1
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Warners MJ, Ambarus CA, Bredenoord AJ, Verheij J, Lauwers GY, Walsh JC, Katzka DA, Nelson S, van Viegen T, Furuta GT, Gupta SK, Stitt L, Zou G, Parker CE, Shackelton LM, D Haens GR, Sandborn WJ, Dellon ES, Feagan BG, Collins MH, Jairath V, Pai RK. Reliability of histologic assessment in patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2018; 47:940-950. [PMID: 29460418 DOI: 10.1111/apt.14559] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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] [Received: 01/04/2018] [Revised: 01/21/2018] [Accepted: 01/21/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The validity of the eosinophilic oesophagitis (EoE) histologic scoring system (EoEHSS) has been demonstrated, but only preliminary reliability data exist. AIM Formally assess the reliability of the EoEHSS and additional histologic features. METHODS Four expert gastrointestinal pathologists independently reviewed slides from adult patients with EoE (N = 45) twice, in random order, using standardised training materials and scoring conventions for the EoEHSS and additional histologic features agreed upon during a modified Delphi process. Intra- and inter-rater reliability for scoring the EoEHSS, a visual analogue scale (VAS) of overall histopathologic disease severity, and additional histologic features were assessed using intra-class correlation coefficients (ICCs). RESULTS Almost perfect intra-rater reliability was observed for the composite EoEHSS scores and the VAS. Inter-rater reliability was also almost perfect for the composite EoEHSS scores and substantial for the VAS. Of the EoEHSS items, eosinophilic inflammation was associated with the highest ICC estimates and consistent with almost perfect intra- and inter-rater reliability. With the exception of dyskeratotic epithelial cells and surface epithelial alteration, ICC estimates for the remaining EoEHSS items were above the benchmarks for substantial intra-rater, and moderate inter-rater reliability. Estimation of peak eosinophil count and number of lamina propria eosinophils were associated with the highest ICC estimates among the exploratory items. CONCLUSION The composite EoEHSS and most component items are associated with substantial reliability when assessed by central pathologists. Future studies should assess responsiveness of the score to change after a therapeutic intervention to facilitate its use in clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - G R D Haens
- Amsterdam, The Netherlands.,London, ON, Canada
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2
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Gandhi M, Stitt L, Gregor JC. A126 SERUM ADALIMUMAB LEVELS IN CROHN DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Gandhi
- Medicine, Western University, London, ON, Canada
| | - L Stitt
- Medicine, Western University, London, ON, Canada
| | - J C Gregor
- Medicine, Los Alamos National Laboratory, London, ON, Canada
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3
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Gandhi M, Stitt L, Gregor JC. A282 DOES SERUM ADALIMUMAB LEVEL CORRELATE WITH DISEASE SEVERITY IN PATIENTS WITH CROHN’S DISEASE? J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Gandhi
- Medicine, Western University, London, ON, Canada
| | - L Stitt
- Western University, London, ON, Canada
| | - J C Gregor
- Medicine, Western University, London, ON, Canada
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4
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Alageeli MH, Yan B, Zepeda-Gomez S, Alshankiti S, Stitt L, Thomas BS, Bahreini Z, Homenauth R, Dang T, ROFAIEL R, Al-Zahrani M, Townsend CM, Yoo D, Jarosh J, Kloc M, Smith A, Singh C, Luhoway J, Merotto L, Gilani O, Friedland J, Sey M. A217 EXTERNAL VALIDATION OF THE PARK SCORE FOR BOWEL PREPARATION CLEANLINESS DURING CAPSULE ENDOSCOPY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.217] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - B Yan
- Medicine, Gastroenterology, Western University, London, ON, Canada
| | - S Zepeda-Gomez
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - S Alshankiti
- Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - B S Thomas
- Medicine, Western University, London, ON, Canada
| | - Z Bahreini
- Gastroenterology, Western University, London, ON, Canada
| | - R Homenauth
- Adult Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - T Dang
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | | | - C M Townsend
- Medicine, University of Western Ontario, London, ON, Canada
| | | | | | | | | | | | | | | | | | | | - M Sey
- Western University, London, ON, Canada
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5
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Samaan MA, Puylaert CAJ, Levesque BG, Zou GY, Stitt L, Taylor SA, Shackelton LM, Vandervoort MK, Khanna R, Santillan C, Rimola J, Hindryckx P, Nio CY, Sandborn WJ, D'Haens G, Feagan BG, Jairath V, Stoker J. The development of a magnetic resonance imaging index for fistulising Crohn's disease. Aliment Pharmacol Ther 2017; 46:516-528. [PMID: 28653753 DOI: 10.1111/apt.14190] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Received: 12/04/2016] [Revised: 10/29/2016] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. AIMS To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a novel index for fistulising CD. METHODS A consensus process developed scoring conventions for existing Van Assche index component items and new items. Four experienced radiologists evaluated 50 MRI images in random order on three occasions. Reliability was assessed by estimates of intraclass correlation coefficients (ICCs). Common sources of disagreement were identified and recommendations made to minimise disagreement. A mixed effects model used a 100 mm visual anologue scale (VAS) for global severity as outcome and component items as predictors to create a modified Van Assche index. RESULTS Intraclass correlation coefficients (95% confidence intervals) for intra-rater reliability of the original and modified Van Assche indices and the VAS were 0.86 (0.81-0.90), 0.90 (0.86-0.93) and 0.86 (0.82-0.89). Corresponding ICCs for inter-rater reliability were 0.66 (0.52-0.76), 0.67 (0.55-0.75) and 0.58 (0.47-0.66). Sources of disagreement included number, location, and extension of fistula tracts, and rectal wall involvement. A modified Van Assche index (range 0-24) was created that included seven component items. CONCLUSIONS Although "almost perfect" intra-rater reliability was observed for the assessment of MRI images for fistulising CD using the Van Assche index, inter-rater reliability was considerably lower. Our modification of this index should result in a more optimal instrument.
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Affiliation(s)
- M A Samaan
- Department of Gastroenterology, Guy's & St Thomas' Hospital, London, UK.,Robarts Clinical Trials, Inc, London, Canada
| | - C A J Puylaert
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B G Levesque
- Department of Gastroenterology, University of California San Diego, La Jolla, CA, USA.,Robarts Clinical Trials, Inc, San Diego, CA, USA
| | - G Y Zou
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
| | - L Stitt
- Robarts Clinical Trials, Inc, London, Canada
| | - S A Taylor
- Department of Medical Imaging, University College London, London, UK
| | | | | | - R Khanna
- Robarts Clinical Trials, Inc, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - C Santillan
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - J Rimola
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - P Hindryckx
- Robarts Clinical Trials, Inc, London, Canada.,Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - C Y Nio
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - W J Sandborn
- Department of Gastroenterology, University of California San Diego, La Jolla, CA, USA.,Robarts Clinical Trials, Inc, San Diego, CA, USA
| | - G D'Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.,Robarts Clinical Trials, BV, Amsterdam, The Netherlands
| | - B G Feagan
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - V Jairath
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - J Stoker
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
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6
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Vincent MD, Breadner D, Cripps MC, Jonker DJ, Klimo P, Biagi JJ, Lam W, O'Connell A, Whiston F, Stitt L, Welch SA. Phase I/II trial of dose-reduced capecitabine in elderly patients with advanced colorectal cancer. ACTA ACUST UNITED AC 2017; 24:e261-e268. [PMID: 28874896 DOI: 10.3747/co.24.3516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Combination chemotherapy is associated with improved outcomes in trials of selected fit patients with advanced colorectal cancer (acrc). For older or less-fit patients, combination chemotherapy is associated with greater toxicity and less benefit. Capecitabine monotherapy is a reasonable option for those patients, but the optimal dose remains controversial. METHODS A multicentre phase i/ii trial of reduced-dose capecitabine (2000 mg/m2, days 1-14 every 21 days) was conducted in 221 patients representing one or more of the following subsets: age greater than 65 years (n = 167), Eastern Cooperative Oncology Group (ecog) performance status of 1 or greater (n = 139), elevated lactate dehydrogenase (ldh) (n = 105), or prior pelvic radiation (n = 54). Based on phase i results, patients with prior pelvic radiation received capecitabine 750 mg/m2 twice daily. The goal was to ascertain efficacy in a design that was unlikely to cause high levels of toxicity. RESULTS Median age in the patient cohort was 72 years. A median of 5 and a mean of 8 capecitabine cycles were given (range: 0-50 cycles). Grade 3 or 4 toxicity occurred in 25% of patients during the first 3 cycles (8.1% hand-foot syndrome, 7.7% diarrhea). The response rate was 13.6%, with a 69.7% disease control rate. Median progression-free survival (pfs) was 5.6 months. Post progression, 56 patients received further capecitabine monotherapy (median of 4 additional cycles). Median overall survival duration for the patients was 14.3 months. Median survival was significantly higher for those who, at baseline, had an ecog performance status of 0 (compared with 1 or more) and normal ldh (compared with elevated ldh). CONCLUSIONS Toxicity is less with dose-reduced capecitabine than with historical full-dose capecitabine, with only a small trade-off in efficacy, seen as a lower objective response rate. The improved tolerability could lead to an increased number of cycles of therapy, and pfs appears to be consistently higher at the lower dose. Those observations should, in the absence of a head-to-head clinical trial, be viewed as compelling evidence that 1000 mg/m2, or even 750 mg/m2, twice daily is an appropriate dose in elderly or frail patients with acrc.
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Affiliation(s)
- M D Vincent
- London Regional Cancer Program, London, ON.,Schulich School of Medicine and Dentistry, London, ON
| | - D Breadner
- London Regional Cancer Program, London, ON.,Schulich School of Medicine and Dentistry, London, ON
| | - M C Cripps
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - D J Jonker
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - P Klimo
- Medical Oncology, Lions Gate Hospital, North Vancouver, BC
| | - J J Biagi
- Department of Oncology, Queen's University, Kingston, ON
| | - W Lam
- Burnaby Hospital Cancer Centre, Burnaby, BC
| | | | - F Whiston
- London Regional Cancer Program, London, ON
| | - L Stitt
- London Regional Cancer Program, London, ON
| | - S A Welch
- London Regional Cancer Program, London, ON.,Schulich School of Medicine and Dentistry, London, ON
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7
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Jairath V, Khanna R, Zou GY, Stitt L, Mosli M, Vandervoort MK, D'Haens G, Sandborn WJ, Feagan BG, Levesque BG. Development of interim patient-reported outcome measures for the assessment of ulcerative colitis disease activity in clinical trials. Aliment Pharmacol Ther 2015; 42:1200-10. [PMID: 26388424 DOI: 10.1111/apt.13408] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [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] [Received: 06/15/2015] [Revised: 07/08/2015] [Accepted: 08/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) have an increasingly important role in the evaluation of new therapies for inflammatory bowel disease. The US Food and Drug Administration has issued formal guidance to describe the role of PRO instruments in evaluation of claims for product labelling. However, no validated PRO exists for ulcerative colitis. AIM To investigate whether the PROs from the Mayo Clinic Score (MCS) for UC can be modified, to develop an interim PRO for use in clinical trials, alone or in combination with endoscopy. METHODS Data from an induction trial of a mesalazine (mesalamine) formulation were used to compare effect sizes between mesalazine and placebo for PRO items (stool frequency and rectal bleeding) alone and in combination with endoscopy. The operating properties of the PRO were validated using data from a phase 2 trial of MLN02, a humanised antibody to the α4β7 integrin in patients with UC. RESULTS A two-item PRO (PRO2) consisting of rectal bleeding = 0 and stool frequency ≤1 or ≤2, combined with an endoscopy subscore ≤1 yielded statistically significant differences between active drug and placebo. This combination yielded the most similar effect sizes and placebo rates for remission, compared to the primary trials. Use of PRO items alone yielded high placebo remission rates in both data sets, although rates were lower when the items were combined and remission defined as PRO2 = 0. CONCLUSION Patient-reported outcomes items derived from the Mayo Clinic Score combined with endoscopy as a co-primary endpoint may be an appropriate interim outcome measure for ulcerative colitis trials.
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Affiliation(s)
- V Jairath
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford Clinical Trials Research Unit, Oxford, UK
| | - R Khanna
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Department of Medicine, University of Western Ontario, London, ON, Canada
| | - G Y Zou
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - L Stitt
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada
| | - M Mosli
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Department of Medicine, University of Western Ontario, London, ON, Canada.,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M K Vandervoort
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada
| | - G D'Haens
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Inflammatory Bowel Disease Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - W J Sandborn
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Division of Gastroenterology, University of California, San Diego, La Jolla, CA, USA
| | - B G Feagan
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Department of Medicine, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - B G Levesque
- Robarts Clinical Trials, University of Western Ontario, London, ON, Canada.,Division of Gastroenterology, University of California, San Diego, La Jolla, CA, USA
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8
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Yu E, Stitt L, Vujovic O, Joseph K, Assouline A, Au J, Younus J, Perera F, Tai P. Male Breast Cancer Prognostic Factors: Similarity to Female Counterparts With Propensity Scores and Matched-Pair Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.800] [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: 11/26/2022]
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9
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Vujovic O, Yu E, Cherian A, Dar A, Stitt L, Perera F. Comparison of 2 Radiation Schedules in the Adjuvant Treatment of Early-Stage Breast Carcinoma With Long-Term Follow-Up. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Alkhayyat SS, Younus J, Mirza FN, Stitt L. Abstract P2-13-08: Comparison of Compliance to Anti Estrogen Therapy in Patients with Early Breast Cancer followed at Tertiary Centers versus Through Family Physicians and Primary Surgeons: A Practice Review. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-13-08] [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: Poor adherence or non-compliance to pharmacologic therapies in chronic diseases is a major clinical problem. Adherence to adjuvant anti-estrogen therapies among patients with early breast cancer (EBC) is variable as reported in different clinical trials. Cancer centres, at present, frequently refer patients with EBC on adjuvant anti-estrogen therapy back to their surgeons and family doctors for follow up. In order to find any difference in compliance for such patients, we reviewed patients followed by their primary surgeons and family doctors (peripheral cohort) for adherence and compared them to patients regularly followed in the cancer center (central cohort).
Patients and Methods: Women with EBC receiving anti-estrogen therapy were identified from breast cancer database at London Regional Cancer Program LRCP). A standardized telephone interview was conducted with patients. We assumed that adherence in the central cohort will be 20% higher than the peripheral cohort. Patient are considered adherent if they took more than 80%, Non-adherent if they took less than 50% and semi-adherent if they took 50–80% of the prescribed medication.
Results: We recruited a total of 160 patients (80 patients in each cohort). Seventy seven (96.3%) patients in central cohort were compliant and 76 (95%) patients were compliant in the peripheral cohort. The HR was 0.7 (p >.999)
Conclusion: From our retrospective review, we did not observe any significant difference in the adherence to adjuvant anti-estrogen therapy in patients with EBC. The present process of discharging such patients to surgeons and family physicians for follow up does not seem to affect their compliance.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-13-08.
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Affiliation(s)
- SS Alkhayyat
- The Scarborough Hospital, Scarborough, ON, Canada; The University of Western Ontario, London, ON, Canada; Harvard University, Cambridge, MA
| | - J Younus
- The Scarborough Hospital, Scarborough, ON, Canada; The University of Western Ontario, London, ON, Canada; Harvard University, Cambridge, MA
| | - FN Mirza
- The Scarborough Hospital, Scarborough, ON, Canada; The University of Western Ontario, London, ON, Canada; Harvard University, Cambridge, MA
| | - L Stitt
- The Scarborough Hospital, Scarborough, ON, Canada; The University of Western Ontario, London, ON, Canada; Harvard University, Cambridge, MA
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11
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Vujovic O, Yu E, Cherian A, Perera F, Dar AR, Stitt L, Hammond A. The Significance of Time Interval From Clinical Presentation to Definitive Breast Surgery in Node Negative Breast Carcinoma With Long-term Follow-up: Clinical Implications. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.584] [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: 11/16/2022]
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12
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Dar A, Neilson C, Pasarikovski C, Woodford C, Stitt L, Coad T, Yartsev S. Megavoltage Imaging: Patterns of Tumor Regression and Predictive Factor for Non-small Cell Lung Cancer Undergoing Radiation Therapy on Tomotherapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Wiebe E, Surry K, Patil N, Aulakh S, Whiston F, Stitt L, D'Souza D. Integration of CT-planned Interstitial Brachytherapy Boost in Advanced Gynecologic Malignancies. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Fisher BJ, Bauman GS, Leighton CE, Stitt L, Cairncross JG, Macdonald DR. Low-grade gliomas in children: tumor volume response to radiation. Neurosurg Focus 2012; 4:e5. [PMID: 17168505 DOI: 10.3171/foc.1998.4.4.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods. Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario, after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm(3), and the postradiotherapy volume was reduced to a mean of 11.5 cm(3). A reduction in tumor was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of "responders" to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions. On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.
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Affiliation(s)
- B J Fisher
- Department of Radiation Oncology, Medical Oncology, and Biometry, London Regional Cancer Centre and University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
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15
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Yu E, Tai P, Malthaner R, Stitt L, Rodrigues G, Dar R, Yaremko B, Younus J, Sanatani M, Vincent M, Dingle B, Fortin D, Inculet R. What are the factors that predict outcome at relapse after previous esophagectomy and adjuvant therapy in high-risk esophageal cancer? ACTA ACUST UNITED AC 2011; 17:46-51. [PMID: 21151409 DOI: 10.3747/co.v17i6.561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study investigated factors affecting outcome at relapse after previous surgery and adjuvant chemoradiation (crt) in high-risk esophageal cancer patients. PATIENTS AND METHODS From 1989 to 1999, we followed high-risk resected esophageal cancer patients who had completed postoperative crt therapy. Patients who relapsed with a disease-free interval of less than 3 months were treated with palliative crt when appropriate. Patients with a disease-free interval of 3 months or more were treated with best supportive care. Post-recurrence survival was estimated using the Kaplan-Meier technique, and statistical comparisons were made using log-rank chi-square tests and Cox regression. RESULTS Of the 69 patients treated with adjuvant crt after esophagectomy, 46 experienced recurrence. Median time to relapse was 28 months (range: 0.1-40 months). Among the 46 relapsed patients, median age was 61 years (range: 37-82 years), and 42 were men. At the initial staging, 44 of 46 were node-positive; 31 of 46 had adenocarcinoma. In 33 of 46, post-esophagectomy resection margins were clear. Median follow-up after recurrence was 30.5 months (range: 1.3-100 months). Median overall survival after recurrence was 5.8 months, and the 12-month, 24-month, and 36-month survival rates were 20%, 10%, and 5% respectively. Of the prognostic factors analyzed, only resection margin status and interval to recurrence were statistically significant for patient outcome in univariate and multivariate analysis. Patients who had positive resection margins and who relapsed 12 or fewer months after surgery and adjuvant crt had a median post-recurrence overall survival of 0.85 months as compared with 6.0 months in other patients (more than 12 months to relapse, or negative resection margins, or both; log-rank p = 0.003). CONCLUSIONS Resection margin status and interval to disease relapse are significant independent prognostic factors for patient outcome after adjuvant crt therapy.
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Affiliation(s)
- E Yu
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Center, University of Western Ontario, London, ON
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Yu E, Tai P, Younus J, Malthaner R, Truong P, Stitt L, Rodrigues G, Ash R, Dar R, Yaremko B, Tomiak A, Dingle B, Sanatani M, Vincent M, Kocha W, Fortin D, Inculet R. Postoperative extended-volume external-beam radiation therapy in high-risk esophageal cancer patients: a prospective experience. ACTA ACUST UNITED AC 2011; 16:48-54. [PMID: 19672424 PMCID: PMC2722060 DOI: 10.3747/co.v16i4.355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 11/15/2022]
Abstract
Background and Purpose Extended-volume external-beam radiation therapy (rt) following esophagectomy is controversial. The present prospective study evaluates the feasibility of extended-volume rt treatment in high-risk esophagectomy patients with a cervical anastomosis receiving postoperative combined chemoradiation therapy. Patients and Methods From 2001 to 2006, 15 patients with resected esophageal cancer were prospectively accrued to this pilot study to evaluate the adverse effects of extended-volume rt. Postoperative management was carried out at London Regional Cancer Program. Eligibility criteria were pathology-proven esophageal malignancy (T3–4, N0–1), disease amenable to surgical resection, and esophagectomy with or without resection margin involvement. Patients with distant metastases (M1) and patients treated with previous rt were excluded. All 15 study patients received 4 cycles of 5-fluorouracil–based chemotherapy. External-beam rt was conducted using conformal computed tomography planning, with multi-field arrangement tailored to the pathology findings, with coverage of a clinical target volume encompassing the primary tumour bed and the anastomotic site in the neck. The radiation therapy dose was 50.40 Gy at 1.8 Gy per fraction. The rt was delivered concurrently with the third cycle of chemotherapy. The study outcomes—disease-free survival (dfs) and overall survival (os)—were calculated by the Kaplan–Meier method. Treatment-related toxicities were assessed using the U.S. National Cancer Institute’s Common Toxicity Criteria. Results The study accrued 10 men and 5 women of median age 64 years (range: 48–80 years) and TNM stages T3N0 (n = 1), T2N1 (n = 2), T3N1 (n = 11), and T4N1 (n = 1). Histopathology included 5 adenocarcinomas and 10 squamous-cell carcinomas. Resection margins were clear in 10 patients. The median follow-up time was 19 months (range: 3.5–53.4 months). Before radiation therapy commenced, delay in chemotherapy occurred in 20% of patients, and dose reduction was required in 13.3%. During the concurrent chemoradiation therapy phase, 20% of the patients experienced chemotherapy delay, and 6.6% experienced dose reduction. No patient experienced treatment-related acute and chronic esophagitis above grade 2. Disease recurred in 40% of the patients (6/15), and median time to relapse was 24 months. No tumour recurred at the anastomotic site. The median dfs was 23 months, and the median os was 21 months. Conclusions Extended-volume external-beam rt encompassing the tumour bed and the anastomotic site is feasible and safe for high-risk T3–4, N0–1 esophageal cancer patients after esophagectomy.
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Affiliation(s)
- E Yu
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON.
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Vincent MD, Welch S, Soulieres D, Sanatani MS, Whiston F, Stitt L, O'Connell A, MacKenzie MJ, Kocha WI, Kerr IG, Dingle BH, Malpage A. Randomized phase II trial of capecitabine (X) versus X plus erlotinib (E) in patients (pts) with metastatic colorectal cancer (mCRC): Differential impact of KRAS. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Li I, Stitt L, Whiston F, Alkhayyat SS, Vincent MD. Wound complications in neoadjuvant versus adjuvant treatment of operable rectal cancer (ORC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lock M, Klein J, Wong E, Walter A, D'Souza D, Erickson A, Ahmad B, Ash R, Bauman G, Venkatesan V, Stitt L, Rodrigues G. 188 THE CLINICAL IMPACT OF VARIATION IN CLINICAL TARGET VOLUMES FOR POST-PROSTATECTOMY PATIENTS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72575-6] [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: 10/27/2022]
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20
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Yu E, Tai P, Malthaner R, Stitt L, Rodrigues G, Dar R, Yaremko B, Younus J, Sanatani M, Vincent M, Dingle B, Fortin D, Inculet R. 190 WHAT FACTORS PREDICT OUTCOME AT RELAPSE AFTER PREVIOUS ESOPHAGECTOMY AND ADJUVANT THERAPY IN HIGH RISK ESOPHAGEAL CANCER? Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72577-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: 11/24/2022]
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21
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Shim K, Potvin KR, Mills K, Whiston F, Stitt L, Winquist E. Risk factors for thromboembolic events in testicular cancer patients receiving chemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16109 Background: Cancer patients are at increased risk for thromboembolic events (TTEs), and those receiving chemotherapy are at even greater risk. Clinical experience and the literature have suggested that men receiving cisplatin-based chemotherapy for metastatic germ cell tumors are at particularly high risk. As TTEs can be fatal and treatment is curative, the stakes are high. Despite this, prophylactic anticoagulation (PA) is not routinely used. Methods: All men treated with cisplatin-based chemotherapy for metastatic germ cell cancer at the London Regional Cancer Program from January 1978 to December 2007 were identified from electronic databases. Data including type and timing of TTEs were extracted by retrospective chart review. Multivariable analyses were used to identify predictors of TTEs. Results: 196 eligible patients were identified with median age 31 years (range, 15–75). No patients received PA. Thirty-two TTEs were identified in 29 patients for an overall incidence of 14.8% (95% CI, 9.8–19.8%). The majority of events were deep venous thromboses, and five patients died due to TTE or its complications. Sixteen of the patients with TTE (55.2%) were diagnosed while on treatment (defined as TTE within 6 months of chemotherapy initiation); 8 (27.6%) had their TTE prior to, and 5 (17.2%) after this time period. Age greater than 30 years (OR = 3.02; 95% CI, 1.10–8.33; p = 0.033) and elevated LDH (OR = 1.93; 95% CI, 1.07–3.48; p = 0.029) were independently associated with an increased risk of TTE. If both adverse risk factors were present, the risk of TTE on treatment was 21.7% (95% CI, 9.8–33.7%). If neither were present, the negative predictive value was 97% (95% CI, 92–100%). Conclusions: The overall TTE incidence rate of 14.8% is consistent with prior reports (8.4–19%). The risk of TTE appears greatest during chemotherapy and shortly thereafter, and nearly one in 10 patients in this group had a TTE. These data support the concept of PA for selected patients starting chemotherapy for metastatic germ cell cancer. However, the efficacy of PA and risk of hemorrhage in this group is unknown. In this cohort, patients under 30 with normal LDH were at very low risk for TTE. Confirmation of these findings to help guide the study and optimal use of PA should be pursued. No significant financial relationships to disclose.
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Affiliation(s)
- K. Shim
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
| | - K. R. Potvin
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
| | - K. Mills
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
| | - F. Whiston
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
| | - L. Stitt
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
| | - E. Winquist
- London Regional Cancer Program, London, ON, Canada; London Health Sciences Centre, London, ON, Canada; University of Western Ontario, London, ON, Canada
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Vujovic O, Yu E, Cherian A, Perera F, Dar R, Stitt L, Hammond A. Is Survival in Early Stage Invasive Breast Cancer Determined by Clinical Presentation and Time Interval to Definitive Breast Surgery? Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leighton C, Fisher B, Macdonald D, Stitt L, Bauman G, Cairncross J. The dose–volume interaction in adult supratentorial low-grade glioma: higher radiation dose is beneficial among patients with partial resection. J Neurooncol 2007; 82:165-70. [PMID: 17357830 DOI: 10.1007/s11060-006-9141-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 03/01/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the hypothesis that adults with partially resected (PR<50% resection) supratentorial low-grade glioma (LGG) benefit from higher doses of radiation. METHODS Patients receiving post-operative radiation for WHO grade I-II LGG at the University of Western Ontario between 1979 and 2001 were studied. Patient characteristics evaluated included: age, gender, symptom duration>30 days, seizures at presentation, Karnofsky performance status (KPS)<70, astrocytoma pathology (AS), and radiation dose. A Cox proportional hazard regression model was constructed to test the influence of radiation dose. RESULTS One hundred and seven patients were analyzed. Patients who had PR were not significantly different from those with STR (subtotal/total resection) in terms of patient characteristics. Median survival (MST) of PR patients who received<or=50 Gy was 16.5 months while those who received>50 Gy had a MST of 109.2 months. The interaction of radiation dose and extent of resection was tested after controlling for other patient factors by Cox regression model. The interaction was highly significant for both OS and PFS (P=0.013 and P=0.003, respectively). This model remained significant after excluding six patients receiving doses<42 Gy (OS, P=0.024, and PFS, P=0.001). CONCLUSIONS The outcome for patients with LGG is dependent on extent of tumor resection and radiation dose. Patients with PR should be considered for higher radiation dose schedules (>50 Gy). Future trials on therapeutic strategies for LGG should consider stratification of patients by extent of tumor resection. Our data suggests that one dose does not fit all.
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Affiliation(s)
- C Leighton
- Division of Radiation Oncology, London Regional Cancer Centre Program, London Health Sciences Hospital, and Department of Medical Oncology, University of Western Ontario, London, Ontario, Canada.
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Vujovic O, Yu E, Cherian A, Dar A, Stitt L, Perera F. 2011. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Nagpal AD, Bhatnagar G, Cutrara CA, Ahmed SM, McKenzie N, Quantz M, Kiaii B, Menkis A, Fox S, Stitt L, Novick RJ. Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians. Can J Cardiol 2006; 22:849-53. [PMID: 16957802 PMCID: PMC2569020 DOI: 10.1016/s0828-282x(06)70303-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly. OBJECTIVE To compare the safety of OPCAB surgery versus CCAB surgery in the octogenarian population of two large southwestern Ontario cardiac surgical units. RESULTS Two hundred thirty-six consecutive octogenarians underwent primary isolated coronary artery bypass surgery from November 2000 to March 2005. Patients undergoing OPCAB surgery tended to have higher Parsonnet scores, while patients undergoing CCAB surgery had a greater number of emergent operations. The Canadian Cardiovascular Network predicted that mortality risk was similar in both groups. In-hospital mortality was similar between groups, as was postoperative myocardial infarction and new onset of renal dysfunction. However, in the OPCAB group, there was a decreased incidence of postoperative neurological dysfunction (2.3% in the OPCAB group versus 10.5% in the CCAB group, P=0.01), in particular cerebrovascular accidents (1.5% in the OPCAB group versus 7.6% in the CCAB group, P=0.05), and a decreased incidence of prolonged intubation (5.3% in the OPCAB group versus 13.3% in the CCAB group, P=0.04). Multivariable analysis found that cardiopulmonary bypass had no significant impact on mortality or length of stay. CONCLUSIONS In octogenarian patients, OPCAB surgery is as safe as CCAB surgery in terms of mortality and major morbidity. Furthermore, a significant reduction in neurological dysfunction and prolonged intubation was seen in the OPCAB group compared with the CCAB group.
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Affiliation(s)
- A D Nagpal
- Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario.
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Vujovic O, Yu E, Cherian A, Dar R, Stitt L, Perera F. 241 The number of axillary nodes removed as a predictor of regional recurrence in node negative breast cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vujovic O, Cherian A, Yu E, Perera F, Dar R, Stitt L, Hammond A. 229 The effect of time interval from clinical presentation to definitive breast surgery on local recurrence and survival in early stage breast cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wiebe E, Rodrigues G, Lock M, Dsouza D, Whiston F, Stitt L. 113 Outcome analysis of prostate cancer patients presenting with PSA >50 Ng/MI. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80854-6] [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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Lupe K, Kwon J, D'Souza D, Carey M, Gawlik C, Stitt L, Whiston F. 93 A prospective study of adjuvant carboplatin and paclitaxel chemotherapy and involved field radiation in women with high risk endometrial cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80834-0] [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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Yoon F, Rodrigues G, D'Souza D, Radwan J, Lock M, Bauman G, Ash R, Venketesan V, Downey D, Stitt L, Weisz D, Izawa J. Assessing the Prognostic Significance of Transrectal Ultrasound Extracapsular Extension in Prostate Cancer. Clin Oncol (R Coll Radiol) 2006; 18:117-24. [PMID: 16523811 DOI: 10.1016/j.clon.2005.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the prognostic value of transrectal ultrasound (TRUS)-detected extraprostatic disease for prostate cancer in patients receiving radical external-beam radiation therapy (EBRT). MATERIALS AND METHODS A chart review of 181 patients treated with radical EBRT for prostate cancer was conducted. All patients underwent TRUS assessment by one radiologist. The median radiation dose delivered to the prostate was 66 Gy (range 53-70 Gy) in 33 fractions (range 20-39 fractions). Median follow-up time for all patients was 6.5 years. Sixty-four (35%) out of 181 patients were found to have extracapsular disease on TRUS. Clinical relapse was defined as the first occurrence of either salvage hormonal therapy administration by the treating oncologist or clinical, radiological, and/or pathologic evidence of recurrent or progressive disease. In terms of biochemical failure, two prognostic variable analyses were carried out using both the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus guidelines and the Houston definition of biochemical failure. The primary end point for the prognostic variable analyses was time to first clinical or biochemical failure (CBF). RESULTS For time to CBF using the ASTRO consensus guidelines for biochemical failure, univariable analysis revealed that the prostate-specific antigen (PSA) (P = 0.018), clinical T stage (P = 0.002), Gleason score (P = 0.021), adjuvant hormonal therapy (P = 0.032) and TRUS T staging (P = 0.0001) were statistically significant prognostic factors. On multivariable analysis, clinical T stage (P = 0.051) was of borderline statistical significance, whereas PSA (P = 0.036), TRUS T stage (P = 0.0002) and adjuvant hormonal therapy (P = 0.015) were found to be independent prognostic factors. For time to CBF using the Houston definition of biochemical failure, univariable analysis revealed that PSA (P = 0.001), Gleason score (P = 0.026) and prostate volume (P = 0.013) were statistically significant prognostic factors. On multivariable analysis, PSA (P = 0.002), Gleason score (P = 0.012), and adjuvant hormonal therapy (P = 0.041) were found to be independent prognostic factors. TRUS T staging was not found to be independently significant. CONCLUSIONS A clear role for TRUS staging as an independent prognostic factor, in the setting of other more established variables, such as Gleason grade, PSA, and digital rectal examination (DRE) T stage, was not confirmed in this study, population.
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Affiliation(s)
- F Yoon
- Department of Oncology, Division of Radiation Oncology, London Regional Cancer Centre and University of Western Ontario, Canada
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Abstract
We tested the hypothesis that variability in the timing of ball release in overarm throws affects ball speed. Nine unskilled and six skilled throwers made 30 throws fast and accurately from a sitting and standing position. Angular positions of finger and arm segments were recorded with search-coils at 1000 Hz; ball speed was measured with a radar gun. The time of ball release from the fingertips was measured with respect to seven arm kinematic reference points. Mean timing windows for ball release were 28 ms for unskilled throwers and 7 ms for skilled throwers. Mixed-model analyses of variance showed that a there was a statistically significant relationship between ball speed and the timing of ball release in unskilled throwers, but not in skilled throwers. This was presumably due to the difference in variability of the timing of ball release between the two groups. In contrast, skilled throwers showed a relationship between ball speed and peak forearm angular velocity (one measure of arm speed). We conclude that although variability in the timing of ball release can affect ball speed, this is only a major factor in unskilled throwers. When skilled throwers throw fast, variability in ball speed is due to variability in arm speed.
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Affiliation(s)
- E Jegede
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
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Yu E, Tai P, Rodrigues G, Ash R, Stitt L, Dar R, Truong P, Videtic G, Malthaner R, Inculet R, Tomiaks A, Younus J, Dingle B, Kocha W, Vincent M. 150 Extended versus small field irradiation in high risk post esophagectomy patients receiving combined chemoradiation therapy: A decade experience in treatment of esophageal cancer. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vujovic O, Cherian A, Yu E, Dar A, Stitt L, Perera F. Pattern of local recurrence with delay in breast irradiation in patients with positive or close resection margins and young age and node negative disease. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Feeny D, Blanchard CM, Mahon JL, Bourne R, Rorabeck C, Stitt L, Webster-Bogaert S. The stability of utility scores: test-retest reliability and the interpretation of utility scores in elective total hip arthroplasty. Qual Life Res 2004; 13:15-22. [PMID: 15058783 DOI: 10.1023/b:qure.0000015307.33811.2d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSES Are utility scores for hypothetical health states stable over time even when the health of the patient changes dramatically? Can investigators who use scores for hypothetical states be confident about the stability of those scores? The first purpose is to assess the stability of standard gamble utility scores for three hypothetical health states describing mild, moderate, and severe osteoarthritis (OA) (test-retest reliability). How should investigators interpret utility scores? The second purpose is to provide evidence on the marker-state approach to assist in interpreting utility scores. BACKGROUND SG scores for three hypothetical marker states and the patient's current state were obtained at multiple times in a longitudinal study of elective total hip arthroplasty (THA). SG scores for current health increased from a mean of 0.59 pre-surgery to 0.76 post-surgery. METHODS Test-retest reliability was assessed using the intra-class correlation coefficient (ICC). The effects of time on scores were analysed using an analysis of covariance. RESULTS At the group level the marker-state scores were stable. Mean scores for mild, moderate, and severe OA were 0.69, 0.61, and 0.41. With respect to test-retest reliability, ICCs varied from 0.49 to 0.62. In general, time did not affect the scores for the three marker states. CONCLUSIONS Group-level standard gamble scores are stable. At the individual level scores for hypothetical health states are somewhat stable over time. The marker states assist in interpretation indicating that, on average, THA converted moderate OA to better than mild.
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Affiliation(s)
- D Feeny
- Institute of Health Economics, Edmonton, Alberta, Canada.
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Hodsman AB, Platt N, Stitt L, Hodsman MJ, Baker S, Nicholson L, Nicholson B. Evaluation of an osteoporosis self-referral program to enhance management outcomes. J Clin Densitom 2004; 7:77-84. [PMID: 14742891 DOI: 10.1385/jcd:7:1:77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/23/2003] [Accepted: 09/11/2003] [Indexed: 11/11/2022]
Abstract
Osteoporosis is a common but undertreated condition. While bone density is known to predict fracture risk, there is currently no economical way of measuring general population risk. This study examined whether an economical screening technique could improve diagnosis and lead to appropriate outcomes in the management of osteoporosis. A self-referral program was established to provide women with information about osteoporosis and an individualized risk assignment. A high-risk designation was provided for postmenopausal women below the lower tertile of a calcaneal broadband ultrasound attenuation (BUA) (< or = 58 db/MHz) or those with a SCORE value > or = 6. A telephone survey was conducted 6 mo after program registration to evaluate osteoporosis management outcomes. Of 271 women surveyed, 181 (67%) were postmenopausal and thus potential candidates for estrogen replacement, and 21% and 63% were assigned a high-risk profile by either calcaneal ultrasound or SCORE, respectively. Women at higher risk were significantly more likely to discuss osteoporosis with their family physician (p < 0.001), and to undergo further testing with dual X-ray absorptiometry measurement (p < 0.005). Utilization of estrogen replacement by postmenopausal women at time of survey was significantly increased compared to registration (p = 0.01). The self-referral program positively impacted decisions women made about preventing osteoporosis, particularly if they considered themselves at higher risk.
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Affiliation(s)
- A B Hodsman
- Department of Medicine and Lawson Research Institute, University of Western Ontario, London, Ontario, Canada.
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Videtic G, Stitt L, Whiston F. Gender, limited stage small cell lung cancer and the experience of concurrent chemoradiation. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tomiak A, Vincent M, Earle CC, Johnston PG, Kocha W, Taylor M, Maroun J, Eidus L, Whiston F, Stitt L. Thymidylate synthase expression in stage II and III colon cancer: a retrospective review. Am J Clin Oncol 2001; 24:597-602. [PMID: 11801762 DOI: 10.1097/00000421-200112000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study is a retrospective analysis of thymidylate synthase (TS) levels in patients with stage II (T3 or T4) and III colon cancer. Two groups of patients were identified: one undergoing surgery alone (98 patients) and the second receiving adjuvant 5-fluorouracil chemotherapy (112 patients). TS analyses were carried out using the 106 monoclonal antibody and a published grading system dividing staining into high and low intensity. The distribution of patients with low versus high TS levels was similar in the two groups. There was no association between TS staining intensity and grade, stage or location of primary. Seventy-nine patients have relapsed: 46 (48%) in the surgery only group, 33 (30%) in the adjuvant therapy group (median follow-up: 51 and 61 months). Similar proportions relapsed when analyzed according to TS: in the surgery only group, 41% of patients with low TS, 48% with high TS; in the adjuvant group, 31% with low TS, 30% with high TS. In the surgery only group, a trend toward improved disease-free survival (DFS) was seen in the low TS group (84 versus 63% at 2 years, p = 0.08). No difference was seen in overall survival. There were no differences in DFS or overall survival in patients receiving adjuvant therapy according to TS intensity. The trend for worse outcome in patients with high TS is consistent with previous reports. The lack of difference in outcome for patients with low and high TS receiving chemotherapy suggests that high TS levels may predict greater benefit from adjuvant treatment.
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Affiliation(s)
- A Tomiak
- London Regional Cancer Centre, London, Ontario, Canada
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Fisher BJ, Leighton CC, Vujovic O, Macdonald DR, Stitt L. Results of a policy of surveillance alone after surgical management of pediatric low grade gliomas. Int J Radiat Oncol Biol Phys 2001; 51:704-10. [PMID: 11597812 DOI: 10.1016/s0360-3016(01)01705-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To document the incidence of tumor progression in pediatric patients with low-grade gliomas (LGGs), with particular emphasis on those patients who did not receive postoperative chemotherapy or radiotherapy (RT). METHODS AND MATERIALS A database of 128 patients with histologically confirmed LGGs (World Health Organization Grade I-II), age <or=18 years, who had been referred to the London Regional Cancer Center and Dalhousie University between 1979 and 1995, was compiled. RESULTS The median follow-up for the 128 patients was 7.3 years. Of the 128 patients, 63 were male and 65 female. The median age was 7.0 years (range 0-18). Twenty-five patients underwent gross complete resection, 63 subtotal resection, and 40 patients biopsy. Ninety-one percent (n = 117) of the tumors were astrocytomas, of which 22 were pilocytic, 3 were oligodendrogliomas, 7 were mixed gliomas, and 1 was a ganglioglioma. Of the 103 subtotally resected patients, 48 received postoperative RT (median dose 59 Gy in 25 fractions) and 10 patients were irradiated at the time of tumor progression. The 5-year overall survival was 86%, cause-specific survival 88%, and 5-year progression-free survival 79%. The results of the univariate analysis of the overall survival by the Wilcoxon model were statistically significant for Karnofsky performance status (p = 0.03), RT timing (i.e., postoperative vs. deferred; p = 0.05), and tumor location (p = 0.02). The analysis of progression-free survival confirmed the statistical significance of the extent of surgical resection (i.e., complete vs. subtotal resection; p = 0.02). None of the patients who underwent gross complete resections received postoperative RT and none developed tumor recurrence. Of the 103 patients who had subtotal resections, 33 had progression, with a median postprogression survival of 39 months. The rate of tumor progression among the subtotally resected LGG patients who did not receive immediate postoperative RT was 42%. The timing of RT and tumor location lost statistical significance for overall survival when the completely resected patients were excluded from the analysis. CONCLUSIONS The extent of surgical resection was prognostically significant for progression-free survival but lost significance as a prognostic factor once the complete resection patients were excluded from the analysis. At a median survival of 7.3 years, 42% of the subtotally resected LGG patients who did not receive immediate postoperative RT had tumor progression. No statistically significant difference in survival was seen between the postoperative and deferred RT groups, even though the postoperative RT group was a group with poorer prognostic features (bulky residual tumor postoperatively, Karnofsky performance status <70, and nonhemispheric, noncerebellar tumors), indicating that RT may be beneficial for this particular subset of patients.
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Affiliation(s)
- B J Fisher
- Department of Radiation Oncology, London Regional Cancer Center, London, Ontario, Canada.
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Perera F, Yu E, Voruganti S, Read N, Vujovic O, Stitt L. A matched pair comparison of breast recurrence between women with early breast cancer treated with brachytherapy only versus whole breast radiation after lumpectomy. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)01832-6] [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: 11/26/2022]
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Abstract
BACKGROUND We report survival and pretreatment prognostic factors for survival and chemosensitivity in 53 oligodendrogliomas treated with PCV (procarbazine, lomustine and vincristine) chemotherapy. METHODS A total of 53 patients with histologically proven oligodendroglioma, anaplastic oligodendroglioma or oligo-astrocytoma and treated with PCV were extracted from the London Regional Cancer Center database. A retrospective review was conducted to evaluate overall survival and pretreatment prognostic factors for survival and chemosensitivity. RESULTS The median survival time from diagnosis was 123.6 months. The overall five- and ten-year survival rates were 72.7% and 52.7% respectively. Age <40, seizure as an initial symptom, absence of cognitive deficit and presence of a homogeneous hypodense lesion without contrast enhancement on the initial pretreatment CT scan were all factors independently associated with favorable outcome. The presence of increased cellularity, pleomorphism, mitosis, vascular proliferation and grading as an anaplastic lesion using these surrogates on pathological assessment, were all associated with an unfavorable outcome in univariable analysis. In multivariable analysis, only the anaplastic grading and presence of increased cellularity were significant determinants of unfavorable survival. The only factor adversely associated with chemosensitivity was the presence of a focal symptom at presentation. CONCLUSION Overall survival is significantly longer in oligodendroglial lesions than in fibrillary astrocytic tumors. A two tier grading system using standard morphological features seems accurate in predicting outcome in these patients. The presence of a neoplastic astrocytic component does not seem to impact the outcome. No clinical, radiological or pathological factor could be identified to reliably predict chemotherapy response.
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Affiliation(s)
- D Fortin
- Department of Neurosurgery and Neuro-oncology, Centre Universitaire de Santé de l'Estrie, Sherbrooke University, Québec, Canada
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41
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Leighton C, Fisher B, Stitt L, Macdonald D, Bauman G, Cairncross J. The dose-volume interaction in adult supratentorial low-grade glioma: higher radiation dose is beneficial amongv patients with partial resection. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Ovarian metastases are reported to occur in 3-8% of women undergoing surgical resection of a primary colorectal adenocarcinoma. Information on clinical outcome after metastectomy for these patients is limited. Patients and Methods A computerized search of the medical record archive at the London Regional Cancer Centre (LRCC) identified 38 patients with metastatic colorectal cancer who underwent ovarian metastectomy between 1984-98. RESULTS Median age at diagnosis colorectal cancer was 54.5 years (range: 19-76). Nine women were <50 and 29 women were >50 years old at diagnosis of metastases. Ovarian metastases were diagnosed a median of 15 months (range: -2-65) after diagnosis of the primary malignancy. Complete resection was achieved in 19 patients. Nodal status of the primary tumor, presence of synchronous metastases, adjuvant therapy for colorectal cancer as well as interval to diagnosis of ovarian metastases had no significant effect on survival. Median survival for women aged <50 was 34.5 months vs. 17 months for those >50 (P = 0.22). Women with metastases confined to the pelvis survived a median of 31 months (range: 20-42) compared to 14 months for women with disease outside of the pelvis (P = 0.011). Median survival after complete metastectomy was 31 months (range: 24-45) and after palliative debulking was 14 months (range: 7-20) (P = 0.014). CONCLUSIONS Our results suggest that ovarian metastectomy may significantly improve overall survival in younger women able to undergo complete metastectomy for disease confined to the pelvis. Results also suggest that extent of disease and feasibility of complete resection may significantly impact on prognosis and must be carefully evaluated before surgery.
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Affiliation(s)
- D Rayson
- QEII Health Sciences Centre, NSCC, Halifax, Nova Scotia, Canada.
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Bauman GS, Ino Y, Ueki K, Zlatescu MC, Fisher BJ, Macdonald DR, Stitt L, Louis DN, Cairncross JG. Allelic loss of chromosome 1p and radiotherapy plus chemotherapy in patients with oligodendrogliomas. Int J Radiat Oncol Biol Phys 2000; 48:825-30. [PMID: 11020580 DOI: 10.1016/s0360-3016(00)00703-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Allelic loss of the short arm of chromosome 1 predicts radiographic response to chemotherapy and long overall survival times in patients with anaplastic oligodendrogliomas. Using a database of patients with oligodendrogliomas in whom chromosome 1p status was known, we explored whether allelic loss of 1p also predicted longer duration of tumor control when radiotherapy was part of the initial treatment of these patients. MATERIALS AND METHODS We measured progression-free survival following radiotherapy in a cohort of patients with World Health Organization (WHO) Grade II and WHO Grade III oligodendrogliomas. The effects on progression-free survival of patient age, Karnofsky performance score (KPS), tumor grade when irradiated and chromosome 1p status were examined by univariate and multivariate statistical analyses. For the subset of patients with newly diagnosed anaplastic oligodendrogliomas, relationships between use of chemotherapy, chromosome 1p status and progression-free survival were also examined. RESULTS Fifty-five patients (29 male, 26 female; ages 18-75 years; median, 44 years; KPS 50-90, median 80) were irradiated for either a WHO Grade II (n = 19) or Grade III (n = 36) oligodendroglioma. Twenty-eight patients had chemotherapy immediately prior to radiotherapy, and 27 had chemotherapy at progression following radiotherapy. The median radiation dose was 54 Gy in 30 fractions. Loss of heterozygosity (LOH) at chromosome 1p was evident in 36 tumors and absent in 19. Overall median progression-free survival after radiotherapy was 40.4 months. Median progression-free survival was 55.0 months for patients whose tumors harbored 1p loss vs. 6.2 months for those patients whose tumors retained both copies of chromosome 1p (p < 0.001). On both univariate and multivariate analyses, chromosome lp loss was the principal independent predictor of longer progression-free survival for patients with Grade II and III oligodendrogliomas. For Grade III oligodendrogliomas, chemotherapy as an adjunct to radiotherapy prolonged tumor control for those patients whose tumors harbored allelic loss of chromosome 1p (p = 0.004). CONCLUSION These data suggest allelic loss of chromosome 1p in patients with oligodendroglial neoplasms predicts longer progression-free survival among patients receiving radiotherapy +/- chemotherapy as part of their initial treatment. Chromosome 1p loss may be an important stratification variable in future therapeutic trials of oligodendroglioma.
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Affiliation(s)
- G S Bauman
- Department of Oncology, University of Western Ontario and London Regional Cancer Centre, London, Ontario, Canada.
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Abstract
This study presents a combined case series of chordomas from two Canadian institutes. Twenty-seven patients were identified for the period 1954-1998. Management issues with regard to diagnostic pitfalls, selection of charged particle treatment and retreatment of recurrences are discussed. The diagnosis of early stage chordoma requires a high index of suspicion. One patient in the series presented with hoarseness and is described in detail. The diagnosis was made coincidentally by a computed tomographic scan of the head, performed after a motor vehicle accident. The planning of both surgery and radiotherapy was optimized by using magnetic resonance imaging. A review of the literature supports the use of a combined surgical and radiotherapeutic approach.
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Affiliation(s)
- P T Tai
- Allan Blair Cancer Centre, Regina, SK, Canada
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Tai P, Hammond A, Dyk JV, Stitt L, Tonita J, Coad T, Radwan J. Pelvic fractures following irradiation of endometrial and vaginal cancers-a case series and review of literature. Radiother Oncol 2000; 56:23-8. [PMID: 10869751 DOI: 10.1016/s0167-8140(00)00178-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To review the induction of pelvic fractures as a result of radiation therapy and to assess their management. MATERIALS AND METHODS The charts of patients with endometrial and vaginal cancers irradiated between 1991 and 1995 were reviewed. All patients were treated with megavoltage machines, energy ranging from cobalt to 25 MV photons. RESULTS We treated 336 patients, with a median follow-up duration of 28.9 months (range 0-73.3). Sixteen patients had symptomatic pelvic fractures. The 5-year actuarial incidence of symptomatic pelvic fracture was 2.1%. All patients had pain as the first symptom. The median time of onset was 11 months (range 4-46). Imaging studies of 37.5% (6/16) were initially interpreted to be recurrent malignancy. All patients were managed conservatively and nine patients showed radiological evidence of healing over a median time of 13 months (range 2-34). Six patients had specific drug treatment including provera, premarin, calcium supplements, or pamidronate. Of these, five healed. For the ten patients who did not have any specific treatment, only four showed signs of healing at the time of last follow-up. There was a trend toward earlier healing with specific drug treatment (P=0.11). CONCLUSIONS Fractures can easily be mistaken for metastatic lesions (37.5% in this series) which might be treated with further irradiation. Although not statistically significant, there was a trend towards early healing with drug therapy. More studies are required to generate quantitative data for dose-response relationships and to evaluate the effect of drug therapy on the healing of such fractures.
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Affiliation(s)
- P Tai
- Department of Radiation Oncology, Allan Blair Cancer Center, 4101 Dewdney Ave., SK S4T 7T1, Regina, Canada
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Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, Gilchrist J. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol 2000; 18:2493-9. [PMID: 10856110 DOI: 10.1200/jco.2000.18.12.2493] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To study the use of chemotherapy for Merkel cell carcinoma (MCC) of the skin. PATIENTS AND METHODS Twenty-five cases of MCC were treated at the London Regional Cancer Center between 1987 and 1997. Thirteen cases treated with chemotherapy were reviewed with 191 cases from the literature. RESULTS At presentation, 24 patients had localized skin lesions (stage I) and one had locoregional involvement (stage II). Among the nine cases with recurrent nodal disease, six had chemotherapy as a component of salvage treatment. They were all free of disease at a median of 19 months (range, 12 to 37 months). In contrast, two patients who had salvage radiotherapy alone died of disease. Overall survival (OS) and disease-free survival (DFS) were 59% and 43%, respectively, at two years. Median OS and DFS were 29 months (range, 1 to 133 months) and 9 months (range, 1 to 133 months), respectively. Nodal disease developed in 12 (50%) of 24 patients with stage I disease, and distant metastases developed in six (25%) of 24. Including those from the literature, there were 204 cases treated with chemotherapy. Cyclophosphamide/doxorubicin (or epirubicin)/vincristine combination +/- prednisone was the most commonly used chemotherapy regimen (47 cases), with an overall response rate of 75.7% (35.1% complete, 35. 1% partial, and 5.4% minor responses). Etoposide/cisplatin (or carboplatin) was the next most commonly used regimen (27 cases), with an overall response rate of 60% (36% complete and 24% partial responses). The difference in response rate was not statistically significant (P =.19). Among the 204 cases, there were seven (3.4%) toxic deaths. CONCLUSION Chemoradiation for locally recurrent or advanced disease may be an option for patients with a good performance status.
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Affiliation(s)
- P T Tai
- London Regional Cancer Center, Ontario, Canada.
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Tai P, Van Dyk J, Yu E, Battista J, Schmid M, Stitt L, Tonita J, Coad T. Radiation treatment for cervical esophagus: patterns of practice study in Canada, 1996. Int J Radiat Oncol Biol Phys 2000; 47:703-12. [PMID: 10837954 DOI: 10.1016/s0360-3016(00)00484-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the patterns of practice among Canadian radiation oncologists who treat esophageal cancers, using a trans-Canada survey, completed at the end of 1996. METHODS AND MATERIALS One of 3 case presentations of different stages of cervical esophageal cancer was randomly assigned and sent to participating radiation oncologists by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline target volumes for the boost phase of radiotherapy. Radiation oncologists from 26 of 27 (96%) of all Canadian centers participated. RESULTS High-energy X-rays (>/= 10 MV) were employed by 68% of the respondents in part of the treatment course. The majority (83%) of the radiation oncologists used at least two phases of treatment. Very few, 10 of 59 (17%), responses started with multifield treatment. The most frequently used prescription dose was 60 Gy/30 fractions/6 weeks, given with concurrent chemotherapy. Dose prescriptions were to the isocenter in 39 of 48 (81%) or to a particular isodose line in 9 of 48 (19%) of respondents. CONCLUSION There was a variety of radiation treatment techniques in this trans-Canada survey. The majority of the patients had combined cisplatin-based chemoradiation. The isocenter was not used consistently as a dose prescription point.
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Affiliation(s)
- P Tai
- Department of Oncology, London Regional Cancer Center, University of Western Ontario, Canada.
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Tomiak A, Vincent M, Kocha W, Taylor M, Winquist E, Keith B, Sawyer M, Griffeth S, Whiston F, Stitt L. Standard dose (Mayo regimen) 5-fluorouracil and low dose folinic acid: prohibitive toxicity? Am J Clin Oncol 2000; 23:94-8. [PMID: 10683088 DOI: 10.1097/00000421-200002000-00025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the perception that standard 5-fluorouracil/folinic acid (5-FU/FA) (425 mg/m2 per day and 20 mg/m2 per day intravenously once daily x 5 every 4 or 5 weeks) is well tolerated, we have been impressed by toxicity seen and frequent need for dose modification. We performed a retrospective analysis to quantitate the proportion of patients experiencing toxicity and attempted to identify associated clinical characteristics. One hundred thirty-four patients received 5-FU/FA at standard doses described by the Mayo regimen. Patient characteristics were as follows: female 35%, median age 66 years, Eastern Cooperative Oncology Group performance status less than or equal to 2, 96%. Sixty-eight percent received chemotherapy for metastatic disease. Forty-seven patients (35%+/-8%) experienced significant toxicity and were unable to receive the second cycle as scheduled: 76% required dose reduction, 11% discontinued therapy (including two toxic deaths), 11% discontinued therapy during the first cycle, and 2% required dose delay. Logistic regression was used to explore the following as predictors of toxicity: age, sex, performance status, adjuvant versus metastatic setting, prior chemotherapy, prior radiation, mean corpuscular volume, red blood cell distribution width, albumin, alkaline phosphatase, aspartate aminotransferase, bilirubin, and calculated creatinine clearance. No clinical characteristic was found to predict toxicity. Only high bilirubin approached statistical significance. We conclude that standard 5-FU/FA, when used in the general population, is associated with significant toxicity. Known clinical characteristics are not helpful in predicting toxicity. The lack of previous formal phase I evaluation of this regimen of 5-FU/FA raises concerns regarding its safety and generalizability in clinical practice.
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Affiliation(s)
- A Tomiak
- London Regional Cancer Centre, Ontario, Canada
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Bauman G, Ino Y, Ueki K, Zlatescu M, Fisher B, Macdonald D, Stitt L, Louis D, Cairncross J. Allelic loss of chromosome 1p and radiotherapy plus chemotherapy in patients with oligodendroglioma. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80194-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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