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Stan DL, Kim JO, Schaid DJ, Carlson EE, Kim CA, Sinnwell JP, Couch FJ, Vachon CM, Cooke AL, Goldenberg BA, Pruthi S. Breast Cancer Polygenic-Risk Score Influence on Risk-Reducing Endocrine Therapy Use: Genetic Risk Estimate (GENRE) Trial 1-Year and 2-Year Follow-Up. Cancer Prev Res (Phila) 2024; 17:77-84. [PMID: 38154464 DOI: 10.1158/1940-6207.capr-23-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
Refinement of breast cancer risk estimates with a polygenic-risk score (PRS) may improve uptake of risk-reducing endocrine therapy (ET). A previous clinical trial assessed the influence of adding a PRS to traditional risk estimates on ET use. We stratified participants according to PRS-refined breast cancer risk and evaluated ET use and ET-related quality of life (QOL) at 1-year (previously reported) and 2-year follow-ups. Of 151 participants, 58 (38.4%) initiated ET, and 22 (14.6%) discontinued ET by 2 years; 42 (27.8%) and 36 (23.8%) participants were using ET at 1- and 2-year follow-ups, respectively. At the 2-year follow-up, 39% of participants with a lifetime breast cancer risk of 40.1% to 100.0%, 18% with a 20.1% to 40.0% risk, and 16% with a 0.0% to 20.0% risk were taking ET (overall P = 0.01). Moreover, 40% of participants whose breast cancer risk increased by 10% or greater with addition of the PRS to a traditional breast cancer-risk model were taking ET versus 0% whose risk decreased by 10% or greater (P = 0.004). QOL was similar for participants taking or not taking ET at 1- and 2-year follow-ups, although most who discontinued ET did so because of adverse effects. However, these QOL results may have been skewed by the long interval between QOL surveys and lack of baseline QOL data. PRS-informed breast cancer prevention counseling has a lasting, but waning, effect over time. Additional follow-up studies are needed to address the effect of PRS on ET adherence, ET-related QOL, supplemental breast cancer screening, and other risk-reducing behaviors. PREVENTION RELEVANCE Risk-reducing medications for breast cancer are considerably underused. Informing women at risk with precise and individualized risk assessment tools may substantially affect the incidence of breast cancer. In our study, a risk assessment tool (IBIS-polygenic-risk score) yielded promising results, with 39% of women at highest risk starting preventive medication.
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Affiliation(s)
- Daniela L Stan
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Cancer Center, Mayo Clinic, Rochester, Minnesota
| | - Julian O Kim
- Department of Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel J Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Erin E Carlson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Christina A Kim
- Department of Medical Oncology and Hematology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason P Sinnwell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Fergus J Couch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Celine M Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Andrew L Cooke
- Department of Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Benjamin A Goldenberg
- Department of Medical Oncology and Hematology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandhya Pruthi
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Cancer Center, Mayo Clinic, Rochester, Minnesota
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Lambert P, Galloway K, Feely A, Bucher O, Czaykowski P, Hebbard P, Kim JO, Pitz M, Singh H, Thiessen M, Decker KM. Measuring the impact of COVID-19 on cancer survival using an interrupted time series analysis. JNCI Cancer Spectr 2024; 8:pkae001. [PMID: 38177077 PMCID: PMC10868396 DOI: 10.1093/jncics/pkae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Few studies have investigated the impact of the COVID-19 pandemic on cancer survival. Those studies that have included pandemic vs prepandemic comparisons can mask differences during different periods of the pandemic such as COVID-19 waves. The objective of this study was to investigate the impact of the COVID-19 pandemic on cancer survival using an interrupted time series analysis and to identify time points during the pandemic when observed survival deviated from expected survival. METHODS A retrospective population-based cohort study that included individuals diagnosed with cancer between January 2015 and September 2021 from Manitoba, Canada, was performed. Interrupted time series analyses with Royston-Parmar models as well as Kaplan-Meier survival estimates and delta restricted mean survival times at 1 year were used to compare survival rates for those diagnosed before and after the pandemic. Analyses were performed for 11 cancer types. RESULTS Survival at 1 year for most cancer types was not statistically different during the pandemic compared with prepandemic except for individuals aged 50-74 years who were diagnosed with lung cancer from April to June 2021 (delta restricted mean survival times = -31.6 days, 95% confidence interval [CI] = -58.3 to -7.2 days). CONCLUSIONS With the exception of individuals diagnosed with lung cancer, the COVID-19 pandemic did not impact overall 1-year survival in Manitoba. Additional research is needed to examine the impact of the pandemic on long-term cancer survival.
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Affiliation(s)
- Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Julian O Kim
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Marshall Pitz
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kathleen M Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Dawe DE, Rittberg R, Syed I, Shanahan MK, Moldaver D, Bucher O, Galloway K, Reynolds K, Paul JT, Harlos C, Kim JO, Banerji S. Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada. Front Oncol 2023; 13:1191920. [PMID: 38125937 PMCID: PMC10731283 DOI: 10.3389/fonc.2023.1191920] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
Background Although therapy for limited-stage small-cell lung cancer (LS-SCLC) is administered with curative intent, most patients relapse and eventually die of recurrent disease. Chemotherapy (CT) with concurrent radiotherapy (RT) remains the standard of care for LS-SCLC; however, this could evolve in the near future. Therefore, understanding the current prognostic factors associated with survival is essential. Objective This real-world analysis examines factors associated with long-term survival in patients with LS-SCLC treated with CT in Manitoba, Canada. Methods A retrospective cohort study was conducted using Manitoba Cancer Registry and CancerCare Manitoba records. Eligible patients were aged >18 years and had cytologically confirmed LS-SCLC diagnosed between January 1, 2004, and December 31, 2018, for which they received CT ± RT. Baseline patient, disease, and treatment characteristics and survival duration, characterized as short (<6 months), medium (6-24 months), and long term (>24 months), were extracted. Overall survival (OS) was estimated at one, two, and five years and assessed using Kaplan-Meier methods and Cox proportional hazards models. Results Over the 15-year study period, 304 patients met the eligibility criteria. Long-term survivors comprised 39.1% of the cohort; at diagnosis, this subgroup was younger, more likely to have Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, and have normal lactate dehydrogenase, sodium, and hemoglobin levels. OS estimates for the entire cohort at one, two, and five years were 66%, 38%, and 18%, respectively. In the ECOG PS 0 subgroup, OS estimates at one, two, and five years were 85%, 52%, and 24%, respectively; OS estimates were 60%, 35%, and 17%, respectively, for ECOG PS 1-2 and were 47%, 23%, and 10%, respectively, for ECOG PS 3-4. OS was significantly higher among patients with normal serum sodium and hemoglobin levels than those with abnormal levels. Univariable hazard regression models found that ECOG PS, age at diagnosis, receipt of prophylactic cranial irradiation (PCI), and thoracic RT were associated with survival. On multivariable hazard regression, ECOG PS and receipt of PCI were associated with survival. Conclusion Survival for greater than two years in patients with LS-SCLC treated with CT ± RT was associated with ECOG PS and receipt of PCI.
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Affiliation(s)
- David E. Dawe
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Iqra Syed
- AstraZeneca Canada, Mississauga, ON, Canada
| | | | | | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kayla Reynolds
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James T. Paul
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Craig Harlos
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Julian O. Kim
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
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Decker KM, Feely A, Bucher O, Czaykowski P, Hebbard P, Kim JO, Singh H, Thiessen M, Pitz M, Musto G, Galloway K, Lambert P. Cancer incidence during the COVID-19 pandemic by region of residence in Manitoba, Canada: A cancer registry-based interrupted time series study. Cancer Med 2023; 12:21465-21479. [PMID: 37974380 PMCID: PMC10726851 DOI: 10.1002/cam4.6698] [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] [Revised: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Health care in Manitoba, Canada is divided into five regions, each with unique geographies, demographics, health care access, and health status. COVID-19-related restrictions and subsequent responses also differed by region. To understand the impact of the pandemic on cancer incidence in the context of these differences, we examined age-standardized cancer incidence rates by region over time before and after the COVID-19 pandemic. METHODS We used a population-based quasi-experimental study design, population-based data, and an interrupted time series analysis to examine the rate of new cancer diagnoses before (January 2015 until December 2019) and after the start of COVID-19 and the interventions implemented to mitigate its impact (April 2020 until December 2021) by region. RESULTS Overall cancer incidence differed by region and remained lower than expected in Winnipeg (4.6% deficit, 447 cases), Prairie Mountain (6.9% deficit, 125 cases), and Southern (13.0% deficit, 238 cases). Southern was the only region that had a significantly higher deficit in cases compared to Manitoba (ratio 0.92, 95% CI 0.86, 0.99). Breast and colorectal cancer incidence decreased at the start of the pandemic in all regions except Northern. Lung cancer incidence decreased in the Interlake-Eastern region and increased in the Northern region. Prostate cancer incidence increased in Interlake-Eastern. CONCLUSIONS The impact of the COVID-19 pandemic on cancer incidence differed by region. The deficit in the number of cases was largest in the southern region and was highest for breast and prostate cancers. Cancer incidence did not significantly decrease in the most northern, remote region.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Allison Feely
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Oliver Bucher
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Pamela Hebbard
- Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Radiation OncologyUniversity of ManitobaWinnipegManitobaCanada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Marshall Pitz
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Grace Musto
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Katie Galloway
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
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Dawe DE, Rittberg R, Syed I, Shanahan MK, Moldaver D, Bucher O, Galloway K, Reynolds K, Paul JT, Harlos C, Kim JO, Banerji S. Real-world predictors of survival in patients with extensive-stage small-cell lung cancer in Manitoba, Canada: a retrospective cohort study. Front Oncol 2023; 13:1191855. [PMID: 37795434 PMCID: PMC10545857 DOI: 10.3389/fonc.2023.1191855] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/07/2023] [Indexed: 10/06/2023] Open
Abstract
Background Extensive-stage small-cell lung cancer (ES-SCLC) is an incurable cancer with poor prognosis in which characteristics predictive of long-term survival are debated. The utility of agents such as immune checkpoint inhibitors highlights the importance of identifying key characteristics and treatment strategies that contribute to long-term survival and could help guide therapeutic decisions. Objective This real-world analysis examines the characteristics, treatment patterns, and clinical outcomes of patients receiving chemotherapy without immunotherapy for ES-SCLC in Manitoba, Canada. Methods A retrospective cohort study assessed patient characteristics, treatment, and survival duration (short: <6 months; medium: 6-24 months; long: >24 months) using the Manitoba Cancer Registry and CancerCare Manitoba records. Eligible patients were aged >18 years with cytologically confirmed ES-SCLC diagnosed between January 1, 2004, and December 31, 2018, and received cytotoxic chemotherapy (CT). The one-, two-, and five-year probabilities of overall survival (OS) were assessed relative to patient, disease, and treatment characteristics using Kaplan-Meier methods and Cox proportional hazards models. Results This analysis included 537 patients. Cisplatin was used in 56.1% of patients, 45.6% received thoracic radiotherapy (RT), and few received prophylactic cranial irradiation (PCI). In the overall cohort, one-, two- and five-year OS rates were 26%, 8%, and 3%, respectively. For patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, OS rates at one, two, and five years were 43%, 17%, and 10%, respectively, vs. 27%, 8%, and 2% for those with ECOG PS 1-2, and 16%, 3%, and 3% for those with ECOG PS 3-4. In long-term survivors, ECOG PS scores were lower and abnormal laboratory test results were less frequent. Overall, 74.4% of long-term survivors received thoracic RT and 53.5% received PCI. Known poor prognostic factors - including brain/liver metastases, high lactate dehydrogenase (LDH), abnormal sodium, and low hemoglobin levels - were less common but still seen in long-term survivors. Conclusion Although rare, patients with ES-SCLC may experience long-term survival with CT ± thoracic RT ± PCI. Factors predicting long-term survival include traditional prognostic factors such as ECOG PS, LDH level, and receipt of thoracic RT or PCI. These findings support current treatment algorithms for ES-SCLC and provide baseline survival estimates to assess the real-world impact of adding immune checkpoint inhibitors in the future.
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Affiliation(s)
- David E. Dawe
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Iqra Syed
- AstraZeneca Canada, Mississauga, ON, Canada
| | | | | | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kayla Reynolds
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James T. Paul
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Craig Harlos
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Julian O. Kim
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
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Kidane B, Gerard IJ, Spicer J, Kim JO, Fiset PO, Wawryko P, Cecchini MJ, Inculet R, Abdulkarim B, Fortin D, Qiabi M, Qing G, Enns S, Bashir B, Tankel J, Wakeam E, Warner A, Kopek N, Yaremko BP, Rodrigues GB, Laba JM, Qu M, Malthaner RA, Palma DA. Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol. Cancer 2023; 129:2798-2807. [PMID: 37221679 DOI: 10.1002/cncr.34880] [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: 12/13/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND During coronavirus disease 2019 (COVID-19)-related operating room closures, some multidisciplinary thoracic oncology teams adopted a paradigm of stereotactic ablative radiotherapy (SABR) as a bridge to surgery, an approach called SABR-BRIDGE. This study presents the preliminary surgical and pathological results. METHODS Eligible participants from four institutions (three in Canada and one in the United States) had early-stage presumed or biopsy-proven lung malignancy that would normally be surgically resected. SABR was delivered using standard institutional guidelines, with surgery >3 months following SABR with standardized pathologic assessment. Pathological complete response (pCR) was defined as absence of viable cancer. Major pathologic response (MPR) was defined as ≤10% viable tissue. RESULTS Seventy-two patients underwent SABR. Most common SABR regimens were 34 Gy/1 (29%, n = 21), 48 Gy/3-4 (26%, n = 19), and 50/55 Gy/5 (22%, n = 16). SABR was well-tolerated, with one grade 5 toxicity (death 10 days after SABR with COVID-19) and five grade 2-3 toxicities. Following SABR, 26 patients underwent resection thus far (13 pending surgery). Median time-to-surgery was 4.5 months post-SABR (range, 2-17.5 months). Surgery was reported as being more difficult because of SABR in 38% (n = 10) of cases. Thirteen patients (50%) had pCR and 19 (73%) had MPR. Rates of pCR trended higher in patients operated on at earlier time points (75% if within 3 months, 50% if 3-6 months, and 33% if ≥6 months; p = .069). In the exploratory best-case scenario analysis, pCR rate does not exceed 82%. CONCLUSIONS The SABR-BRIDGE approach allowed for delivery of treatment during a period of operating room closure and was well-tolerated. Even in the best-case scenario, pCR rate does not exceed 82%.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian J Gerard
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Julian O Kim
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pierre O Fiset
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Paul Wawryko
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Bassam Abdulkarim
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Mehdi Qiabi
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Gefei Qing
- Department of Physiology and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Enns
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Tankel
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Elliot Wakeam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Warner
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Neil Kopek
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Brian P Yaremko
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Melody Qu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada
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Decker KM, Feely A, Bucher O, Czaykowski P, Hebbard P, Kim JO, Pitz M, Singh H, Thiessen M, Lambert P. New Cancer Diagnoses Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2332363. [PMID: 37669049 PMCID: PMC10481240 DOI: 10.1001/jamanetworkopen.2023.32363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Disruptions to health care during the COVID-19 pandemic may have led to missed cancer diagnoses. It is critical to evaluate the association between the COVID-19 pandemic and cancer incidence to address public and patient anxiety, inform recovery efforts, and identify strategies to reduce the system's vulnerability to future disruptions. Objective To examine the association between the COVID-19 pandemic and cancer incidence in Manitoba, Canada. Design, Setting, and Participants A population-based cross-sectional study design was conducted using data from the Manitoba Cancer Registry and an interrupted time-series analysis. All individuals diagnosed with cancer in Manitoba, Canada, from January 1, 2015, until December 31, 2021, were included. Individuals diagnosed with breast, colon, rectal, or lung cancer were grouped by age as follows: younger than 50 years, 50 to 74 years, and 75 years and older. Exposures COVID-19 pandemic. Main Outcomes and Measures Age-standardized cancer incidence rates and the estimated cumulative difference between the number of cases in the absence of COVID-19 and observed (fitted) number of cancer cases. Results A total of 48 378 individuals were included. The median (IQR) age at diagnosis was 68 (59-77) years and 23 972 participants (49.6%) were female. In April 2020, there was a 23% decrease in overall cancer incidence. Cancer incidence decreased by 46% for breast, 35% for colon, 47% for rectal, 50% for head and neck, 65% for melanoma, and 33% for endocrine cancer diagnoses and increased by 12% for hematological cancer diagnoses and 8% for diagnoses of cancers with an unknown primary site. Lung cancer incidence remained stable until December 2020 when it decreased by 11%. Brain and central nervous system and urinary cancer diagnoses decreased consistently over time from April 2020 to December 2021 by 26% and 12%, respectively. No association was observed with gynecologic (1% increase), other digestive (1% decrease), or pancreatic (7% increase) cancer incidence. As of December 2021, Manitoba had an estimated deficit of 692 (5.3%) cancers. The largest estimated deficits were for breast (273 cases, 14.1% deficit), colon (133 cases, 12.2% deficit), and lung cancers (132 cases, 7.6% deficit). Conclusions and Relevance In this study, the COVID-19 pandemic was associated with an initial decrease in cancer diagnosis incidence followed by a recovery for most cancer sites. However, the cumulative deficit for some cancers with high fatality needs immediate attention.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Hebbard
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Cheng JC, Buduhan G, Venkataraman S, Tan L, Sasaki D, Bashir B, Ahmed N, Kidane B, Sivananthan G, Koul R, Leylek A, Butler J, McCurdy B, Wong R, Kim JO. Endobronchially Implanted Real-Time Electromagnetic Transponder Beacon-Guided, Respiratory-Gated SABR for Moving Lung Tumors: A Prospective Phase 1/2 Cohort Study. Adv Radiat Oncol 2023; 8:101243. [PMID: 37408673 PMCID: PMC10318214 DOI: 10.1016/j.adro.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Endobronchial electromagnetic transponder beacons (EMT) provide real-time, precise positional data of moving lung tumors. We report results of a phase 1/2, prospective, single-arm cohort study evaluating the treatment planning effects of EMT-guided SABR for moving lung tumors. Methods and Materials Eligible patients were adults, Eastern Cooperative Oncology Group 0 to 2, with T1-T2N0 non-small cell lung cancer or pulmonary metastasis ≤4 cm with motion amplitude ≥5 mm. Three EMTs were endobronchially implanted using navigational bronchoscopy. Four-dimensional free-breathing computed tomography simulation scans were obtained, and end-exhalation phases were used to define the gating window internal target volume. A 3-mm expansion of gating window internal target volume defined the planning target volume (PTV). EMT-guided, respiratory-gated (RG) SABR was delivered (54 Gy/3 fractions or 48 Gy/4 fractions) using volumetric modulated arc therapy. For each RG-SABR plan, a 10-phase image-guided SABR plan was generated for dosimetric comparison. PTV/organ-at-risk (OAR) metrics were tabulated and analyzed using the Wilcoxon signed-rank pair test. Treatment outcomes were evaluated using RECIST (Response Evaluation Criteria in Solid Tumours; version 1.1). Results Of 41 patients screened, 17 were enrolled and 2 withdrew from the study. Median age was 73 years, with 7 women. Sixty percent had T1/T2 non-small cell lung cancer and 40% had M1 disease. Median tumor diameter was 1.9 cm with 73% of targets located peripherally. Mean respiratory tumor motion was 1.25 cm (range, 0.53-4.04 cm). Thirteen tumors were treated with EMT-guided SABR and 47% of patients received 48 Gy in 4 fractions while 53% received 54 Gy in 3 fractions. RG-SABR yielded an average PTV reduction of 46.9% (P < .005). Lung V5, V10, V20, and mean lung dose had mean relative reductions of 11.3%, 20.3%, 31.1%, and 20.3%, respectively (P < .005). Dose to OARs was significantly reduced (P < .05) except for spinal cord. At 6 months, mean radiographic tumor volume reduction was 53.5% (P < .005). Conclusions EMT-guided RG-SABR significantly reduced PTVs of moving lung tumors compared with image-guided SABR. EMT-guided RG-SABR should be considered for tumors with large respiratory motion amplitudes or those located in close proximity to OARs.
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Affiliation(s)
- Jui Chih Cheng
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Buduhan
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lawrence Tan
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Sasaki
- Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Naseer Ahmed
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gokulan Sivananthan
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmet Leylek
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Butler
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyd McCurdy
- Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ralph Wong
- Medical Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julian O. Kim
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
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9
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Usmani N, Kim JO. In Reply to Hsu and Shueng. Int J Radiat Oncol Biol Phys 2023; 116:694-695. [PMID: 37270253 DOI: 10.1016/j.ijrobp.2023.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Nawaid Usmani
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Julian O Kim
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.
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Antony F, Shrivastav A, Dubey A, Usmani N, Ong A, Koul R, Quon H, Sivananthan G, Hunter W, Yee D, Rowe L, Danielson B, Plesniarski A, Su RC, Kim JO. Abstract 4858: Effect of mTOR activity in peripheral blood mononuclear cells with metformin in high-risk prostate cancer patients receiving external beam radiotherapy and androgen deprivation therapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Introduction: There is considerable interest in the antineoplastic properties of metformin for prostate cancer treatment, however, the underlying mechanism of action of metformin in this setting is poorly understood. It is suspected that metformin’s antineoplastic activity is related to inhibition of mTOR (mammalian target of rapamycin), which ultimately inhibits cell proliferation. In this pilot study, we assessed the mTOR activity of peripheral blood mononuclear cells (PBMCs) from high-risk Prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT) and external beam radiotherapy (EBRT) plus metformin versus placebo. We hypothesized decreased mTOR expression in PBMCs from patients receiving metformin versus placebo.
Methods: Normoglycemic adult males with high-risk PCa receiving ADT & EBRT were randomized to metformin 500 mg 3 times daily or placebo. Peripheral blood samples were collected from participants
≥ 6 months after starting study drug, buffy coats were extracted, and PBMCs were isolated ≤2 hours after specimen collection using ficoll-hypaque density gradient method. The mTOR expression was assessed by phosphorylation of serine 2448 (pmTOR; S2448). Activity of mTOR was measured in both unstimulated or stimulated (using CD3/CD28 antibodies) CD4+ and CD8+ T cells.
Results: Samples from 15 patients were analyzed (11 placebo & 4 metformin). We observed lower expression of pmTOR in PBMCs in patients receiving metformin compared to placebo indicating metformin demonstrated inhibition of mTOR activity in PBMCs. A general trend of mTOR inhibition was observed in the metformin group across the cell population and conditions (unstimulated vs. stimulated T cell populations). However, the most pronounced difference was observed in unstimulated CD4+ cells, which is of interest since they represent the closest physiological state to the study participants.
Conclusion: In this pilot study, we observed mTOR inhibition in the PBMCs of PCa patients treated with metformin. Further assessment of mTOR activity amongst PCa patients receiving metformin is warranted in order to confirm these findings.
Citation Format: Febin Antony, Anuraag Shrivastav, Arbind Dubey, Nawaid Usmani, Aldrich Ong, Rashmi Koul, Harvey Quon, Gokulan Sivananthan, William Hunter, Don Yee, Lindsay Rowe, Brita Danielson, Andrew Plesniarski, Ruey-Chyi Su, Julian O. Kim. Effect of mTOR activity in peripheral blood mononuclear cells with metformin in high-risk prostate cancer patients receiving external beam radiotherapy and androgen deprivation therapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4858.
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Affiliation(s)
- Febin Antony
- 1Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arbind Dubey
- 1Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Aldrich Ong
- 1Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- 1Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Quon
- 4Tom Baker Cancer Center, Calgary, Alberta, Canada
| | | | | | - Don Yee
- 5Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Lindsay Rowe
- 5Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Andrew Plesniarski
- 6JC Wilt Infectious Diseases Research Centre, Winnipeg, Manitoba, Canada
| | - Ruey-Chyi Su
- 6JC Wilt Infectious Diseases Research Centre, Winnipeg, Manitoba, Canada
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Usmani N, Ghosh S, Sanghera KP, Ong AD, Koul R, Dubey A, Ahmed S, Quon H, Yee D, Parliament M, Sivananthan G, Hunter W, Danielson B, Rowe L, McDonald M, Kim JO. Metformin for Prevention of Anthropometric and Metabolic Complications of Androgen Deprivation Therapy in Prostate Cancer Patients Receiving Radical Radiotherapy: A Phase II Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2023; 115:317-326. [PMID: 35907513 DOI: 10.1016/j.ijrobp.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/02/2022] [Accepted: 07/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with prostate cancer undergoing treatment with radical radiation therapy (RT) plus androgen deprivation therapy (ADT) experience a constellation of deleterious metabolic and anthropometric changes related to hypogonadism that are associated with increased morbidity and mortality. We assessed the effect of metformin versus placebo to blunt the adverse effects of ADT on body weight, waist circumference, and other metabolic parameters. METHODS AND MATERIALS This phase 2, multicenter, randomized controlled trial (RCT) randomized normoglycemic men with locally advanced prostate cancer receiving radical RT and ADT (18-36 months) in a 1:1 ratio to receive metformin 500 mg by mouth 3 times a day (for 30-36 months) versus identical placebo. RESULTS From December 2015 to October 2019, 83 men were randomized with median follow-up of 23 months. Baseline mean body mass Index (BMI) of the cohort was 30.2 (range 22.2-52.5). Change in mean weight relative to baseline was lower among men who received metformin compared with placebo at 5 months (-1.80 kg, P = .038), but was not significant with longer follow-up (1 year: +0.16 kg, P = .874). Although participants on ADT had increases in waist circumference in both study arms, metformin did not significantly reduce these changes (1 year: +2.79 cm (placebo) versus +1.46 cm (metformin), P = .336). Low-density lipoprotein (LDL) cholesterol was lower in the metformin arm (-0.32 mmol/L) compared with the placebo arm (-0.03 mmol/L) at 5 months (P = .022), but these differences were not significant with longer follow-up (1 year: -0.17 mmol/L vs -0.19 mmol/L, P = .896). There were no differences in HbA1C, triglyceride, high-density lipoprotein (HDL) cholesterol, and total cholesterol by study arm. CONCLUSIONS Men receiving radical RT and ADT gained weight and had increases in waist circumference over time that metformin did not significantly mitigate. Although this study did not observe any preventive effect of metformin on the anthropometric and metabolic complications of ADT, metformin continues to be studied in phase 3 RCTs in this patient population to assess its potential antineoplastic effects.
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Affiliation(s)
- Nawaid Usmani
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Division of Experimental Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Karan P Sanghera
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Aldrich D Ong
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shahida Ahmed
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Quon
- Division of Radiation Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Don Yee
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Gokulan Sivananthan
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Western Manitoba Cancer Centre, Brandon, Manitoba, Canada
| | - William Hunter
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Western Manitoba Cancer Centre, Brandon, Manitoba, Canada
| | - Brita Danielson
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Lindsay Rowe
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Megan McDonald
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julian O Kim
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Heath Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.
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12
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Kim JO, Balshaw R, Trevena C, Banerji S, Murphy L, Dawe D, Tan L, Srinathan S, Buduhan G, Kidane B, Qing G, Domaratzki M, Aliani M. Data-driven identification of plasma metabolite clusters and metabolites of interest for potential detection of early-stage non-small cell lung cancer cases versus cancer-free controls. Cancer Metab 2022; 10:16. [PMID: 36224630 PMCID: PMC9559833 DOI: 10.1186/s40170-022-00294-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolomics is a potential means for biofluid-based lung cancer detection. We conducted a non-targeted, data-driven assessment of plasma from early-stage non-small cell lung cancer (ES-NSCLC) cases versus cancer-free controls (CFC) to explore and identify the classes of metabolites for further targeted metabolomics biomarker development. METHODS Plasma from 250 ES-NSCLC cases and 250 CFCs underwent ultra-high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) in positive and negative electrospray ionization (ESI) modes. Molecular feature extraction, formula generation, and find-by-ion tools annotated metabolic entities. Analysis was restricted to endogenous metabolites present in ≥ 80% of samples. Unsupervised hierarchical cluster analysis identified clusters of metabolites. The metabolites with the strongest correlation with the principal component of each cluster were included in logistic regression modeling to assess discriminatory performance with and without adjustment for clinical covariates. RESULTS A total of 1900 UHPLC-QTOF-MS assessments identified 1667 and 2032 endogenous metabolites in the ESI-positive and ESI-negative modes, respectively. After data filtration, 676 metabolites remained, and 12 clusters of metabolites were identified from each ESI mode. Multivariable logistic regression using the representative metabolite from each cluster revealed effective classification of cases from controls with overall diagnostic accuracy of 91% (ESI positive) and 94% (ESI negative). Metabolites of interest identified for further targeted analysis include the following: 1b, 3a, 12a-trihydroxy-5b-cholanoic acid, pyridoxamine 5'-phosphate, sphinganine 1-phosphate, gamma-CEHC, 20-carboxy-leukotriene B4, isodesmosine, and 18-hydroxycortisol. CONCLUSIONS Plasma-based metabolomic detection of early-stage NSCLC appears feasible. Further metabolomics studies targeting phospholipid, steroid, and fatty acid metabolism are warranted to further develop noninvasive metabolomics-based detection of early-stage NSCLC.
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Affiliation(s)
- Julian O Kim
- Section of Radiation Oncology, Department of Radiology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. .,CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.
| | - Robert Balshaw
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Connel Trevena
- Department of Computer Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shantanu Banerji
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.,Section of Medical Oncology, Department of Internal Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh Murphy
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.,Section of Medical Oncology, Department of Internal Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sadeesh Srinathan
- Section of Thoracic Surgery, Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gefei Qing
- Department of Human Pathology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Domaratzki
- Department of Computer Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michel Aliani
- Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Shahhat S, Hanumanthappa N, Chung YT, Beck J, Koul R, Bashir B, Cooke A, Dubey A, Butler J, Nashed M, Hunter W, Ong AD, Rathod S, Tran K, Kim JO. Do Sustainable Palliative Single Fraction Radiotherapy Practices Proliferate or Perish 2 Years after a Knowledge Translation Campaign? Curr Oncol 2022; 29:5097-5109. [PMID: 35877264 PMCID: PMC9324375 DOI: 10.3390/curroncol29070404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation (KT) campaign to improve the utilization of single fraction radiotherapy (SFRT) over multiple fraction radiotherapy (MFRT) for palliative management of bone metastases. The campaign significantly increased short-term SFRT utilization. We assess the time-dependent effects of KT-derived SFRT utilization 12–24 months removed from the KT campaign in a Provincial Cancer Program. This study identified patients receiving palliative radiotherapy for bone metastases in Manitoba in the 2018 calendar year using the provincial radiotherapy database. The proportion of patients treated with SFRT in 2018 was compared to 2017. Logistic regression analyses identified risk factors associated with MFRT receipt. In 2018, 1008 patients received palliative radiotherapy for bone metastasis, of which 63.3% received SFRT, a small overall increase in SFRT use over 2017 (59.1%). However, 41.1% of ROs demonstrated year-over-year decreases in SFRT utilization, indicative of a time-dependent loss of SFRT prescription habits derived from KT. Although SFRT use increased slightly overall in 2018, evidence of compliance fatigue was observed, suggestive of a time-perishing property of RO prescription behaviours derived from KT methodologies. Verification of the study’s findings in larger cohorts would be beneficial. These findings highlight the need for additional longitudinal KT reinforcement practices in the years following KT campaigns.
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Affiliation(s)
- Shaheer Shahhat
- Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada;
| | - Nikesh Hanumanthappa
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India;
| | - Youn Tae Chung
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - James Beck
- Department of Medical Physics, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Rashmi Koul
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Bashir Bashir
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Andrew Cooke
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Arbind Dubey
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Jim Butler
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Maged Nashed
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - William Hunter
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
- Radiation Oncology, Western Manitoba Cancer Center, Brandon, MB R7A 2B3, Canada
| | - Aldrich D. Ong
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Shrinivas Rathod
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
| | - Kim Tran
- Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Julian O. Kim
- Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (R.K.); (B.B.); (A.C.); (A.D.); (J.B.); (M.N.); (W.H.); (A.D.O.); (S.R.)
- CancerCare Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada
- Correspondence:
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Abstract
Central nervous system (CNS) metastasis will develop in 50% of small cell lung cancer (SCLC) patients throughout disease course. Development of CNS metastasis poses a particular treatment dilemma due to the accompanied cognitive changes, poor permeability of the blood-brain barrier to systemic therapy and relatively advanced state of disease. Survival of patients with untreated SCLC brain metastases is generally <3 months with whole brain radiotherapy used as first-line management in most SCLC patients. To prevent development of CNS metastasis prophylactic cranial irradiation (PCI) is recommended in limited stage disease, after response to chemotherapy and radiation, while PCI may be considered in extensive stage disease after favorable response to upfront treatment. Neurocognitive toxicity with whole brain radiotherapy and PCI is a concern and remains difficult to predict. The mechanism of toxicity is likely multifactorial, but a potential mechanism of injury to the hippocampus has led to hippocampal sparing radiation techniques. Treatment of established non-small cell lung cancer CNS metastases has increasingly focused on using stereotactic radiotherapy (SRS) and it is tempting to extrapolate these results to SCLC. In this review, we explore the evidence surrounding the prediction, prevention, detection, and treatment of CNS metastases in SCLC. We further review whether existing evidence supports extrapolating less toxic treatments to SCLC patients with CNS metastases and discuss trials that may shed more light on this question.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
- Research Institute in Oncology and Hematology at CancerCare Manitoba, Winnipeg, MB, Canada
| | | | | | - David E Dawe
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
- Research Institute in Oncology and Hematology at CancerCare Manitoba, Winnipeg, MB, Canada
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15
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Kim JO, McDonald MO, Ong A, Koul R, Dubey A, Hunter W, Ahmed S, Quon H, Yee D, Parliament M, Sivananthan G, Danielson B, Rowe L, Ghosh S, Usmani N. Gastrointestinal and genitourinary toxicity profiles of metformin versus placebo in men with prostate cancer receiving prostate radiotherapy: interim toxicity results of a double-blinded, multicenter, phase II randomized controlled trial. Radiat Oncol 2021; 16:212. [PMID: 34736499 PMCID: PMC8567697 DOI: 10.1186/s13014-021-01935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Androgen deprivation therapy (ADT) used for prostate cancer (PCa) management is associated with metabolic and anthropometric toxicity. Metformin given concurrent to ADT is hypothesized to counteract these changes. This planned interim analysis reports the gastrointestinal and genitourinary toxicity profiles of PCa patients receiving ADT and prostate/pelvic radiotherapy plus metformin versus placebo as part of a phase 2 randomized controlled trial. Men with intermediate or high-risk PCa were randomized 1:1 to metformin versus placebo. Both groups were given ADT for 18–36 months with minimum 2-month neoadjuvant phase prior to radiotherapy. Acute gastrointestinal and genitourinary toxicities were quantified using CTCAE v4.0. Differences in ≥ grade 2 toxicities by treatment were assessed by chi-squared test. 83 patients were enrolled with 44 patients randomized to placebo and 39 randomized to metformin. There were no significant differences at any time point in ≥ grade 2 gastrointestinal toxicities or overall gastrointestinal toxicity. Overall ≥ grade 2 gastrointestinal toxicity was low prior to radiotherapy (7.9% (placebo) vs. 3.1% (metformin), p = 0.39) and at the end of radiotherapy (2.8% (placebo) vs 3.1% (metformin), p = 0.64). There were no differences in overall ≥ grade 2 genitourinary toxicity between treatment arms (19.0% (placebo) vs. 9.4% (metformin), p = 0.30). Metformin added to radiotherapy and ADT did not increase rates of ≥ grade 2 gastrointestinal or genitourinary toxicity and is generally safe and well-tolerated.
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Affiliation(s)
- Julian O Kim
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. .,CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
| | - Megan O McDonald
- Postgraduate Medical Education, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aldrich Ong
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William Hunter
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Western Manitoba Cancer Center, Brandon, Manitoba, Canada
| | - Shahida Ahmed
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Quon
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Don Yee
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Gokulan Sivananthan
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Western Manitoba Cancer Center, Brandon, Manitoba, Canada
| | - Brita Danielson
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay Rowe
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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16
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Decker KM, Lambert P, Feely A, Bucher O, Kim JO, Hebbard P, Thiessen M, Fatoye T, Pitz M, Koul R, Czaykowski P. Evaluating the Impact of the COVID-19 Pandemic on New Cancer Diagnoses and Oncology Care in Manitoba. ACTA ACUST UNITED AC 2021; 28:3081-3090. [PMID: 34436035 PMCID: PMC8395519 DOI: 10.3390/curroncol28040269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022]
Abstract
Individuals with cancer are vulnerable to infection with SARS-CoV-2, the virus causing COVID-19. Physical distancing, the reallocation of health care resources, and the implementation of procedures to reduce the spread of COVID-19 may also have serious consequences for people with cancer. We evaluated the impact of COVID-19 on new cancer diagnoses and oncology care in Manitoba, Canada using an interrupted time series design and data from the Manitoba Cancer Registry and CancerCare Manitoba's (CCMB) electronic medical record. In April 2020, there was a 23% decrease in new cancer diagnoses, a 21% decrease in pathology reports, and a 43% reduction in surgical resections. There was no difference in new cancer diagnoses by August 2020, surgery by July 2020, and pathology reports by September 2020. From April 2020 to June 2021, there was a 13% decrease in radiotherapy (RT) fractions, an 18% decrease in UCC visits, and a 52% decrease in in-person visits. There was no change in intravenous chemotherapy visits per month, first RT visits, or overall patient visits. The impact of COVID-19 on shifts in the stage at diagnosis and survival will be assessed in future analyses.
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Affiliation(s)
- Kathleen M. Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (J.O.K.); (M.P.); (R.K.)
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0V9, Canada;
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (A.F.); (O.B.)
- Correspondence: ; Tel.: +1-204-390-3912
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (J.O.K.); (M.P.); (R.K.)
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (A.F.); (O.B.)
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (A.F.); (O.B.)
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (A.F.); (O.B.)
| | - Julian O. Kim
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (J.O.K.); (M.P.); (R.K.)
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street GA216, Winnipeg, MB R3T 2N2, Canada
- Department of Radiation Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Pamela Hebbard
- Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada;
| | - Maclean Thiessen
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Tunji Fatoye
- Department of Primary Care Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada;
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Marshall Pitz
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (J.O.K.); (M.P.); (R.K.)
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Rashmi Koul
- CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada; (P.L.); (J.O.K.); (M.P.); (R.K.)
- Department of Radiology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street GA216, Winnipeg, MB R3T 2N2, Canada
- Department of Radiation Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0V9, Canada;
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
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17
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Shahhat S, Hanumanthappa N, Chung YT, Beck J, Koul R, Bashir Bashir, Cooke A, Dubey A, Butler J, Nashed M, Hunter W, Rathod S, Ong A, Tran K, Kim JO. Do Coordinated Knowledge Translation Campaigns Persuade Radiation Oncologists to Use Single-Fraction Radiation Therapy Compared With Multiple-Fraction Radiation Therapy for Bone Metastases? Int J Radiat Oncol Biol Phys 2021; 109:365-373. [DOI: 10.1016/j.ijrobp.2020.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
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Abdalmassih M, Bucher O, Rathod S, Dubey A, Kim JO, Ahmed N, Leylek A, Chowdhury A, Bashir B. Clinical Outcomes After Stereotactic Body Radiation Therapy for Early Stage Non-Small Cell Lung Cancer: A Single Institutional Study. Cureus 2020; 12:e11886. [PMID: 33304707 PMCID: PMC7719484 DOI: 10.7759/cureus.11886] [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] [Indexed: 12/25/2022] Open
Abstract
Introduction The standard of care for early-stage non-small cell lung cancer (NSCLC) is surgery. However, for medical inoperable patients stereotactic body radiation therapy (SBRT) is an alternative method. The aim of the study is to assess the overall survival (OS), progression-free survival (PFS) and local control (LC) of patients diagnosed with NSCLC in Manitoba, Canada, between 2013 and 2017 and managed with SBRT. Materials and methods This retrospective study included a total of 158 patients (60.13% of the population were females) that were diagnosed with stage I-II NSCLC and were treated with lung SBRT between 2013 and 2017 in Manitoba. Demographics and clinical data were retrospectively extracted from the electronic patient record. Kaplan-Meier and Cumulative incidence curves were used to describe the OS, PFS, and LC outcomes. Results From the 158 patients, 32 patients were treated with 60 Gy in eight fractions, while 121 patients were treated with 48 Gy in four fractions. Only 85 patients had biopsy-proven NSCLC. The median OS was 2.87 years (95% confidence interval [CI] 2.16-3.43). OS rates at one and two years were 85% and 66%, respectively. The median PFS was 2.03 years (95% CI 1.65-2.77). Furthermore, one-year and two-year PFS rates were 77% and 51%, respectively. Only 10 patients progressed locally at one year and 17 at two years, making the LC rate 93% at the one-year and 87% at the two-year mark. Conclusion These findings add to a growing evidence base supporting SBRT in the treatment of clinically suspected and biopsy-proven early-stage NSCLC patients.
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Affiliation(s)
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, CAN
| | - Shrinivas Rathod
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Arbind Dubey
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Julian O Kim
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Naseer Ahmed
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Ahmet Leylek
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Amitava Chowdhury
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Bashir Bashir
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
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19
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Hiebert BM, Janzen BW, Sanjanwala RM, Ong AD, Feldman RD, Kim JO. Impact of spironolactone exposure on prostate cancer incidence amongst men with heart failure: A Pharmacoepidemiological study. Br J Clin Pharmacol 2020; 87:1801-1813. [PMID: 32986870 DOI: 10.1111/bcp.14568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Aldosterone has been found to influence cancer cell growth, cell cycle regulation and cell migration, including in prostate cancer cells. Spironolactone is an aldosterone antagonist used for managing chronic heart failure (HF) with known antiandrogenic effects. We examined the effect of spironolactone exposure amongst men with HF on the incidence of prostate cancer. METHODS This retrospective cohort study utilized provincial clinical and administrative databases from the Manitoba Centre for Health Policy. Incident cases of prostate cancer were identified from the provincial cancer registry, and spironolactone exposure was quantified from pharmacare databases. A multivariable proportional hazards model was used to assess the time-dependent impact of spironolactone exposure on prostate cancer incidence. RESULTS A total of 18 562 men with newly diagnosed HF from 2007 to 2015 with a median age of 72 years (interquartile range: 61-81) and a median follow-up from HF diagnosis to prostate cancer incidence of 2.7 years (interquartile range: 1.1-4.9) were included. A time-dependent multivariable analysis of spironolactone exposure following HF diagnosis found a reduced the risk of prostate cancer hazard ratio 0.55 (95% confidence interval 0.31-0.98, P = .043). CONCLUSION Spironolactone exposure significantly reduced the incidence of prostate cancer amongst men with HF. These findings support the plausibility of aldosterone as a promoter of prostate cancer growth and development. Prospective clinical trials are warranted to further assess the role of spironolactone or other mineralocorticoid receptor antagonists as a means to prevent prostate cancer development or as an adjunctive measure to prostate cancer treatments.
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Affiliation(s)
- Brett M Hiebert
- Cardiac Sciences Program, Winnipeg Regional Heath Authority, Winnipeg, Canada
| | - Bryan W Janzen
- Division of Radiation Oncology, University of Manitoba, Winnipeg, Canada
| | - Rohan M Sanjanwala
- Cardiac Sciences Program, Winnipeg Regional Heath Authority, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Aldrich D Ong
- Division of Radiation Oncology, University of Manitoba, Winnipeg, Canada
| | - Ross D Feldman
- Cardiac Sciences Program, Winnipeg Regional Heath Authority, Winnipeg, Canada.,Departments of Medicine, of Pharmacology & Therapeutics and of Physiology & Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - Julian O Kim
- Division of Radiation Oncology, University of Manitoba, Winnipeg, Canada.,Research Institute of Oncology & Hematology, University of Manitoba and CancerCare Manitoba, Winnipeg, Manitoba, Canada
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20
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Kim JO, Schaid DJ, Vachon CM, Cooke A, Couch FJ, Kim CA, Sinnwell JP, Hasadsri L, Stan DL, Goldenberg B, Neal L, Grenier D, Degnim AC, Thicke LA, Pruthi S. Impact of Personalized Genetic Breast Cancer Risk Estimation With Polygenic Risk Scores on Preventive Endocrine Therapy Intention and Uptake. Cancer Prev Res (Phila) 2020; 14:175-184. [PMID: 33097489 DOI: 10.1158/1940-6207.capr-20-0154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/06/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Endocrine therapy is underutilized to reduce breast cancer incidence among women at increased risk. Polygenic risk scores (PRSs) assessing 77 breast cancer genetic susceptibility loci personalizes risk estimates. We examined effect of personalized PRS breast cancer risk prediction on intention to take and endocrine therapy uptake among women at increased risk. Eligible participants had a 10-year breast cancer risk ≥5% by Tyrer-Cuzick model [International Breast Cancer Intervention Study (IBIS)] or ≥3.0 % 5-year Gail Model risk with no breast cancer history or hereditary breast cancer syndrome. Breast cancer risk was estimated, endocrine therapy options were discussed, and endocrine therapy intent was assessed at baseline. After genotyping, PRS-updated breast cancer risk estimates, endocrine therapy options, and intent to take endocrine therapy were reassessed; endocrine therapy uptake was assessed during follow-up. From March 2016 to October 2017, 151 patients were enrolled [median (range) age, 56.1 (36.0-76.4 years)]. Median 10-year and lifetime IBIS risks were 7.9% and 25.3%. Inclusion of PRS increased lifetime IBIS breast cancer risk estimates for 81 patients (53.6%) and reduced risk for 70 (46.4%). Of participants with increased breast cancer risk by PRS, 39 (41.9%) had greater intent to take endocrine therapy; of those with decreased breast cancer risk by PRS, 28 (46.7%) had less intent to take endocrine therapy (P < 0.001). On multivariable regression, increased breast cancer risk by PRS was associated with greater intent to take endocrine therapy (P < 0.001). Endocrine therapy uptake was greater among participants with increased breast cancer risk by PRS (53.4%) than with decreased risk (20.9%; P < 0.001). PRS testing influenced intent to take and endocrine therapy uptake. Assessing PRS effect on endocrine therapy adherence is needed.Prevention Relevance: Counseling women at increased breast cancer risk using polygenic risk score (PRS) risk estimates can significantly impact preventive endocrine therapy uptake. Further development of PRS testing to personalize breast cancer risk assessments and endocrine therapy counselling may serve to potentially reduce the incidence of breast cancer in the future.
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Affiliation(s)
- Julian O Kim
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel J Schaid
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Andrew Cooke
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Fergus J Couch
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Christina A Kim
- Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jason P Sinnwell
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Linda Hasadsri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Daniela L Stan
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota.,Cancer Center, Mayo Clinic, Rochester, Minnesota
| | - Benjamin Goldenberg
- Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Lonzetta Neal
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota.,Cancer Center, Mayo Clinic, Rochester, Minnesota
| | - Debjani Grenier
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.,Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Amy C Degnim
- Cancer Center, Mayo Clinic, Rochester, Minnesota.,Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lori A Thicke
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota. .,Cancer Center, Mayo Clinic, Rochester, Minnesota
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Kidane B, Spicer J, Kim JO, Fiset PO, Abdulkarim B, Malthaner R, Palma D. SABR-BRIDGE: Stereotactic ABlative Radiotherapy Before Resection to Avo Id Delay for Early-Stage Lun G Cancer or Oligom Ets During the COVID-19 Pandemic. Front Oncol 2020; 10:580189. [PMID: 33072612 PMCID: PMC7544973 DOI: 10.3389/fonc.2020.580189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
Surgical resection is the standard-of-care approach for early-stage non-small cell lung cancer (NSCLC). Surgery is also considered an acceptable standard infit patients with oligometastatic lesions in the lungs. The COVID-19 pandemic has led to worldwide issues with access to operating room time, with patients and physicians facing uncertainty as to when surgical resection will be available, with likely delays of months. Further compounding this are concerns about increased risks of respiratory complications with lung cancer surgery during active phases of the pandemic. In this setting, many thoracic oncology teams are embracing a paradigm where stereotactic ablative radiotherapy (SABR) is used as a bridge, to provide radical-intent treatment based on a combination of immediate SABR followed by planned surgery in 3–6 months. This pragmatic approach to treatment has been named SABR-BRIDGE (Stereotactic ABlative Radiotherapy Before Resection to avoId Delay for early-stage lunG cancer or oligomEts). This term has also been applied to the pragmatic study of the outcomes of this approach. In this paper, we discuss the standards of care in treatment of early-stage (NSCLC) and pulmonary oligometastases, the impetus for the SABR-BRIDGE approach, and the controversies surrounding assessment of pathological response to neo-adjuvant radiation therapy.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Research Institute in Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Julian O Kim
- Research Institute in Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada.,Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Bassam Abdulkarim
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, QC, Canada
| | - Richard Malthaner
- Division of Thoracic Surgery, Department of Surgery, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - David Palma
- Lawson Health Research Institute, London, ON, Canada.,Division of Radiation Oncology, Western University, London, ON, Canada
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22
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McDonald MO, Usmani N, Ong A, Koul R, Dubey A, Ahmed S, Quon H, Yee D, Parliament M, Sivananthan G, Danielson B, Rowe L, Rose J, Hunter W, Sanghera KP, Ghosh S, Kim JO. 2: Acute and Subacute Gastrointestinal and Genitourinary Toxicity Profiles of Metformin Versus Placebo Plus Prostate and Pelvic Radiotherapy for the Management of High Risk Prostate Cancer: Interim Toxicity Results of a Double-Blinded, Multicentre, Phase Ii Randomized Controlled Trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim JO, Hanumanthappa N, Chung YT, Beck J, Koul R, Bashir B, Cooke A, Dubey A, Butler J, Nashed M, Hunter W, Ong A. Does dissemination of guidelines alone increase the use of palliative single-fraction radiotherapy? Initial report of a longitudinal change management campaign at a provincial cancer program. Curr Oncol 2020; 27:190-197. [PMID: 32905177 PMCID: PMC7467795 DOI: 10.3747/co.27.6193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 12/25/2022] Open
Abstract
Background Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (sfrt) and multiple-fraction radiotherapy (mfrt) for the palliation of painful bone metastases, sfrt remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (cwc) that recommend sfrt. We assessed whether dissemination of the guidelines influenced sfrt use in Manitoba in 2016, and we identified factors associated with mfrt. Methods All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with mfrt. Results In 2016, 807 patients (mean age: 70 years; range: 35-96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, mfrt was used-a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (or): 5.3] or lung primary (or: 3.3), complicated bone metastasis (or: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of mfrt use. Conclusions Dissemination of cwc recommendations alone did not increase sfrt use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of sfrt in Manitoba.
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Affiliation(s)
- J O Kim
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | | | - Y T Chung
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg
| | - J Beck
- Medical Physics, CancerCare Manitoba, Winnipeg
| | - R Koul
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - B Bashir
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Cooke
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Dubey
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - J Butler
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - M Nashed
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - W Hunter
- Radiation Oncology, Western Manitoba Cancer Centre, Brandon, MB
| | - A Ong
- Radiation Oncology, CancerCare Manitoba, Winnipeg
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Pruthi S, Kim JO, Schaid D, Cooke A, Kim C, Goldenberg B, Sinnwell J, Grenier D, Couch F, Vachon C. Abstract PD3-03: Impact of the breast cancer polygenic risk score on preventive endocrine therapy adherence and endocrine therapy usage on quality of life - The Genetic Risk Estimate (GENRE) trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd3-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Studies demonstrate breast cancer risk reduction of 50-65% with the use of endocrine therapy (ET) and yet drug uptake and adherence in this setting is suboptimal even among high risk women. A Polygenic Risk Score (PRS) comprised of 77 BC genetic susceptibility loci (Single Nucleotide Polymorphisms (SNP)) can provide a personalized risk assessment and potentially influence ET adherence. We assessed ET adherence at 1 year comparing women whose risk estimate increased due to PRS versus women whose risk estimate decreased due to PRS. The effect of ET use on quality of life (hot flashes, night sweats, vaginal dryness, weight gain, joint pain) was evaluated.
Methods: Eligible women required either a 5 year Gail Model risk of ≥3% or 10 year IBIS ( International Breast Intervention Study or Tyrer-Cuzick model) of ≥5%. Women with a history of breast cancer (BC) or hereditary BC syndrome were excluded. High risk women were counseled at baseline using their Gail and IBIS risk scores and ET options were discussed including benefits and risks. Participants completed a self-reported questionnaire at baseline to assess their understanding of breast cancer risk and decision to take preventive ET. Blood samples were obtained and genotyped for 77 SNPs, and the odds ratio from the SNPs were used to modify the IBIS and Gail risk estimates. The BC -PRS risk estimate information was shared with study participants that reflected the IBIS and Gail risk estimates for 5 year, 10 year, & lifetime BC risk with and without the PRS. Follow up questionnaires at year 1 were administered to assess drug adherence and ET usage on quality of life.
Results: 151 women were enrolled at Mayo Clinic Rochester and CancerCare Manitoba from 2016 to 2017. The median age was 56.1 (range 36-76.4), 35.6% were premenopausal, 98.7% were Caucasian and 64.7% had>1 family member with BC. Median 5yr, 10yr, & lifetime IBIS- PRS risk estimates were 3.8% (2.0-11.5), 7.9% (5.0-23.1), and 25.3% (5.5 to 92.2). At year 1 (n=112 women) 46 % of those with an increase in risk when considering the BC-PRS score and 16 % with a decrease in risk were taking ET ( p< 0.001). Types of ET taken: tamoxifen-18, raloxifene- 3, exemestane -14 and missing-1. Women taking ET reported weight gain ( 19.4% vs 6.7%, p=0.04) and more joint pain ( 27.8 % vs 12%, p=0.04) when compared to women not taking ET.
Conclusion: In high risk women, BC-PRS risk estimates in addition to standard BC risk calculators had a significant impact on preventive ET adherence. ET use was associated with weight gain and joint pain.
Citation Format: Sandhya Pruthi, Julian O Kim, Daniel Schaid, Andrew Cooke, Christina Kim, Benjamin Goldenberg, Jason Sinnwell, Debjani Grenier, Fergus Couch, Celine Vachon. Impact of the breast cancer polygenic risk score on preventive endocrine therapy adherence and endocrine therapy usage on quality of life - The Genetic Risk Estimate (GENRE) trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD3-03.
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Kim JO, Lee J, Lee BH. Effect of Scapular Stabilization Exercise during Standing on Upper Limb Function and Gait Ability of Stroke Patients. J Neurosci Rural Pract 2019; 8:540-544. [PMID: 29204011 PMCID: PMC5709874 DOI: 10.4103/jnrp.jnrp_464_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The purpose of this study was to determine the effect of scapular stabilization exercise during standing on a paretic side on upper limb function and gait ability of stroke patients. Methods This study was a hospital-based, randomized controlled trial with a blinded assessor. A total of 17 patients with hemiplegic diagnosis after stroke were divided into two groups (9 patients in a study group and 8 patients in a control group). The study group received physical therapy and scapular stabilization exercise on a paretic side. Participants were subjected to initial evaluation before the treatment. Subjects were subsequently re-evaluated 4 and 8 weeks later to compare the changes. Measurements of hand function and gait ability were performed. Results Based on multivariate analysis of variance for repeated-measures, there was a significant time effect for Timed Up and Go test (TUG) (F = 13.816, P = 0.000), Functional Gait Assessment (FGA) (F = 18.613, P = 0.000), and manual function test (MFT) (F = 16.777, P = 0.000). The group × time interaction effect was also significant for FGA (F = 4.966, P = 0.024) and MFT (F = 6.946, P = 0.003), but not for TUG test (F = 3.343, P = 0.069). Conclusion Results of the present study indicated that scapular stabilization exercise during standing on a paretic side for 8 weeks had an effect on hand function and gait ability of hemiplegic patients after stroke. Further studies are needed to find the most proper exercise for stroke patients who have gait disability and upper limb dysfunction.
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Affiliation(s)
- J O Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
| | - J Lee
- Department of Physical Therapy, Graduate School of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
| | - B H Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
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Kim JO, Kim CA. Abscopal Resolution of a Hepatic Metastasis in a Patient with Metastatic Cholangiocarcinoma Following Radical Stereotactic Body Radiotherapy to a Synchronous Early Stage Non-small Cell Lung Cancer. Cureus 2019; 11:e4082. [PMID: 31019860 PMCID: PMC6467432 DOI: 10.7759/cureus.4082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This case report describes the abscopal resolution of a liver metastasis in a patient with two separate primary malignancies. A 70-year-old male with an unresectable cholangiocarcinoma with an associated 5 cm liver metastasis was found during his staging investigations to have a 1.8 cm right upper lobe lung tumor. A CT-guided biopsy of the lung tumor revealed a primary adenocarcinoma of lung origin. Given the expected worse prognosis of the metastatic cholangiocarcinoma, after review of his case in provincial gastrointestinal and lung tumor boards, he was treated with eight cycles of palliative gemcitabine and cisplatin chemotherapy. Post eight cycles, the disease in the liver and the lung was stable. After completion of first line palliative systemic therapy, radical stereotactic body radiotherapy (SBRT), consisting of 48 Gy in four fractions, was delivered to the right upper lobe non-small cell lung cancer (NSCLC) primary. Three months post-completion of the SBRT, restaging CT scans were performed which revealed the intriguing spontaneous and complete resolution of his liver metastasis. These findings were confirmed on subsequent MRI imaging of his liver. As his liver metastasis was well outside of the SBRT fields, the spontaneous resolution of his liver metastasis presents clinical evidence of the abscopal effect of cholangiocarcinoma in response to SBRT to his lung tumor.
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Affiliation(s)
- Julian O Kim
- Radiation Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, CAN
| | - Christina A Kim
- Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
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Razzak R, Bédard ELR, Kim JO, Gazala S, Guo L, Ghosh S, Joy A, Nijjar T, Wong E, Roa WH. MicroRNA expression profiling of sputum for the detection of early and locally advanced non-small-cell lung cancer: a prospective case-control study. ACTA ACUST UNITED AC 2016; 23:e86-94. [PMID: 27122989 DOI: 10.3747/co.23.2830] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Non-small-cell lung cancer (nsclc) is associated with very poor overall survival because 70% of patients present with locally advanced or metastatic disease at the time of diagnosis. Micrornas (mirnas) are a class of short, noncoding rna molecules whose presence in samples of biologic fluids such as sputum has demonstrated promise as a potential means of detecting nsclc. We investigated the stage-specific nsclc detection potential of an efficient panel of 3 mirnas (mir-21, mir-210, mir-372) using a single sputum sample. METHODS A single spontaneously expectorated sputum sample was prospectively collected from 21 early nsclc (≤stage ii) patients, 22 advanced nsclc (≥stage iii) patients, and 10 control subjects. Mirna expression profiles were determined by quantitative real-time polymerase chain reaction and were analyzed by unsupervised hierarchical cluster analysis. RESULTS Mean tumour size (±95% confidence interval) in the early and advanced nsclc patients was 3.3 cm ± 0.9 cm and 4.8 cm ± 0.7 cm respectively. Adenocarcinoma constituted 61.9% of the early and 45.5% of the advanced nsclc cases respectively. In comparing the early nsclc group with the control group, the mirna panel yielded a diagnostic sensitivity of 67% and a specificity of 90.0%. For the advanced nsclc group, the mirna panel detected nsclc with a sensitivity and specificity of 64% and 100% respectively. CONCLUSIONS A sputum mir-21, mir-210, and mir-372 expression profile might provide a sensitive and highly specific means for detecting nsclc. Sputum mirna analysis demonstrates promise as a potential complementary screening tool.
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Affiliation(s)
- R Razzak
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB
| | - E L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB
| | - J O Kim
- Department of Radiation Oncology, CancerCare Manitoba, and University of Manitoba, Winnipeg, MB
| | - S Gazala
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB
| | - L Guo
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - S Ghosh
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - A Joy
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - T Nijjar
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - E Wong
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - W H Roa
- Division of Pulmonary Medicine, Department of Internal Medicine, University of Alberta Hospital and University of Alberta, Edmonton, AB
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Jung MH, Jung SJ, Vinay TN, Nikapitiya C, Kim JO, Lee JH, Lee J, Oh MJ. Effects of water temperature on mortality in Megalocytivirus-infected rock bream Oplegnathus fasciatus (Temminck et Schlegel) and development of protective immunity. J Fish Dis 2015; 38:729-737. [PMID: 25073547 DOI: 10.1111/jfd.12286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 04/10/2014] [Revised: 05/30/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
Rock bream iridovirus (RBIV) causes huge losses, especially in rock bream Oplegnathus fasciatus. Rock bream injected with RBIV and held at 29, 26, 23 or 20 °C had 100% mortality. Conversely, all infected fish held at 17 °C survived even after the temperature was progressively increased to 26 °C at 100 dpi. Rock bream exposed to virus and held for 2, 4 and 7 days at 23/26 °C before the temperature was reduced to 17 °C had mortality rates of 26.6/73.2%, 66.6/100% and 93.4/100%, respectively, through 100 dpi. When surviving fish had the water temperature increased from 17 to 26 °C at 100 dpi, they did not exhibit signs of disease and had low virus copy numbers (below 10(3)). To investigate the development of a protective immune, rock bream were infected with RBIV and held at 23 °C before shifting the water temperature to 17 °C at 4 dpi. All injected fish survived until 120 dpi. While 100% of the previously unexposed fish died, 80.2% of the previously infected fish survived. When the survivors were rechallenged again at 160 dpi, no further mortality occurred. The high survival rate of fish following rechallenge with RBIV indicates that protective immunity was established in the surviving rock bream.
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Affiliation(s)
- M H Jung
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
- Aquatic Animal Hospital, Chonnam National University, Yeosu, Chonnam, Korea
| | - S J Jung
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
- Aquatic Animal Hospital, Chonnam National University, Yeosu, Chonnam, Korea
| | - T N Vinay
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
| | - C Nikapitiya
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
| | - J O Kim
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
| | - J H Lee
- Genetic and Breeding Research Centre, National Fisheries Research and Development Institute, Koje, KyungNam, Korea
| | - J Lee
- Department of Marine Life Sciences, Jeju National University, Jeju, Korea
| | - M J Oh
- Department of Aqualife Medicine, Chonnam National University, Yeosu, Chonnam, Korea
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Kim JO, Gazala S, Razzak R, Guo L, Ghosh S, Roa WH, Bédard ELR. Non-small cell lung cancer detection using microRNA expression profiling of bronchoalveolar lavage fluid and sputum. Anticancer Res 2015; 35:1873-1880. [PMID: 25862841] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To assess if miRNA expression profiling of bronchoalveolar lavage (BAL) fluid and sputum could be used to detect early-stage non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Hierarchical cluster analysis was performed on the expression levels of 5 miRNAs (miR-21, miR-143, miR-155, miR-210, and miR-372) which were quantified using RNA reverse transcription and quantitative real-time polymerase chain reaction in sputum and BAL samples from NSCLC cases and cancer-free controls. RESULTS Cluster analysis of the miRNA expression levels in BAL samples from 21 NSCLC cases and sputum samples from 10 cancer-free controls yielded a diagnostic sensitivity of 85.7% and specificity of 100%. Cluster analysis of sputum samples from the same patients yielded a diagnostic sensitivity of 67.8% and specificity of 90%. CONCLUSION miRNA expression profiling of sputum and BAL fluids represent a potential means to detect early-stage NSCLC.
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Affiliation(s)
- Julian O Kim
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada Division of Radiation Oncology, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada Cross Cancer Institute, Edmonton, Alberta, Canada CancerCare, Winnipeg, Manitoba, Canada
| | - Sayf Gazala
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Rene Razzak
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Linghong Guo
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Wilson H Roa
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Noeiaghaei T, Yun JH, Nam SW, Zoh KD, Gomes VG, Kim JO, Chae SR. The influence of geometrical characteristics on the photocatalytic activity of TiO2 nanotube arrays for degradation of refractory organic pollutants in wastewater. Water Sci Technol 2015; 71:1301-1309. [PMID: 25945845 DOI: 10.2166/wst.2015.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The effects of geometrical characteristics such as surface area (SA) and porosity of TiO2 nanotube arrays (TNAs) on its photocatalytic activity were investigated by applying variable voltages and reaction times for the anodization of Ti substrates. While larger SA of nanotubes was observed under higher applied potential, the porosity of TNAs decreased by increasing anodizing voltage. Under applied potential of 80 V, the SA of TNAs increased from 0.164 to 0.471 m2/g as anodization time increased from 1 to 5 hours, respectively. However, no significant effect on the porosity of TNAs was observed. On the other hand, both SA and porosity of TNAs, synthesized at 60 V, increased by augmenting the anodization time from 1 to 3 hours. But further increasing of anodization time to 5 hours resulted in a decreased SA of TNAs with no effect on their porosity. Accordingly, the TNAs with SA of 0.368 m2/g and porosity of 47% showed the highest photocatalytic activity for degradation of 4-chlorobenzoic acid (4CBA). Finally, the degradation of refractory model compounds such as carbamazepine and bisphenol-A was tested and more than 50% of both compounds could be degraded under UV-A irradiation (λmax=365 nm).
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Affiliation(s)
- T Noeiaghaei
- School of Chemical and Biomolecular Engineering, The University of Sydney, NSW 2006, Australia
| | - J-H Yun
- Nanomaterials Centre, School of Chemical Engineering and Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - S W Nam
- Department of Environmental Health, School of Public Health, Seoul National University, Seoul 151-742, South Korea
| | - K D Zoh
- Department of Environmental Health, School of Public Health, Seoul National University, Seoul 151-742, South Korea
| | - V G Gomes
- School of Chemical and Biomolecular Engineering, The University of Sydney, NSW 2006, Australia
| | - J O Kim
- Department of Civil and Environmental Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-792, Republic of Korea
| | - S R Chae
- Department of Biomedical, Chemical, and Environmental Engineering, 701 Engineering Research Center, University of Cincinnati, Cincinnati, Ohio 45221-0012, USA E-mail:
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Kim JO, Ma R, Akagami R, McKenzie M, Johnson M, Gete E, Nichol A. Long-term outcomes of fractionated stereotactic radiation therapy for pituitary adenomas at the BC Cancer Agency. Int J Radiat Oncol Biol Phys 2013; 87:528-33. [PMID: 23953637 DOI: 10.1016/j.ijrobp.2013.06.2057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/24/2013] [Accepted: 06/27/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the long-term disease control and toxicity outcomes of fractionated stereotactic radiation therapy (FSRT) in patients with pituitary adenomas treated at the BC Cancer Agency. METHODS AND MATERIALS To ensure a minimum of 5 years of clinical follow-up, this study identified a cohort of 76 patients treated consecutively with FSRT between 1998 and 2007 for pituitary adenomas: 71% (54/76) had nonfunctioning and 29% (22/76) had functioning adenomas (15 adrenocorticotrophic hormone-secreting, 5 growth hormone-secreting, and 2 prolactin-secreting). Surgery was used before FSRT in 96% (73/76) of patients. A median isocenter dose of 50.4 Gy was delivered in 28 fractions, with 100% of the planning target volume covered by the 90% isodose. Patients were followed up clinically by endocrinologists, ophthalmologists, and radiation oncologists. Serial magnetic resonance imaging was used to assess tumor response. RESULTS With a median follow-up time of 6.8 years (range, 0.6 - 13.1 years), the 7-year progression-free survival was 97.1% and disease-specific survival was 100%. Of the 2 patients with tumor progression, both had disease control after salvage surgery. Of the 22 patients with functioning adenomas, 50% (11/22) had complete and 9% (2/22) had partial responses after FSRT. Of the patients with normal pituitary function at baseline, 48% (14/29) experienced 1 or more hormone deficiencies after FSRT. Although 79% (60/76) of optic chiasms were at least partially within the planning target volumes, no patient experienced radiation-induced optic neuropathy. No patient experienced radionecrosis. No secondary malignancy occurred during follow-up. CONCLUSION In this study of long-term follow-up of patients treated for pituitary adenomas, FSRT was safe and effective.
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Affiliation(s)
- Julian O Kim
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada; Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
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Chae SR, Hotze EM, Badireddy AR, Lin S, Kim JO, Wiesner MR. Environmental implications and applications of carbon nanomaterials in water treatment. Water Sci Technol 2013; 67:2582-2586. [PMID: 23752392 DOI: 10.2166/wst.2013.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Carbon nanomaterials have been proposed as a basis for developing new technologies for photocatalytic oxidation and disinfection, improved membrane processes, adsorbents, and biofilm-resistant surfaces. This study details recent progress towards the development of these proposed applications. We explored the use of carbon nanomaterials such as fullerene C60, single-wall carbon nanotubes (SWCNTs), and multi-wall carbon nanotubes (MWCNTs) for a range of new technologies including, degradation of a probe organic compound by in situ generation of reactive oxygen species (ROS), new strategies for microbial disinfection, and the inhibition of biofilm development on membrane surfaces. The results show that the degradation of 2-chlorophenol by ROS produced microbial inactivation, and the mobility of the nanoparticle aggregates of the carbon nanomaterials all increased as suspensions were fractionated to enrich with smaller aggregates with sonication followed by successive membrane filtration.
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Affiliation(s)
- S R Chae
- School of Chemical and Biomolecular Engineering, The University of Sydney, NSW 2006, Australia
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Roa WH, Kim JO, Razzak R, Du H, Guo L, Singh R, Gazala S, Ghosh S, Wong E, Joy AA, Xing JZ, Bedard EL. Sputum MicroRNA Profiling: A Novel Approach for the Early Detection of Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2012; 35:E271. [DOI: 10.25011/cim.v35i5.18700] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Indexed: 11/03/2022]
Abstract
Purpose: MicroRNAs (miRNAs) post-transcriptionally regulate hundreds of gene targets involved in tumorigenesis thereby controlling vital biological processes, including cellular proliferation, differentiation and apoptosis. MiRNA profiling is an emerging tool for the potential early detection of a variety of malignancies. This study was conducyed to assess the feasibility and methodological robustness of quantifying sputum miRNAs, employing quantitative real-time polymerase chain reaction (RT-qPCR) and cluster analysis on an optimized miRNA profile as a novel approach for the early detection of non-small cell lung cancer (NSCLC).
Methods: The relative expressions of 11 miRNAs in sputum (miR-21, miR-145, miR-155, miR-205, miR-210, miR-92, miR-17-5p, miR-143, miR-182, miR-372, and let-7a) in addition to U6 were retrospectively assessed in four NSCLC-positive and four negative controls. Subsequently, a set of five miRNAs (miR-21, miR-143, miR-155, miR-210, miR-372) was selected because of degree of relatedness observed in the cluster analysis and tested in the same sputum sample set. The five optimized miRNAs accurately clustered these eight retrospective patients into NSCLC positive cases and negative controls. The five miRNA panel was then prospectively quantified in the sputum of 30 study patients (24 NSCLC cases and six negative controls) in a double-blind fashion to validate a five miRNA panel using hierarchical cluster analysis.
Results: The optimized five miRNA panel detected NSCLC (83.3% sensitivity and 100% specificity) in 30 prospectively accrued study patients.
Conclusion: Sputum miRNA profiling using cluster analysis is a promising approach for the early detection of non-small cell lung cancer. Further investigation using this approach is warranted.
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Park CH, Cheon JH, Kim JO, Shin JE, Jang BI, Shin SJ, Jeen YT, Lee SH, Ji JS, Han DS, Jung SA, Park DI, Baek IH, Kim SH, Chang DK. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy 2011; 43:790-5. [PMID: 21735371 DOI: 10.1055/s-0030-1256414] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIM Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. PATIENTS AND METHODS The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. RESULTS A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2% based on endoscopic appearance (CR-E) and 60.2% based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (κ=0.192). No residual tumors were found in 77 of 85 patients (90.6%) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5 mm, at which the sensitivity and the specificity for metastasis were 100% and 89%, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. CONCLUSIONS Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10 mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.
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Affiliation(s)
- C H Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Im HS, Kim JO, Lee SJ, Lee YS, Park EK. Borderline mucinous tumor arising in a paratubal cyst: a case report. EUR J GYNAECOL ONCOL 2011; 32:206-207. [PMID: 21614917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Paratubal borderline tumors (PBTs) are found incidentally at frozen section or permanant pathology, and are extremely rare. We describe the first case of a paratubal borderline mucinous tumor (PBMT). CASE REPORT A 20-year-old woman was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic paratubal cyst enucleation. We used an endobag for cyst extraction. Cyst rupture or tearing of the endobag in the laparoscopic field was absent. Frozen section analysis was reported as a borderline mucinous tumor of low malignant potential. Currently, she has had no evidence of disease recurrence after a laparoscopic fertility-sparing staging procedure. CONCLUSION A proper preoperative differential diagnosis of an adnexal mass is difficult. Thus, laparoscopy is needed in large or symptomatic cysts. Although growth, torsion and malignancy are rare in paratubal cysts, the possibility of tumor seeding should be excluded with use of an endobag.
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Affiliation(s)
- H S Im
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Korea
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Kim JO, Baek JM, Jeung C, Park EK, Lee HN, Lee YS. A case of primary ovarian adenomyoma mimicking ovarian malignancy. EUR J GYNAECOL ONCOL 2011; 32:103-106. [PMID: 21446338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is an extremely rare entity. After an extensive literature search, only four cases of primary ovarian adenomyoma appear to have thus far been reported. Here, we report a case of ovarian adenomyoma in a 39-year-old woman mimicking malignant neoplasma of the ovary, along with a brief literature review.
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Affiliation(s)
- J O Kim
- Department of Pathology, The Catholic University of Korea, Korea
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Lee YS, Kim JO, Park SE. Ancient schwannoma of the thigh mimicking a malignant tumour: a report of two cases, with emphasis on MRI findings. Br J Radiol 2010; 83:e154-7. [PMID: 20603402 DOI: 10.1259/bjr/19325350] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ancient schwannomas are rare, encapsulated tumours of long duration and are benign in nature. The tumour is solitary and may grow to a large size before detection of notable degenerative changes. The term "ancient schwannoma" is used to describe a tumour that has undergone such changes, typified by relative loss of Antoni type A tissue, perivascular hyalinisation, calcification, cystic necrosis, haemorrhage and the presence of degenerative nuclei that may be misinterpreted as sarcomatous pleomorphism. We report two cases of ancient schwannoma in the thigh mimicking malignancies. Identifying the fibrous capsule of the mass and a split fat sign using MRI is important for differentiating ancient schwannoma from other malignant tumours.
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Affiliation(s)
- Y Soo Lee
- Department of Radiology, The Catholic University of Korea, Daejeon, Korea
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Abstract
Here, we present the case of a 51-year-old man with limited-stage small cell lung cancer (LS-SCLC) who received concurrent chemoradiotherapy and photodynamic therapy (PDT). The patient was diagnosed as having LS-SCLC with an endobronchial mass in the left main bronchus. Following concurrent chemoradiotherapy, a mass remaining in the left lingular division was treated with PDT. Clinical and histological data indicate that the patient has remained in complete response for 2 years without further treatment. This patient represents a rare case of complete response in LS-SCLC treated with PDT.
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Affiliation(s)
- J E Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital and Cancer Research Institute, Jungku, Daejeon, South Korea
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Affiliation(s)
- S H Eun
- Institute for Digestive Research, Soonchunhyang University, College of Medicine, Yongsan-gu, Seoul, Korea
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Jeon SR, Eun SH, Shim CS, Ryu CB, Kim JO, Cho JY, Lee JS, Lee MS, Jin SY. Effect of drug-eluting metal stents in benign esophageal stricture: an in vivo animal study. Endoscopy 2009; 41:449-56. [PMID: 19418400 DOI: 10.1055/s-0029-1214607] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The aim of this study in canines was to investigate the effectiveness and safety of self-expandable metal stents, which were coated with paclitaxel to minimize the tissue response. MATERIALS AND METHODS 14 dogs (5-10 kg) were randomly allocated to two groups. Drug-eluting stents (DES, n = 7) or nondrug-eluting stents (non-DES, n = 7) were endoscopically inserted and fixed in the esophagus of healthy dogs. Every 2 weeks, for a maximum period of 8 weeks, an endoscopic examination was performed to evaluate the status of stent insertion, the grade of tissue hyperplasia, and mucosal change at both ends of the stent. RESULTS One case of stent migration was observed after 4 weeks in the non-DES group. In this group, tissue reaction and hyperplasia remained for more than 4 weeks after stent insertion. By contrast, an endoscopic examination of the surrounding esophageal mucosa in the DES group showed very little tissue reaction, and the stent was easily separated from the esophageal tissue. CONCLUSION Although further studies are required to confirm our results, we suggest that these newly designed DES may provide an alternative tool to manage refractory benign esophageal stricture.
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Affiliation(s)
- S R Jeon
- Digestive Disease Center, Soon Chun Hyang University Hospital, Seoul, Korea
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41
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Park JS, Park DI, Park SK, Choi JS, Kim YH, Chang DK, Son HJ, Kim JE, Kim JO, Lee SH, Kim HS, Sin JE, Lee SG, Lee SY, Park SJ, Park CH, Baek IH, Jang BI, Jeen YT, Huh KC. Endoscopic evaluation of significant gastrointestinal lesions in patients with iron deficiency with and without anaemia: a Korean Association for the Study of Intestinal Disease study. Intern Med J 2008; 39:441-6. [PMID: 19220549 DOI: 10.1111/j.1445-5994.2008.01785.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although endoscopy is recommended for patients with iron deficiency anaemia, there is, currently, no consensus on the role of endoscopy for iron-deficient patients without anaemia. The goal of this study was to determine the prevalence of serious gastrointestinal (GI) lesions, identified by endoscopy in patients with iron deficiency and anaemia compared with patients with iron deficiency without anaemia. METHODS One thousand five hundred and eighteen patients with a ferritin value of <or=50 ng/mL and a total iron-binding capacity >or=300 mg/dL were retrospectively investigated using oesophagogastroduodenoscopy and colonoscopy between January 2005 and September 2006. The lesions identified were classified as clinically important according to standard predetermined criteria. RESULTS Among the 1518 cases, 749 patients had anaemia and 769 had normal haemoglobin levels. Clinically important lesions were identified in 24.6% of the patients with anaemia and in 22.8% of the patients without anaemia (P > 0.05). The frequency of lower GI tract lesions (13.6 vs 11.4%, P > 0.05) and upper GI tract lesions (11.9 vs 12.5%, P > 0.05) was similar in the comparisons between the two groups. However, the frequency of malignant GI lesions was higher in the patients with anaemia (5.1 vs 0.7%, P < 0.01). In addition, the patients without anaemia were significantly more likely to have early-stage neoplasia (adenoma, early gastric cancer and Dukes' A and B colon cancer) than were the patients with anaemia (98.4 vs 52.5%, P < 0.01). CONCLUSION The results of this study suggest that patients with iron deficiency should undergo endoscopic evaluation of the GI tract, irrespective of whether they have anaemia. The endoscopic evaluation of the GI tract in patients with iron deficiency without anaemia could provide an opportunity for the detection of early-stage neoplasia at a curable stage.
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Affiliation(s)
- J S Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Kim JO, Huq MS. SU-GG-T-334: Improvement of Off-Axis Energy Sampling in XVMC Beam Model for Varian 2100C/D. Med Phys 2008. [DOI: 10.1118/1.2962086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kim YH, Lee JH, Yang SK, Kim TI, Kim JS, Kim HJ, Kim JI, Kim SW, Kim JO, Jung IK, Jung SA, Jung MK, Kim HS, Myung SJ, Kim WH, Rhee JC, Choi KY, Song IS, Hyun JH, Min YI. Primary colon lymphoma in Korea: a KASID (Korean Association for the Study of Intestinal Diseases) Study. Dig Dis Sci 2005; 50:2243-7. [PMID: 16416168 DOI: 10.1007/s10620-005-3041-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Accepted: 03/22/2005] [Indexed: 12/16/2022]
Abstract
Although almost all primary colorectal lymphomas are of B-cell lineage in Western countries, primary colorectal T-cell lymphomas are not uncommon in the East. The aim of this study was to review the clinical characteristics and treatment outcomes of primary colorectal lymphomas, with special emphasis on the differences between T-cell and B-cell lymphomas. Ninety-five cases of primary colorectal lymphomas that satisfied Dawson's criteria were identified from the clinical databases of 13 university hospitals in Korea. The mean age at the time of presentation was 51.1 years and the male:female ratio was 64:31. The clinical information, including endoscopic and histological characteristics, was retrospectively analyzed. Of the primary colorectal lymphomas, 78 cases (82.1%) were of B-lineage and 17 cases (17.9%) were of T-cell lineage. Patients with T-cell lymphomas presented at a younger age than patients with B-cell lymphomas (42.8 vs 52.9 years, respectively; P = 0.016). The most common presenting symptom was abdominal pain (87.1%) for B-cell lymphomas, whereas hematochezia or night fever was more common for T-cell lymphomas (52.9% and 35.3%, respectively). The most common endoscopic type was fungating mass (54.0%) for B-cell lymphomas and ulcerative/ulcero-infiltrative lesions (80.0%) for T-cell lymphomas. Intussusception was more common in B-cell lymphomas than in T-cell lymphomas (30.8% vs 5.9%, respectively; P = 0.035), but perforation was more common in T-cell lymphomas than in B-cell lymphomas (23.5% vs 3.8%, respectively; P = 0.005). The prognosis was significantly worse for T-cell lymphomas than for B-cell lymphomas (P = 0.002). Primary colorectal T-cell lymphomas are characterized by multifocal ulcerative lesions in relatively young patients, a high rate of hematochezia, fever, or perforation, and a poor prognosis even for cases of localized disease.
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Affiliation(s)
- Y-H Kim
- Sungkyunkwan University, Korea
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Shim CS, Jung IS, Cheon YK, Ryu CB, Hong SJ, Kim JO, Cho JY, Lee JS, Lee MS, Kim BS. Management of malignant stricture of the esophagogastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy 2005; 37:335-9. [PMID: 15824943 DOI: 10.1055/s-2005-861113] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND STUDY AIMS When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction. PATIENTS AND METHODS Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed. RESULTS The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents. CONCLUSIONS The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.
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Affiliation(s)
- C S Shim
- Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, South Korea
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Shim CS, Jung IS, Bhandari S, Ryu CB, Hong SJ, Kim JO, Cho JY, Lee JS, Lee MS, Kim BS. Management of malignant strictures of the cervical esophagus with a newly-designed self-expanding metal stent. Endoscopy 2004; 36:554-7. [PMID: 15202054 DOI: 10.1055/s-2004-814555] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recently, the use of self-expanding metal stents has become a well-established method of palliative treatment for stenotic malignant diseases in the middle and distal esophagus. However, published results on the use of self-expanding metal stents in cervical esophageal cancer are somewhat limited by a paucity of clinical details and experience. A new self-expanding esophageal metal stent with a short upper flange 0.7 cm in length was studied prospectively in order to assess its efficacy for palliative treatment. This report presents experience in three patients in whom this new stent was used in the treatment of cervical esophageal cancers. Stent placement was successful in all three patients, with no serious complications such as esophageal perforation, hemorrhage, or foreign-body sensation. All of the patients experienced rapid improvement in dysphagia and clinical symptoms. The newly designed self-expanding stent can be of value in the treatment of stenotic cervical esophageal cancer.
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Affiliation(s)
- C S Shim
- Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, South Korea.
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Jung IS, Jang JY, Ryu CB, Hong SJ, Kim JO, Cho JY, Lee JS, Lee MS, Jin SY, Shim CS, Kim BS. Angiolipoma of the duodenum diagnosed after endoscopic resection. Endoscopy 2004; 36:375. [PMID: 15057700 DOI: 10.1055/s-2004-814213] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- I S Jung
- Institute for Digestive Research, Soon Chun Hyang University, College of Medicine Seoul, Korea
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Chae SR, Lee SH, Kim JO, Paik BC, Song YC, Park HS, Shin HS. Simultaneous removal of organic and strong nitrogen from sewage in a pilot-scale BNR process supplemented with food waste. Water Sci Technol 2004; 49:257-264. [PMID: 15137432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
As the sewerage system is incomplete, sewage in Korea lacks easily biodegradable organics for nutrient removal. In this country, about 11,400 tons of food waste of high organic materials is produced daily. Therefore, the potential of food waste as an external carbon source was examined in a pilot-scale BNR (biological nutrient removal) process for a half year. It was found that as the supply of the external carbon increased, the average removal efficiencies of T-N (total nitrogen) and T-P (total phosphorus) increased from 53% and 55% to 97% and 93%, respectively. VFAs (volatile fatty acids) concentration of the external carbon source strongly affected denitrification efficiency and EBPR (enhanced biological phosphorus removal) activity. Biological phosphorus removal was increased to 93% when T-N removal efficiency increased from 78% to 97%. In this study, several kinds of PHAs (poly-hydroxyalkanoates) in cells were observed. The observed PHAs was composed of 37% 3HB (poly-3-hydroxybutyrate), 47% 3HV (poly-3-hydroxyvalerate), 9% 3HH (poly-3-hydroxyhexanoate), 5% 3HO (poly-3-hydroxyoctanoate), and 2% 3HD (poly-3-hydroxydecanoate).
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Affiliation(s)
- S R Chae
- Department of Civil and Environmental Engineering, Korea Advanced Institute of Science and Technology, 373-1 Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea.
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Kim SK, Kang MH, Kim JO, Kim JK, Matsui S, Shimizu Y. Performance evaluation of leachate treatment system using innovative sulfur circulation method. Environ Technol 2003; 24:1283-1290. [PMID: 14669809 DOI: 10.1080/09593330309385671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A pilot-scale experimental study was carried out to evaluate the performance of an innovative method for early stabilization of landfill. This method employs sequential processes of: leachate collection; nitrification through aeration; sulfate addition in effluent tank; and leachate injection back to the landfill. This study focused on: 1) decomposition of recalcitrant organic matters, 2) the characteristics of denitrification, 3) sulfide oxidation for sulfate recovery, and 4) nitrification by aerating discharged leachate. It was found that, when sulfate (SO4(2-)) added leachate was introduced inside the landfill, sulfate-reducing bacteria decomposed recalcitrant organic matters like lignocellulose by using SO4(2-) as an electron acceptor and simultaneously sulfur-oxidizing bacteria denitrified the leachate using sulfides (H2S, HS-, S2-) as electron donors. These two types of bacteria existed not competitively but symbiotically on substrate utilization. Sulfate-reducing bacteria produced S2- while sulfur-oxidizing bacteria oxidized S2- to SO4(2-). During aeration, the concentration of NO3(-)-N increased from near zero up to 925 mg l(-1). Eventual denitrification efficiency in the simulated waste landfill was observed to be approximately 92.3%. Also, S2- present in the discharged leachate was converted to SO4(2-) again in the aeration process. Sulfate needed in this process could be recirculated. Therefore, the amount of sulfate required in the operation of this method could be maintained marginal after the initial addition of sulfate in the effluent tank. Decomposition of recalcitrant organic matters and denitrification hastened the stabilization of landfill. The results of this study indicated that this innovative method was effective and economic.
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Affiliation(s)
- S K Kim
- Water Resources and Environmental Research Division, Institute of Construction Technology, 2311 Daehwa-dong, Ilsan-gu, Koyang, Kyonggi-do, 411-712, Korea
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Kim JO, Lee WB. Biodegradation of gaseous benzene with microbial consortium in a biofilter. Environ Technol 2002; 23:437-444. [PMID: 12088371 DOI: 10.1080/09593332508618401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The objective of this study was to investigate the biodegradation of gaseous benzene in a biofilter inoculated with benzene-oxidizing microorganisms. The biofilter performance was monitored in terms of benzene removal efficiency and carbon dioxide production. The biofilter was capable of achieving as much as 96% benzene removal efficiency at a residence time of 2 min and an inlet concentration of 220 ppm. During operation with an inlet benzene of 220 ppm, the maximum elimination capacity of the biofilter was 483 g of C6H6 m(-3) day(-1). Under the same conditions, carbon dioxide with a concentration of up to 726 ppm was produced. It was found that carbon dioxide wasproduced at a rate of 608 mg day(-1), which corresponded to a volume of 0.35 l day(-1). Observable features of the microorganisms, meaning microbial activity occurrence in the biofilter, were investigated with the microscopy analysis.
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Affiliation(s)
- J O Kim
- Department of Environmental Education, Mokpo National University, Muan-Kun, Chonnam, Republic of Korea
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Abstract
We describe two cases of elderly women who presented hypoglycemic episodes with suppressed levels of insulin and insulin-like growth factor I. They were found to have huge malignant solitary fibrous tumor of the pleura. The tumors had rich vascularization on enhanced CT scans and showed characteristic low signal intensity on T2-weighted MR images. This paraneoplastic hypoglycemia is caused by an incompletely processed precursor of insulin-like growth factor II secreted from the tumor. Hypoglycemia and insulin suppression were resolved after removal of the tumors.
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Affiliation(s)
- J H Kim
- Department of Diagnostic Radiology, Chungnam National University Hospital, 640 Daesa-dong, Joong-gu, Taejon, 301-040, South Korea.
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