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van Geffen EGM, Langhout JMA, Hazen SJA, Sluckin TC, van Dieren S, Beets GL, Beets-Tan RGH, Borstlap WAA, Burger JWA, Horsthuis K, Intven MPW, Aalbers AGJ, Havenga K, Marinelli AWKS, Melenhorst J, Nederend J, Peulen HMU, Rutten HJT, Schreurs WH, Tuynman JB, Verhoef C, de Wilt JHW, Marijnen CAM, Tanis PJ, Kusters M, On Behalf Of The Dutch Snapshot Research Group. Evolution of clinical nature, treatment and survival of locally recurrent rectal cancer: Comparative analysis of two national cross-sectional cohorts. Eur J Cancer 2024; 202:114021. [PMID: 38520925 DOI: 10.1016/j.ejca.2024.114021] [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: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In the Netherlands, use of neoadjuvant radiotherapy for rectal cancer declined after guideline revision in 2014. This decline is thought to affect the clinical nature and treatability of locally recurrent rectal cancer (LRRC). Therefore, this study compared two national cross-sectional cohorts before and after the guideline revision with the aim to determine the changes in treatment and survival of LRRC patients over time. METHODS Patients who underwent resection of primary rectal cancer in 2011 (n = 2094) and 2016 (n = 2855) from two nationwide cohorts with a 4-year follow up were included. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival after LRRC. RESULTS Use of neoadjuvant (chemo)radiotherapy for the primary tumour decreased from 88.5% to 60.0% from 2011 to 2016. The 3-year LRRC rate was not significantly different with 5.1% in 2011 (n = 114, median time to LRRC 16 months) and 6.3% in 2016 (n = 202, median time to LRRC 16 months). Synchronous metastasis rate did not significantly differ (27.2% vs 33.7%, p = 0.257). Treatment intent of the LRRC shifted towards more curative treatment (30.4% vs. 47.0%, p = 0.009). In the curatively treated group, two-year overall survival after LRRC diagnoses increased from 47.5% to 78.7% (p = 0.013). CONCLUSION Primary rectal cancer patients in 2016 were treated less often with neoadjuvant (chemo)radiotherapy, while LRRC rates remained similar. Those who developed LRRC were more often candidate for curative intent treatment compared to the 2011 cohort, and survival after curative intent treatment also improved substantially.
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Affiliation(s)
- E G M van Geffen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J M A Langhout
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G L Beets
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - W A A Borstlap
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Horsthuis
- Department of Radiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M P W Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre Utrecht, the Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - K Havenga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A W K S Marinelli
- Department of Surgery, Haaglanden Medisch Centrum, Den Haag, the Netherlands
| | - J Melenhorst
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - H M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - W H Schreurs
- Department of Surgery, Nothwest Clinics, Alkmaar, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Kusters
- Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
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2
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van Vulpen JK, Eijkelenkamp H, Wessels F, Mulder S, Meijer GJ, Intven MPW. MR-Guided Stereotactic Ablative Body Radiotherapy for Pancreatic Oligometastases from Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e112. [PMID: 37784652 DOI: 10.1016/j.ijrobp.2023.06.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with pancreatic metastases from renal cell carcinoma (RCC) have been reported to have an unusually favorable prognosis. Traditionally, treatment for these pancreatic oligometastases comprises either surgical resection or systemic therapy. However, stereotactic ablative body radiotherapy (SAbR) may be an effective, non-invasive alternative strategy, provided that it shows acceptable toxicity and high local control rates among treated patients. MATERIALS/METHODS We reviewed all patients treated with MR-guided SABR for pancreatic oligometastases from renal cell carcinoma at a single institute. We explored adverse events (AE), freedom from local progression (FFLP), progression-free survival (PFS), and freedom from start of systemic therapy (FFST) among treated patients. The Kaplan-Meier method was used to describe the time-to-event endpoints. RESULTS From June 2019 to September 2022, we identified 11 patients treated with MR-guided SAbR to 31 pancreatic oligometastases from RCC. Patients had a mean age of 65.6 years (±6.8) and had a median of 3 irradiated pancreatic metastases (range 1-7). Metastases were treated with 5 fractions of 7 Gy (n = 1 metastasis) or 8 Gy (n = 30 metastases) per fraction. One grade 3 adverse event (bleeding) was observed. At a median follow-up of 10.5 months (range 5-46 months), estimated FFLP at 1 year was 100%. 1y-PFS was 83% (95% CI 58-100%), and 1y-FFST was 91% (95% CI 75-100%). CONCLUSION First exploration of MR-guided SAbR to pancreatic oligometastases from RCC indicates that it can be an effective and safe treatment option. Moreover, MR-guided SAbR may facilitate deferral of systemic therapy initiation in this select group of patients with favorable prognosis.
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Affiliation(s)
| | - H Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Wessels
- UMC Utrecht, Utrecht, The Netherlands
| | - S Mulder
- Radboud UMC, Nijmegen, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Peltenburg J, Hosni A, Bahij R, Böke S, Braam PM, Hall WA, Intven MPW, Nicosia LD, Sonke JJ, Nowee ME, Janssen T. Interobserver Variation in Tumor Delineation of Liver Metastases using Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e145. [PMID: 37784723 DOI: 10.1016/j.ijrobp.2023.06.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic Resonance (MR-) guided stereotactic body radiotherapy enables accurate treatment of liver metastases. Despite the accuracy of treatment delivery, one of the main uncertainties is the variation in tumor delineation, which requires additional treatment margins. The aim of this study was to quantify the interobserver variation (IOV) in MRI based delineation of the gross tumor volume (GTV) of liver metastases. MATERIALS/METHODS A cohort of 20 liver metastases treated on a MR-Linac were consecutively selected per primary tumor (colorectal (6), breast (6) and lung (8)). Planning MRI scans (T1 weighted with IV-contrast) were collected and anonymized. GTV delineation guidelines and case-specific information were provided to 8 radiation oncologists from 8 institutions. All cases were quantitatively reviewed and delineations with major violations of the guidelines were marked as outliers (such as contours including a vein or excluding obvious parts of a tumor). IOV was quantified by comparing individual delineations with the median contour and calculating the standard deviation (SD) and 95th percentile Hausdorff distance (HD95). Analyses were conducted on all delineations and on a subgroup excluding outliers per case to distinguish between accuracy of delineation and individual guideline interpretation. Sphericity was calculated from the volume and surface area of all delineations. Correlation between SD and sphericity was determined using Spearman's rs. Differences in SD between primary tumors were analyzed using the Kruskal-Wallis test. RESULTS The median volume of all metastases was 6.5 cc (IQR 3.7 - 29.8 cc) and sphericity was 0.84 (IQR 0.80 - 0.87) based on all contours (Table 1). The SD was 1.6 mm and the median HD95 was 2.7 mm. In the subgroup analysis, one (in 15 cases) or two (in 5 cases) delineations were excluded. Subgroup analyses showed a SD of 1.1 mm and median HD 95 of 2.6mm. The Kruskal-Wallis test showed no difference (p = 0.59) in SD between primary tumors. There was a significant negative correlation between IOV (SD) and sphericity (rs = -0.70; p = 0.008). Table 1: Overview of SD (mm), HD95 (mm) and volume (cc) of all observers and subgroup per primary tumor and in total CONCLUSION: MRI based GTV delineation variation of liver metastases is 1.1 - 1.6 mm, which is smaller than anticipated, although significant outliers (HD95 up to 3.9 mm) were present. Use of common delineation guidelines will ensure consistency in contouring and have the potential to decrease treatment margins when taking IOV into account.
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Affiliation(s)
- J Peltenburg
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Bahij
- Odense University Hospital (OUH), Odense, Denmark
| | - S Böke
- Tübingen University Hospital, Tübingen, Germany
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L D Nicosia
- Advanced Radiation Oncology Department - Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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4
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Westley R, Peltenburg J, Aitken KL, Awan MJ, Braam PM, Daamen LA, Hosni A, Intven MPW, Janssen T, Schytte T, Sonke JJ, Straza MW, Paulson ES, Hall WA, Nowee ME. Outcomes of Tolerability, Acute Toxicity and Quality of Life from MR-Guided Radiation Therapy (1.5T MR-Linac) for Liver Metastases in the MOMENTUM Study. Int J Radiat Oncol Biol Phys 2023; 117:e156. [PMID: 37784746 DOI: 10.1016/j.ijrobp.2023.06.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiation therapy (SBRT) offers an important treatment option for metastatic liver tumors. The introduction of magnetic resonance (MR) guided SBRT has paved the way for optimal tumor visualization and daily plan adaptation. The purpose of this study is to review tolerability of MR-guided SBRT of liver metastases and to present early toxicity and quality of life outcomes. MATERIALS/METHODS All patients with liver metastases who were treated on a 1.5T MR-Linac and enrolled in the MOMENTUM study (NTC04075305) were included. Patients were treated between April 2019 and December 2022 in 5 different institutes across 3 countries. Descriptive statistics were used to present the tolerability of treatment, toxicity (CTCAE v5.0) and quality of life outcomes (QLQ C30 and EQ 5D-5L) at baseline and 3 months after treatment. RESULTS A total of 127 patients with liver metastases were included in the analysis. There were 64 females and 63 men, with a median age of 66 years (range 31 to 93). The median ECOG-score was 0 (range 0-2). The most common primary origin was colorectal cancer (66%), followed by bronchus and lung cancer (12%), with ocular melanoma, pancreatic and breast cancer being joint third (all 6-7%). Fractionation schedules ranged from 12 - 67.5 Gy in 2 - 12 fractions. The most commonly prescribed fractionation dose was 60 Gy in 3-5 fractions (53% and 13% respectively) and 50 Gy in 5 fractions (11%). Completion data was available for 116 patients. 112 patients (97%) received all fractions. 4 Patients (3%) did not complete treatment due to technical issues and 2 of the 4 receiving no treatment on the MR-Linac. Physician reported toxicity at 3 months was recorded for 82 patients (66%). No grade 4 or 5 toxicities were reported. There were 12 grade 3 toxicities reported in 6 (7%) patients with 5 deemed radiation therapy related (Table 1) and 34 grade 2 toxicities in 21 (26%) patients. CONCLUSION We have presented the largest cohort (to our knowledge) of 127 patients treated using 1.5 Tesla MR Guidance for metastatic liver tumors. 97% of treatments were completed successfully with all treatments being well tolerated. Acute grade 3 toxicity was reported in 7% of patients with no grade 4 or 5 toxicities present. These outcomes suggest radiotherapy on the MR-Linac is a safe and promising treatment for patients with liver metastases. Additional prospective follow up is ongoing for late toxicity events and long-term control data. Table 1: Grade ≥3 toxicity at 3 months related to radiation therapy (total No. of patients was 82) There was QLQ-C30 data on 89 patients at baseline and on 62 patients at 3 months. At 3 months the median score was worse for physical functioning, VAS score and pain.
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Affiliation(s)
- R Westley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Peltenburg
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - K L Aitken
- Royal Marsden Hospital, London, United Kingdom
| | - M J Awan
- Case Western Reserve University, Cleveland, OH
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M W Straza
- Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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5
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Grimbergen G, Eijkelenkamp H, Bernchou U, Bouchart C, Brown K, Chuter R, Dunlop A, Scripes PG, Heerkens HD, de Leon J, Ng SSW, Renz PB, Shessel A, Intven MPW, Meijer GJ. Toward Global Consensus for MR-Guided Treatment Planning for Pancreatic Tumors on a 1.5 T MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e305. [PMID: 37785110 DOI: 10.1016/j.ijrobp.2023.06.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided SBRT with a 1.5 T MR-Linac is a relatively new therapy for pancreatic tumors with varying expertise levels. Moreover, treatment planning in the upper abdomen can be challenging as target coverage is often compromised by dosimetric constraints of abutting bowel structures. This may lead to large differences between centers in protocols, practices. To increase harmonization a worldwide consortium was founded among 1.5 T MR-Linac users. In this work we report on the outcome of the first phase within this collaboration, which is the assessment of the baseline variation between the treatment planning protocols and subsequent dose distributions. MATERIALS/METHODS Twelve centers across three continents (North America, Europe, and Australia) participated in this consortium. Each center was sent the same two anonymized data sets reflecting two cases of locally advanced pancreatic cancer of different complexity levels. The data sets included a CT scan, a predefined structure set containing the gross target volume (GTV) and the OARs, a brief medical history, tumor motion characteristics, and auxiliary CT and MR imaging. Centers were asked to create an MRgRT treatment plan according to their clinical five-fraction SBRT protocol, using their institutional margin structures, beam setup, target prescriptions, and OAR constraints. Key DVH parameters that were evaluated are D99%, D90%, D50%, D1% for the GTV and D0.5cc for the duodenum, small bowel, and stomach. RESULTS In general, large variations were observed in planning objectives and machine settings yielding widely varying inhomogeneous dose distributions to both the tumor and organs at risk (Table 1). This was especially manifest for case 2 where the tumor abutted with both the duodenum and small bowel over a trajectory of multiple centimeters. Not only were different trade-offs between target coverage and OAR sparing observed, but also different strategies for optimizing the integral dose to the tumor. CONCLUSION These results indicate a large variety in the treatment planning strategies that could well translate to differences in outcome. Based on this first evaluation, the consortium will work towards a collective consensus protocol with a second evaluation round after internal discussions.
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Affiliation(s)
- G Grimbergen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - C Bouchart
- Department of Radiation Oncology, HUB Institut Jules Bordet, Brussels, Belgium
| | - K Brown
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - R Chuter
- The Christie NHS Foundation, Manchester, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - P Godoy Scripes
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - H D Heerkens
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J de Leon
- GenesisCare, Alexandria, NSW, Australia
| | - S S W Ng
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - P B Renz
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - A Shessel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Daamen LA, Westerhoff JM, Couwenberg AM, Braam PM, Rütten H, Christodouleas JP, Hall WA, Verkooijen H, Intven MPW. Patient-Reported Outcomes of Rectal Cancer Patients Treated on a 1.5T MR-Linac within the MOMENTUM Study. Int J Radiat Oncol Biol Phys 2023; 117:e291. [PMID: 37785076 DOI: 10.1016/j.ijrobp.2023.06.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) With the 1.5 MR-Linac, planning target volume (PTV) margins for the treatment of rectal cancer can be reduced by 1/3 compared to conventional radiotherapy techniques. This allows better sparing of surrounding tissues, potentially resulting in less toxicity and greater patient comfort. Patient-reported outcomes (PROs) after rectal cancer treatment on a 1.5T MR-Linac have not yet been reported. Through international collaboration, the 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-Linac (MOMENTUM)' registry provides the unique opportunity to study these outcomes in a relatively large patient cohort. The aim of this study is to assess PROs of rectal cancer patients treated on a 1.5T MR-Linac within MOMENTUM. MATERIALS/METHODS An international, prospective, observational cohort study was performed, including all patients with rectal cancer who were treated with 25 Gy in five fractions on an MR-Linac in three institutions located in the Netherlands (2019-2022). Patient-reported outcomes were measured using the general EORTC QLQ-C30 and colorectal cancer-specific EORTC QLQ-CR29 questionnaires. Scores were calculated according to the EORTC QLQ-C30 scoring manual. A high score for a functional scale represents a high functioning level, while a high score for a symptom scale represents a high symptomatology level. Outcomes were measured at regular time points (i.e., at baseline and after three, 6 and 12 months follow-up). Patients who underwent tumor resection were censored at the date of surgery. RESULTS In total, 152patients were included, with a median follow-up of 17 (interquartile range [IQR] 11-27) months. Of these, six patients (4%) had American Joint Committee on Cancer (AJCC) stage I disease, 11 patients (7%) stage II, 85 patients (56%) stage III, and 12 patients (8%) stage IV. A total of 87 patients (57%) reached three months follow-up without surgery, 60 patients (39%) six months, and 40 patients (26%) twelve months. At six months follow-up, 25/132 patients (19%) had received additional chemotherapy. The median global health score was 83 (interquartile range [IQR] 67-83) at baseline, 75 (IQR 58-83) at three months, 75 (IQR 58-83) at six months and 83 (IQR 83-100) at twelve months. In most QLQ-C30 domains, functional and symptom scores deteriorated during the first six months after treatment, but returned to or exceeded baseline scores at 12 months. Overall, treatment resulted in improved QLQ-CR29 scores after 12 months follow-up. Most frequently reported symptoms were blood and mucus in stool, urinary frequency, stool frequency and anxiety. CONCLUSION This study presents patient-reported outcomes in the currently largest cohort of patients with rectal cancer who received treatment on a 1.5T MR-Linac. Overall, treatment resulted in improved symptom management, and stabilized or improved quality of life outcomes after twelve months of follow-up.
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Affiliation(s)
- L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - A M Couwenberg
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Rütten
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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van Goor IWJM, Daamen LA, Besselink MG, Bruynzeel AME, Busch OR, Cirkel GA, Koerkamp BG, Mohammed NH, Heerkens HD, van Laarhoven HWM, Meijer GJ, Nuyttens J, van Santvoort HC, van Tienhoven G, Verkooijen HM, Wilmink JW, Molenaar IQ, Intven MPW. Correction: A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE). Trials 2023; 24:55. [PMID: 36694252 PMCID: PMC9875523 DOI: 10.1186/s13063-022-07036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- I W J M van Goor
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands. .,Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
| | - L A Daamen
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.,Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - A M E Bruynzeel
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiation Oncology, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
| | - O R Busch
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - G A Cirkel
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N Haj Mohammed
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - H D Heerkens
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - J Nuyttens
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H C van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - G van Tienhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J W Wilmink
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - I Q Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands.
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8
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Doppenberg D, Besselink MG, van Eijck CHJ, Intven MPW, Groot Koerkamp B, Kazemier G, van Laarhoven HWM, Meijerink M, Molenaar IQ, Nuyttens JJME, van Os R, van Santvoort HC, van Tienhoven G, Verkooijen HM, Versteijne E, Wilmink JW, Lagerwaard FJ, Bruynzeel AME. Correction: Stereotactic ablative radiotherapy or best supportive care in patients with localized pancreatic cancer not receiving chemotherapy and surgery (PANCOSAR): a nationwide multicenter randomized controlled trial according to a TwiCs design. BMC Cancer 2023; 23:70. [PMID: 36670370 PMCID: PMC9854019 DOI: 10.1186/s12885-023-10521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- D. Doppenberg
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - M. G. Besselink
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - C. H. J. van Eijck
- grid.508717.c0000 0004 0637 3764Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M. P. W. Intven
- grid.5477.10000000120346234Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - B. Groot Koerkamp
- grid.508717.c0000 0004 0637 3764Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - G. Kazemier
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands
| | - H. W. M. van Laarhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - M. Meijerink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Intervention Radiology, Amsterdam, The Netherlands
| | - I. Q. Molenaar
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J. J. M. E. Nuyttens
- grid.508717.c0000 0004 0637 3764Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - R. van Os
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - H. C. van Santvoort
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - G. van Tienhoven
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - H. M. Verkooijen
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - E. Versteijne
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - J. W. Wilmink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - F. J. Lagerwaard
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - A. M. E. Bruynzeel
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
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9
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Doppenberg D, Besselink MG, van Eijck CHJ, Intven MPW, Koerkamp BG, Kazemier G, van Laarhoven HWM, Meijerink M, Molenaar IQ, Nuyttens JJME, van Os R, van Santvoort HC, van Tienhoven G, Verkooijen HM, Versteijne E, Wilmink JW, Lagerwaard FJ, Bruynzeel AME. Stereotactic ablative radiotherapy or best supportive care in patients with localized pancreatic cancer not receiving chemotherapy and surgery (PANCOSAR): a nationwide multicenter randomized controlled trial according to a TwiCs design. BMC Cancer 2022; 22:1363. [PMID: 36581914 PMCID: PMC9801528 DOI: 10.1186/s12885-022-10419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Significant comorbidities, advanced age, and a poor performance status prevent surgery and systemic treatment for many patients with localized (non-metastatic) pancreatic ductal adenocarcinoma (PDAC). These patients are currently treated with 'best supportive care'. Therefore, it is desirable to find a treatment option which could improve both disease control and quality of life in these patients. A brief course of high-dose high-precision radiotherapy i.e. stereotactic ablative body radiotherapy (SABR) may be feasible. METHODS A nationwide multicenter trial performed within a previously established large prospective cohort (the Dutch Pancreatic cancer project; PACAP) according to the 'Trial within cohorts' (TwiCs) design. Patients enrolled in the PACAP cohort routinely provide informed consent to answer quality of life questionnaires and to be randomized according to the TwiCs design when eligible for a study. Patients with localized PDAC who are unfit for chemotherapy and surgery or those who refrain from these treatments are eligible. Patients will be randomized between SABR (5 fractions of 8 Gy) with 'best supportive care' and 'best supportive care' only. The primary endpoint is overall survival from randomization. Secondary endpoints include preservation of quality of life (EORTC-QLQ-C30 and -PAN26), NRS pain score response and WHO performance scores at baseline, and, 3, 6 and 12 months. Acute and late toxicity will be scored using CTCAE criteria version 5.0: assessed at baseline, day of last fraction, at 3 and 6 weeks, and 3, 6 and 12 months following SABR. DISCUSSION The PANCOSAR trial studies the added value of SBRT as compared to 'best supportive care' in patients with localized PDAC who are medically unfit to receive chemotherapy and surgery, or refrain from these treatments. This study will assess whether SABR, in comparison to best supportive care, can relieve or delay tumor-related symptoms, enhance quality of life, and extend survival in these patients. TRIAL REGISTRATION Clinical trials, NCT05265663 , Registered March 3 2022, Retrospectively registered.
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Affiliation(s)
- D. Doppenberg
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - M. G. Besselink
- grid.7177.60000000084992262Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - C. H. J. van Eijck
- grid.508717.c0000 0004 0637 3764Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M. P. W. Intven
- grid.5477.10000000120346234Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - B. Groot Koerkamp
- grid.508717.c0000 0004 0637 3764Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - G. Kazemier
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, The Netherlands
| | - H. W. M. van Laarhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - M. Meijerink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Intervention Radiology, Amsterdam, The Netherlands
| | - I. Q. Molenaar
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J. J. M. E. Nuyttens
- grid.508717.c0000 0004 0637 3764Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - R. van Os
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - H. C. van Santvoort
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - G. van Tienhoven
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - H. M. Verkooijen
- grid.5477.10000000120346234Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - E. Versteijne
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - J. W. Wilmink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - F. J. Lagerwaard
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
| | - A. M. E. Bruynzeel
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, The Netherlands
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10
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van Goor IWJM, Daamen LA, Besselink MG, Bruynzeel AME, Busch OR, Cirkel GA, Groot Koerkamp B, Haj Mohammed N, Heerkens HD, van Laarhoven HWM, Meijer GJ, Nuyttens J, van Santvoort HC, van Tienhoven G, Verkooijen HM, Wilmink JW, Molenaar IQ, Intven MPW. A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE). Trials 2022; 23:913. [PMID: 36307892 PMCID: PMC9617359 DOI: 10.1186/s13063-022-06829-1] [Citation(s) in RCA: 4] [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: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Disease recurrence is the main cause of mortality after resection of pancreatic ductal adenocarcinoma (PDAC). In 20-30% of resected patients, isolated local PDAC recurrence occurs. Retrospective studies have suggested that stereotactic body radiation therapy (SBRT) might lead to improved local control in these patients, potentially having a beneficial effect on both survival and quality of life. The "nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy" (ARCADE) will investigate the value of SBRT in addition to standard of care in patients with isolated local PDAC recurrence compared to standard of care alone, regarding both survival and quality of life outcomes. METHODS The ARCADE trial is nested within a prospective cohort (Dutch Pancreatic Cancer Project; PACAP) according to the 'Trials within Cohorts' design. All PACAP participants with isolated local PDAC recurrence after primary resection who provided informed consent for being randomized in future studies are eligible. Patients will be randomized for local therapy (5 fractions of 8 Gy SBRT) in addition to standard of care or standard of care alone. In total, 174 patients will be included. The main study endpoint is survival after recurrence. The most important secondary endpoint is quality of life. DISCUSSION It is hypothesized that additional SBRT, compared to standard of care alone, improves survival and quality of life in patients with isolated local recurrence after PDAC resection. TRIAL REGISTRATION ClinicalTrials.gov registration NCT04881487 . Registered on May 11, 2021.
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Affiliation(s)
- I. W. J. M. van Goor
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands ,Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - L. A. Daamen
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands ,grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M. G. Besselink
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - A. M. E. Bruynzeel
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Radiation Oncology, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
| | - O. R. Busch
- grid.7177.60000000084992262Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands
| | - G. A. Cirkel
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - B. Groot Koerkamp
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - H. D. Heerkens
- grid.10417.330000 0004 0444 9382Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H. W. M. van Laarhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - G. J. Meijer
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
| | - J. Nuyttens
- grid.5645.2000000040459992XDepartment of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - H. C. van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands
| | - G. van Tienhoven
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.7177.60000000084992262Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H. M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. W. Wilmink
- grid.16872.3a0000 0004 0435 165XCancer Center Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Medical Oncology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, the Netherlands
| | - I. Q. Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands ,Nieuwegein, the Netherlands
| | - M. P. W. Intven
- Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands
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11
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Verweij ME, Hoendervangers S, Couwenberg AM, Burbach JPM, Berbee M, Buijsen J, Roodhart J, Reerink O, Pronk A, Consten ECJ, Smits AB, Heikens JT, van Grevenstein WMU, Intven MPW, Verkooijen HM. Impact of dose-escalated chemoradiation on quality of life in patients with locally advanced rectal cancer: two year follow-up of the randomized RECTAL-BOOST trial. Int J Radiat Oncol Biol Phys 2021; 112:694-703. [PMID: 34634436 DOI: 10.1016/j.ijrobp.2021.09.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dose-escalated chemoradiation (CRT) for locally advanced rectal cancer (LARC) did not result in higher complete response rates, but initiated more tumor regression in the randomized XXXXX trial (Clinicaltrials.gov XXXXX). This study compared patient reported outcomes (PROs) between patients who received dose-escalated CRT (5 × 3Gy boost + CRT) or standard CRT for two years following randomization. METHODS Patients with LARC, participating in the XXXXX trial, filled out EORTC QLQ-C30 and CR29 questionnaires on quality of life (QoL) and symptoms at baseline, 3, 6, 12, 18 and 24 months following start of treatment. Between-group differences in functional QoL domains were estimated using a linear mixed-effects model and expressed as effect size (ES). Symptom scores were compared using Mann-Whitney U test. RESULTS Patients treated with dose-escalated CRT (boost group, n=51) experienced a significantly stronger decline in global health at 3 and 6 months (ES -0,4 and ES -0,4), physical functioning at 6 months (ES -1,1), role functioning at 3 and 6 months (ES -0,8 and ES -0,6) and social functioning at 6 months (ES -0,6) compared to patients treated with standard CRT (control group, n=64). The boost group reported significantly more fatigue at 3 and 6 months (83% vs. 66% resp. 89% vs. 76%), pain at 3 and 6 months (67% vs. 36% resp. 80% vs. 44%) and diarrhea at 3 months (45% vs. 29%) compared to the control group. From 12 months onwards, QoL and symptoms were similar between groups, apart from more blood/mucus in stool in the boost group. CONCLUSION In patients with LARC, dose-escalated CRT resulted in a transient deterioration in global health, physical, role, and social functioning and more pain, fatigue and diarrhea at 3 and 6 months following start of treatment compared to standard CRT. From 12 months onwards, the impact of dose-escalated CRT on QoL largely resolved.
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Affiliation(s)
- M E Verweij
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A M Couwenberg
- Department of Radiation Oncology, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - J P M Burbach
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - M Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O Reerink
- Department of Radiation Oncology, Isala Clinic, Zwolle, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J T Heikens
- Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
| | | | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Daamen LA, van Goor IWJM, Schouten TJ, Dorland G, van Roessel SR, Besselink MG, Bonsing BA, Bosscha K, Brosens LAA, Busch OR, van Dam RM, Fariña Sarasqueta A, Festen S, Groot Koerkamp B, van der Harst E, de Hingh IHJT, Intven MPW, Kazemier G, de Meijer VE, Nieuwenhuijs VB, Raicu GM, Roos D, Schreinemakers JMJ, Stommel MWJ, van Velthuysen MF, Verheij J, Verkooijen HM, van Santvoort HC, Molenaar IQ. Microscopic resection margin status in pancreatic ductal adenocarcinoma - A nationwide analysis. Eur J Surg Oncol 2020; 47:708-716. [PMID: 33323293 DOI: 10.1016/j.ejso.2020.11.145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/19/2020] [Accepted: 11/28/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION First, this study aimed to assess the prognostic value of different definitions for resection margin status on disease-free survival (DFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC). Second, preoperative predictors of direct margin involvement were identified. MATERIALS AND METHODS This nationwide observational cohort study included all patients who underwent upfront PDAC resection (2014-2016), as registered in the prospective Dutch Pancreatic Cancer Audit. Patients were subdivided into three groups: R0 (≥1 mm margin clearance), R1 (<1 mm margin clearance) or R1 (direct margin involvement). Survival was compared using multivariable Cox regression analysis. Logistic regression with baseline variables was performed to identify preoperative predictors of R1 (direct). RESULTS 595 patients with a median OS of 18 months (IQR 10-32 months) months were analysed. R0 (≥1 mm) was achieved in 277 patients (47%), R1 (<1 mm) in 146 patients (24%) and R1 (direct) in 172 patients (29%). R1 (direct) was associated with a worse OS, as compared with both R0 (≥1 mm) (hazard ratio (HR) 1.35 [95% and confidence interval (CI) 1.08-1.70); P < 0.01) and R1 (<1 mm) (HR 1.29 [95%CI 1.01-1.67]; P < 0.05). No OS difference was found between R0 (≥1 mm) and R1 (<1 mm) (HR 1.05 [95% CI 0.82-1.34]; P = 0.71). Preoperative predictors associated with an increased risk of R1 (direct) included age, male sex, performance score 2-4, and venous or arterial tumour involvement. CONCLUSION Resection margin clearance of <1 mm, but without direct margin involvement, does not affect survival, as compared with a margin clearance of ≥1 mm. Given that any vascular tumour involvement on preoperative imaging was associated with an increased risk of R1 (direct) resection with upfront surgery, neoadjuvant therapy might be considered in these patients.
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Affiliation(s)
- L A Daamen
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | - I W J M van Goor
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | - T J Schouten
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
| | - G Dorland
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands; Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - S R van Roessel
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M G Besselink
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - B A Bonsing
- Dept. of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - K Bosscha
- Dept. of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - L A A Brosens
- Dept. of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O R Busch
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - R M van Dam
- Dept. of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - A Fariña Sarasqueta
- Dept. of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Dept. of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - S Festen
- Dept. of Surgery, OLVG, Amsterdam, the Netherlands
| | | | - E van der Harst
- Dept. of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - I H J T de Hingh
- Dept. of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M P W Intven
- Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | - G Kazemier
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - V E de Meijer
- Dept. of Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | | | - G M Raicu
- Dept. of Pathology, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
| | - D Roos
- Dept. of Surgery, Reinier de Graaf Group, Delft, the Netherlands
| | | | - M W J Stommel
- Dept. of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - J Verheij
- Dept. of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - H M Verkooijen
- Imaging Division, University Medical Centre Utrecht, the Netherlands, Utrecht University, Utrecht, the Netherlands
| | - H C van Santvoort
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
| | - I Q Molenaar
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands.
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Bruijnen T, van der Heide O, Intven MPW, Mook S, Lagendijk JJW, van den Berg CAT, Tijssen RHN. Technical feasibility of magnetic resonance fingerprinting on a 1.5T MRI-linac. Phys Med Biol 2020; 65:22NT01. [PMID: 32977318 DOI: 10.1088/1361-6560/abbb9d] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hybrid MRI-linac (MRL) systems enable daily multiparametric quantitative MRI to assess tumor response to radiotherapy. Magnetic resonance fingerprinting (MRF) may provide time efficient means of rapid multiparametric quantitative MRI. The accuracy of MRF, however, relies on adequate control over system imperfections, such as eddy currents and [Formula: see text], which are different and not as well established on MRL systems compared to diagnostic systems. In this study we investigate the technical feasibility of gradient spoiled 2D MRF on a 1.5T MRL. We show with phantom experiments that the MRL generates reliable MRF signals that are temporally stable during the day and have good agreement with spin-echo reference measurements. Subsequent in-vivo MRF scans in healthy volunteers and a patient with a colorectal liver metastasis showed good image quality, where the quantitative values of selected organs corresponded with the values reported in literature. Therefore we conclude that gradient spoiled 2D MRF is feasible on a 1.5T MRL with similar performance as on a diagnostic system. The precision and accuracy of the parametric maps are sufficient for further investigation of the clinical utility of MRF for online quantitatively MRI-guided radiotherapy.
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Affiliation(s)
- T Bruijnen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. Computational Imaging Group for MRI Diagnostics and Therapy, Centre for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Hoendervangers S, Burbach JPM, Lacle MM, Koopman M, van Grevenstein WMU, Intven MPW, Verkooijen HM. Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2020; 27:4319-4336. [PMID: 32524461 PMCID: PMC7497700 DOI: 10.1245/s10434-020-08615-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/21/2019] [Indexed: 12/18/2022]
Abstract
Background Pathological complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) is associated with better survival, less local recurrence, and less distant failure. Furthermore, pCR indicates that the rectum may have been preserved. This meta-analysis gives an overview of available neoadjuvant treatment strategies for LARC and analyzes how these perform in achieving pCR as compared with the standard of care. Methods Pubmed, Embase, and Cochrane Central bibliographic databases were searched. Randomized controlled trials in which patients received neoadjuvant treatment for MRI-staged nonmetastatic resectable LARC were included. The primary outcome was pCR, defined as ypT0N0. A meta-analysis of studies comparing an intervention with standard fluoropyrimidine-based chemoradiation (CRT) was performed. Results Of the 17 articles included in the systematic review, 11 were used for the meta-analysis. Addition of oxaliplatin to fluoropyrimidine-based CRT resulted in significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ grade 3 toxicity. Other treatment strategies, including consolidation/induction chemotherapy and short-course radiotherapy (SCRT), did not improve pCR rates. None of the included trials reported a benefit in local control or OS. Five-year DFS was significantly worse after SCRT-delay compared with CRT (59% vs. 75.1%, HR 1.93). Conclusions All included trials fail to deliver high-level evidence to show an improvement in pCR compared with standard fluoropyrimidine-based CRT. The addition of oxaliplatin might result in more pCR but at the expense of more toxicity. Furthermore, this benefit does not translate into less local recurrence or improved survival. Electronic supplementary material The online version of this article (10.1245/s10434-020-08615-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J P M Burbach
- Department of Surgery, MC Leeuwarden, Leeuwarden, The Netherlands
| | - M M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Hoendervangers S, Sparreboom CL, Intven MPW, Lange JF, Verkooijen HM, Doornebosch PG, van Grevenstein WMU. The effect of neoadjuvant short-course radiotherapy and delayed surgery versus chemoradiation on postoperative outcomes in locally advanced rectal cancer patients - A propensity score matched nationwide audit-based study. Eur J Surg Oncol 2020; 46:1605-1612. [PMID: 32192792 DOI: 10.1016/j.ejso.2020.03.002] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate differences in postoperative outcomes between short-course radiotherapy and delayed surgery (SCRT-delay) and chemoradiation (CRT) in patients with locally advanced rectal cancer (LARC). BACKGROUND Previous trials suggest that SCRT-delay could serve as an adequate neoadjuvant treatment for LARC. Therefore, in frail LARC patients SCRT-delay is recommended as an alternative to CRT. However, data on postoperative outcomes after SCRT-delay in comparison to CRT is scarce. METHODS This was an observational study with data from the Dutch ColoRectal Audit (DCRA). LARC patients who underwent surgery (2014-2017) after an interval of ≥6 weeks were included. Missing values were replaced by multiple imputation. Propensity score matching (PSM), using age, Charlson Comorbidity Index, cT-stage and surgical procedure, was applied to create comparable groups. Differences in postoperative outcomes were analyzed using Chi-square test for categorical variables, independent sample t-test for continuous variables and Mann-Whitney U test for non-parametric data. RESULTS 2926 patients were included. In total, 288 patients received SCRT-delay and 2638 patients underwent CRT. Patients in the SCRT-delay group were older and had more comorbidities. Also, ICU-admissions and permanent colostomies were more common, as well as pulmonic, cardiologic, infectious and neurologic complications. After PSM, both groups comprised 246 patients with equivalent age, comorbidities and tumor stage. There were no differences in postoperative complications. CONCLUSION Postoperative complications were not increased in LARC patients undergoing SCRT-delay as neoadjuvant treatment. Regarding treatment-related complications, SCRT-delay is a safe alternative neoadjuvant treatment option for frail LARC patients.
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Affiliation(s)
- S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - C L Sparreboom
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Surgery, IJsselland Ziekenhuis, Capelle a/d Ijssel, the Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P G Doornebosch
- Department of Surgery, IJsselland Ziekenhuis, Capelle a/d Ijssel, the Netherlands
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16
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van der Sluis FJ, Couwenberg AM, de Bock GH, Intven MPW, Reerink O, van Leeuwen BL, van Westreenen HL. Population-based study of morbidity risk associated with pathological complete response after chemoradiotherapy for rectal cancer. Br J Surg 2019; 107:131-139. [DOI: 10.1002/bjs.11324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer may induce a pathological complete response (pCR) but increase surgical morbidity due to radiation-induced fibrosis. In this study the association between pCR and postoperative surgical morbidity was investigated.
Methods
Patients in the Netherlands with rectal cancer who underwent nCRT followed by total mesorectal excision between 2009 and 2017 were included. Data were stratified into patients who underwent resection with creation of a primary anastomosis and those who had a permanent stoma procedure. The association between pCR and postoperative morbidity was investigated in univariable and multivariable logistic regression analyses.
Results
pCR was observed in 976 (12·2 per cent) of 8003 patients. In 3472 patients who had a primary anastomosis, the presence of pCR was significantly associated with surgical complications (122 of 443 (27·5 per cent) versus 598 of 3029 (19·7 per cent) in those without pCR) and anastomotic leak (35 of 443 (7·9 per cent) versus 173 of 3029 (5·7 per cent) respectively). Multivariable analysis also showed associations between pCR and surgical complications (adjusted odds ratio (OR) 1·53, 95 per cent c.i. 1·22 to 1·92) and pCR and anastomotic leak (adjusted OR 1·41, 1·03 to 2·05). Of 4531 patients with a permanent stoma, surgical complications were observed in 120 (22·5 per cent) of 533 patients with a pCR, compared with 798 (20·0 per cent) of 3998 patients with no pCR (adjusted OR 1·17, 0·94 to 1·46).
Conclusion
Patients with a pCR in whom an anastomosis was created were at increased risk of developing an anastomotic leak.
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Affiliation(s)
| | - A M Couwenberg
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - O Reerink
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - B L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Daamen LA, Groot VP, Intven MPW, Besselink MG, Busch OR, Koerkamp BG, Mohammad NH, Hermans JJ, van Laarhoven HWM, Nuyttens JJ, Wilmink JW, van Santvoort HC, Molenaar IQ, Stommel MWJ. Postoperative surveillance of pancreatic cancer patients. Eur J Surg Oncol 2019; 45:1770-1777. [PMID: 31204168 DOI: 10.1016/j.ejso.2019.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study is to collect the best available evidence for diagnostic modalities, frequency, and duration of surveillance after resection for pancreatic ductal adenocarcinoma (PDAC). METHODS PDAC guidelines published after 2015 were collected. Furthermore, a systematic search of the literature on postoperative surveillance was performed in PubMed and Embase from 2000 to 2019. Articles comparing different diagnostic modalities and frequencies of postoperative surveillance in PDAC patients with regard to survival, quality of life, morbidity and cost-effectiveness were selected. RESULTS The literature search resulted in 570 articles. A total of seven guidelines and twelve original clinical studies were eventually evaluated. PDAC guidelines increasingly recommend a combination of tumor marker testing and computed tomography (CT) imaging every three to six months during the first two years after resection. These guidelines are, however, based on expert opinion and other low-level evidence. Prospective studies comparing different surveillance strategies are lacking. According to recent studies, surveillance with tumor markers and imaging at regular intervals results in the detection of PDAC recurrence before the onset of symptoms and more frequent administration of further therapy, such as chemotherapy or radiotherapy. CONCLUSION Current evidence for recurrence-focused surveillance after PDAC resection is limited and contradictory. Consequently, recommendations on surveillance are conflicting. To define the clinical merit of recurrence-focused surveillance, patients who are most likely to benefit from early detection and treatment of PDAC recurrence need to be identified. To this purpose, well-designed prospective studies are needed, accounting for both economical and psychosocial implications of surveillance.
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Affiliation(s)
- L A Daamen
- Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, the Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands.
| | - V P Groot
- Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | - M P W Intven
- Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | - M G Besselink
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - O R Busch
- Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | | | - N Haj Mohammad
- Dept. of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - J J Hermans
- Dept. of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H W M van Laarhoven
- Dept. of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - J J Nuyttens
- Dept. of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J W Wilmink
- Dept. of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - H C van Santvoort
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
| | - I Q Molenaar
- Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
| | - M W J Stommel
- Dept. of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
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Gerlich AS, van der Velden JM, Kotte ANTJ, Tseng CL, Fanetti G, Eppinga WSC, Kasperts N, Intven MPW, Pameijer FA, Philippens MEP, Verkooijen HM, Seravalli E. Inter-observer agreement in GTV delineation of bone metastases on CT and impact of MR imaging: A multicenter study. Radiother Oncol 2017; 126:534-540. [PMID: 28919003 DOI: 10.1016/j.radonc.2017.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 05/24/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE The use of Stereotactic Body Radiotherapy (SBRT) for bone metastases is increasing rapidly. Therefore, knowledge of the inter-observer differences in tumor volume delineation is essential to guarantee precise dose delivery. The aim of this study is to compare inter-observer agreement in bone metastases delineated on different imaging modalities. MATERIAL AND METHODS Twenty consecutive patients with bone metastases treated with SBRT were selected. All patients received CT and MR imaging in treatment position prior to SBRT. Five observers from three institutions independently delineated gross tumor volume (GTV) on CT alone, CT with co-registered MRI and MRI alone. Four contours per imaging modality per patient were available, as one set of contours was shared by 2 observers. Inter-observer agreement, expressed in generalized conformity index [CIgen], volumes of contours and contours center of mass (COM) were calculated per patient and imaging modality. RESULTS Mean GTV delineated on MR (45.9±52.0cm3) was significantly larger compared to CT-MR (40.2±49.4cm3) and CT (34.8±41.8cm3). A considerable variation in CIgen was found on CT (mean 0.46, range 0.15-0.75) and CT-MRI (mean 0.54, range 0.17-0.71). The highest agreement was found on MRI (mean 0.56, range 0.20-0.77). The largest variations of COM were found in anterior-posterior direction for all imaging modalities. CONCLUSIONS Large inter-observer variation in GTV delineation exists for CT, CT-MRI and MRI. MRI-based GTV delineation resulted in larger volumes and highest consistency between observers.
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Affiliation(s)
- A S Gerlich
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - J M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - A N T J Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - C L Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - G Fanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - W S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - N Kasperts
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - F A Pameijer
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - M E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - H M Verkooijen
- Trial Office Imaging Division, University Medical Center Utrecht, The Netherlands
| | - E Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
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