed to better preserve swallowing function, while not negatively influencing local control and/or overall survival. This review focuses on the current literature of swallowing outcomes after curative treatment strategies. Available results from recent studies relevant to this topic are presented, demonstrating the potential role of new treatment modalities for early- and intermediate-stage oropharyngeal cancers. Based on this, we present the rationale and design of the currently active EORTC 1420 "Best of" trial, and highlight the potential of this study to help prioritizing either surgery- or radiation-based treatment modalities for the treatment of oropharyngeal cancer in the future.
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Affiliation(s)
- Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | - Wojciech Golusiñski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznań, Poland
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznań, Poland
| | - Terry Jones
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Mohssen Ansarin
- Division of Otolaryngology Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - Martina A Broglie
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Zurich (USZ), Zurich, Switzerland
| | - Roland Giger
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Jens Peter Klussmann
- Department of Otolaryngology-Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Mererid Evans
- Velindre University NHS Trust, Wales, United Kingdom
| | - Jean Bourhis
- Department of Radiation Oncology, CHUV, Lausanne, Switzerland
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centres, VU University, Amsterdam, Netherlands
| | - Giuseppe Spriano
- Department of Otolaryngology Head and Neck Surgery, Humanitas University Milan, Rozzano, Italy
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - Keith Hunter
- Academic Unit of Oral Medicine, Pathology and Surgery, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Frank Zimmermann
- Department of Radiation Oncology, University of Basel, Basel, Switzerland
| | - Ingeborg Tinhofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Radiooncology and Radiotherapy, Berlin, Germany
| | - Joanne M Patterson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | | | | | - Christian Simon
- Service d'Oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Lausanne, Switzerland
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11
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Arnaud-Coffin P, Maillet D, Gan HK, Stelmes JJ, You B, Dalle S, Péron J. A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors. Int J Cancer 2019; 145:639-648. [PMID: 30653255 DOI: 10.1002/ijc.32132] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/02/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022]
Abstract
The advent of immune checkpoint-inhibitors (CPI) has transformed treatment for several cancer types. This review was performed to assess the rate of adverse events (AEs) associated with the use of CPI, alone or in combinations. A review of AEs reporting quality was also performed. All publications of Randomized Clinical Trials (RCTs) assessing CPI published before December 2017 were included. To investigate the quality of AEs reporting, a set of items was defined based on the 2004 CONSORT harms extension statement. Rates of Grade 5, serious, and study-withdrawal related AEs were collected in each treatment category. Specific immune related AEs (irAEs) were also collected when available. Pooled estimates of adverse event rates were calculated by using generalized linear mixed model. A total of 35 RCTs including 16,485 patients were included. The overall quality of AEs reporting was satisfactory, but items pertaining to methods of data collection and analysis were infrequently reported. Grade ≥ 3 AEs were reported for 14% (95% CI 12-16) of patients treated with PD(L)-1 inhibitors, 34% (95% CI 27-42) of patients treated with CTLA-4 inhibitors, 55% (95% CI 51-59) of patients on CPI combinations and 46% (95% CI 40-53) of patients on immunotherapy-chemotherapy combination. The profile of irAEs was different among the treatment categories. The use of CPI, especially in combination, is associated with significant rates of Grade ≥ 3 AEs. Healthcare planning should anticipate the expected high number of patients presenting with irAEs in the future.
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Affiliation(s)
- Patrick Arnaud-Coffin
- Department of Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France.,Department of ImmuCare (Immunology Cancer Research), Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Sud, Lyon 1 University, EMR 3738, Oullins, France
| | - Denis Maillet
- Department of Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France.,Department of ImmuCare (Immunology Cancer Research), Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia.,School of Cancer Medicine, La Trobe University, Heidelberg, VIC, Australia.,Department of Medicine, Melbourne University, Melbourne, VIC, Australia
| | - Jean-Jacques Stelmes
- Department of Radiation Oncology, University Hospital of Zurich, Zürich, Switzerland
| | - Benoit You
- Department of Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France.,Department of ImmuCare (Immunology Cancer Research), Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Sud, Lyon 1 University, EMR 3738, Oullins, France
| | - Stephane Dalle
- Department of ImmuCare (Immunology Cancer Research), Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Sud, Lyon 1 University, EMR 3738, Oullins, France.,Department of Dermatology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Julien Péron
- Department of Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Pierre-Bénite, France.,Department of ImmuCare (Immunology Cancer Research), Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Sud, Lyon 1 University, EMR 3738, Oullins, France.,Department of Statistics unit, Hospices Civils de Lyon, Pierre-Bénite, France.,CNRS, UMR 5558 Biometry and Evolutionary Biology Laboratory, Université Lyon 1, Villeurbanne, France
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12
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Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, Lucas A, Veninga T, Pica A, Jefferies S, Ricardi U, Miralbell R, Stelmes JJ, Liu Y, Collette L, Collette S. Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042). Radiother Oncol 2018; 128:260-265. [PMID: 29960684 DOI: 10.1016/j.radonc.2018.06.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients. MATERIALS AND METHODS In this multi-cohorts non-randomized phase II and observational study, non-benign meningioma patients were treated according to their WHO grade and Simpson's grade. Patients with atypical meningioma (WHO grade II) and Simpson's grade 1-3 [Arm 1] entered the non-randomized phase II study designed to show a 3-year PFS > 70% (primary endpoint). All other patients entered the 3 observational cohorts: WHO grade II Simpson grade 4-5 [Arm 2] and Grade III Simpson grade 1-3 or 4-5 [Arm 3&4] in which few patients were expected. RESULTS Between 02/2008 and 06/2013, 78 patients were enrolled into the study. This report focuses on the 56 (median age, 54 years) eligible patients with WHO grade II Simpson's grade 1-3 meningioma who received RT (60 Gy). At a median follow up of 5.1 years, the estimated 3-year PFS is 88.7%, hence significantly greater than 70%. Eight (14.3%) treatment failures were observed. The 3-year overall survival was 98.2%. The rate of late signs and symptoms grade 3 or more was 14.3%. CONCLUSIONS These data show that 3-year PFS for WHO grade II meningioma patients undergoing a complete resection (Simpson I-III) is superior to 70% when treated with high-dose (60 Gy) RT.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland; Radiation Oncology Department, University Hospital of Zürich, Switzerland.
| | - Carmen Ares
- Radiation Oncology Department, Geneva University Hospital, Switzerland; Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands
| | - Salvador Villa
- Department of Radiation Oncology, Catalan Institut of Oncology, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain
| | - Saskia M Peerdeman
- Department of Neurosurgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Laurette Renard
- Department of Radiation Oncology, University Hospital St Luc, Brussels, Belgium
| | - Brigitta G Baumert
- Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands; Department of Radiation Oncology, Paracelsus Clinic Osnabrück and Univeristy of Münster, Germany
| | - Anna Lucas
- Department of Radiation Oncology, Institut Català d'Oncologia - L'Hospitalet, Barcelona, Spain
| | | | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
| | - Sarah Jefferies
- Oncology Department, Addenbrookes Hospital, Cambridge, United Kingdom
| | | | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospital, Switzerland
| | | | - Yan Liu
- EORTC Headquarters, Brussels, Belgium
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13
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Simon C, Caballero CA, Fortpied C, Evans M, Koivunen P, Stelmes JJ, Urbanowicz M, Bourhis J, Zimmermann F, Klussmann JP, Dietz A, Spriano G, Leemans CR, Singer S, Tinhofer I, Patterson J, Quaglini S, Hunter K, Gregoire V. BEST OF: A phase III study assessing the best of radiotherapy (Intensity Modulated RadioTherapy, IMRT) compared to the best of surgery (Trans-Oral Surgery, TOS) in patients with T1-T2, N0 oropharyngeal squamous cell carcinoma (OPSCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps6098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian Simon
- CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | | | | | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | | | - C. Rene Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands
| | | | - Inge Tinhofer
- Department of Radiooncology and Radiotherapy, Charité University Hospital and German Cancer Research Center Heidelberg (DKFZ)/German Cancer Consortium (DKTK), Berlin, Germany
| | | | - Silvana Quaglini
- Dept. of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Keith Hunter
- The University of Sheffield, Sheffield, United Kingdom
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