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Gogna K, Back M, Morgan M. Graeme William Morgan AM, B Pharm, MBBS, FRCP(UK), FRANZCR (9th September 1943 - 31st August 2022). J Med Imaging Radiat Oncol 2024; 68:353-354. [PMID: 38437240 DOI: 10.1111/1754-9485.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Kumar Gogna
- ICON Cancer Centre Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Michael Back
- Radiation Oncology, Northern Sydney Cancer Centre Royal North Shore Hospital, Sydney, New South Wales, Australia
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Barry N, Koh ES, Ebert MA, Moore A, Francis RJ, Rowshanfarzad P, Hassan GM, Ng SP, Back M, Chua B, Pinkham MB, Pullar A, Phillips C, Sia J, Gorayski P, Le H, Gill S, Croker J, Bucknell N, Bettington C, Syed F, Jung K, Chang J, Bece A, Clark C, Wada M, Cook O, Whitehead A, Rossi A, Grose A, Scott AM. [18]F-fluoroethyl-l-tyrosine positron emission tomography for radiotherapy target delineation: Results from a Radiation Oncology credentialing program. Phys Imaging Radiat Oncol 2024; 30:100568. [PMID: 38585372 PMCID: PMC10998205 DOI: 10.1016/j.phro.2024.100568] [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: 01/08/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background and purpose The [18]F-fluoroethyl-l-tyrosine (FET) PET in Glioblastoma (FIG) study is an Australian prospective, multi-centre trial evaluating FET PET for newly diagnosed glioblastoma management. The Radiation Oncology credentialing program aimed to assess the feasibility in Radiation Oncologist (RO) derivation of standard-of-care target volumes (TVMR) and hybrid target volumes (TVMR+FET) incorporating pre-defined FET PET biological tumour volumes (BTVs). Materials and methods Central review and analysis of TVMR and TVMR+FET was undertaken across three benchmarking cases. BTVs were pre-defined by a sole nuclear medicine expert. Intraclass correlation coefficient (ICC) confidence intervals (CIs) evaluated volume agreement. RO contour spatial and boundary agreement were evaluated (Dice similarity coefficient [DSC], Jaccard index [JAC], overlap volume [OV], Hausdorff distance [HD] and mean absolute surface distance [MASD]). Dose plan generation (one case per site) was assessed. Results Data from 19 ROs across 10 trial sites (54 initial submissions, 8 resubmissions requested, 4 conditional passes) was assessed with an initial pass rate of 77.8 %; all resubmissions passed. TVMR+FET were significantly larger than TVMR (p < 0.001) for all cases. RO gross tumour volume (GTV) agreement was moderate-to-excellent for GTVMR (ICC = 0.910; 95 % CI, 0.708-0.997) and good-to-excellent for GTVMR+FET (ICC = 0.965; 95 % CI, 0.871-0.999). GTVMR+FET showed greater spatial overlap and boundary agreement compared to GTVMR. For the clinical target volume (CTV), CTVMR+FET showed lower average boundary agreement versus CTVMR (MASD: 1.73 mm vs. 1.61 mm, p = 0.042). All sites passed the planning exercise. Conclusions The credentialing program demonstrated feasibility in successful credentialing of 19 ROs across 10 sites, increasing national expertise in TVMR+FET delineation.
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Affiliation(s)
- Nathaniel Barry
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Martin A. Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Australian Centre for Quantitative Imaging, Medical School, University of Western Australia, Crawley, WA, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA, Australia
| | - Alisha Moore
- Trans Tasman Radiation Oncology Group (TROG) Cancer Research, Newcastle, NSW Australia
| | - Roslyn J. Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Australian Centre for Quantitative Imaging, Medical School, University of Western Australia, Crawley, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA, Australia
| | - Ghulam Mubashar Hassan
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
| | - Sweet P. Ng
- Department of Radiation Oncology, Austin Health, Heidelberg, VIC, Australia
| | - Michael Back
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Benjamin Chua
- Department of Radiation Oncology, Royal Brisbane Womens Hospital, Brisbane, QLD, Australia
| | - Mark B. Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Andrew Pullar
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - Joseph Sia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jeremy Croker
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Nicholas Bucknell
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Catherine Bettington
- Department of Radiation Oncology, Royal Brisbane Womens Hospital, Brisbane, QLD, Australia
| | - Farhan Syed
- Department of Radiation Oncology, The Canberra Hospital, Canberra, ACT, Australia
| | - Kylie Jung
- Department of Radiation Oncology, The Canberra Hospital, Canberra, ACT, Australia
| | - Joe Chang
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Andrej Bece
- Department of Radiation Oncology, St George Hospital, Kogarah, NSW, Australia
| | - Catherine Clark
- Department of Radiation Oncology, St George Hospital, Kogarah, NSW, Australia
| | - Mori Wada
- Department of Radiation Oncology, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Cook
- Trans Tasman Radiation Oncology Group (TROG) Cancer Research, Newcastle, NSW Australia
| | - Angela Whitehead
- Trans Tasman Radiation Oncology Group (TROG) Cancer Research, Newcastle, NSW Australia
| | - Alana Rossi
- Trans Tasman Radiation Oncology Group (TROG) Cancer Research, Newcastle, NSW Australia
| | - Andrew Grose
- Trans Tasman Radiation Oncology Group (TROG) Cancer Research, Newcastle, NSW Australia
| | - Andrew M. Scott
- Department of Molecular Imaging and Therapy, Austin Health, and University of Melbourne, Melbourne, VIC, Australia
- Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine La Trobe University, Melbourne, VIC, Australia
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Back M, Lee W, Aldridge D. Pain management in ICU: all smoke and mirrors? Anaesthesia 2024. [PMID: 38306496 DOI: 10.1111/anae.16243] [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] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
- M Back
- Wythenshawe Hospital, Manchester, UK
| | - W Lee
- Wythenshawe Hospital, Manchester, UK
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Al‐Attar A, Back M, Sebastian J. Dexmedetomidine target controlled infusion for awake craniotomy †. Anaesth Rep 2024; 12:e12283. [PMID: 38464956 PMCID: PMC10918716 DOI: 10.1002/anr3.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
A 73-year-old woman underwent an awake craniotomy for the resection of a supratentorial brain tumour. We provided sedation for the surgery using a dexmedetomidine target controlled infusion using the Dyck pharmacokinetic model. Using a target controlled infusion allowed more rapid titration to the desired plasma level compared with a manual infusion, without any unexpected cardiovascular, respiratory or other complications. Rapid titration of sedation during awake craniotomy is desirable, allowing deeper sedation during stimulating parts of the surgery, followed by lighter sedation - or absence of sedation - during cortical mapping. While this can be performed manually, we found utilising the Dyck model in this case simple and quick to use, avoiding the need to manually calculate infusion rates. We believe this is the first report of using a target controlled infusion model to administer dexmedetomidine for awake craniotomy, and suggest it could be considered as an alternative to administering a manual infusion.
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Affiliation(s)
- A. Al‐Attar
- North West School of AnaesthesiaManchesterUK
| | - M. Back
- North West School of AnaesthesiaManchesterUK
| | - J. Sebastian
- Department of AnaesthesiaSalford Royal NHS Foundation TrustSalfordUK
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Brighi C, Waddington DEJ, Keall PJ, Booth J, O’Brien K, Silvester S, Parkinson J, Mueller M, Yim J, Bailey DL, Back M, Drummond J. The MANGO study: a prospective investigation of oxygen enhanced and blood-oxygen level dependent MRI as imaging biomarkers of hypoxia in glioblastoma. Front Oncol 2023; 13:1306164. [PMID: 38192626 PMCID: PMC10773871 DOI: 10.3389/fonc.2023.1306164] [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: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Background Glioblastoma (GBM) is the most aggressive type of brain cancer, with a 5-year survival rate of ~5% and most tumours recurring locally within months of first-line treatment. Hypoxia is associated with worse clinical outcomes in GBM, as it leads to localized resistance to radiotherapy and subsequent tumour recurrence. Current standard of care treatment does not account for tumour hypoxia, due to the challenges of mapping tumour hypoxia in routine clinical practice. In this clinical study, we aim to investigate the role of oxygen enhanced (OE) and blood-oxygen level dependent (BOLD) MRI as non-invasive imaging biomarkers of hypoxia in GBM, and to evaluate their potential role in dose-painting radiotherapy planning and treatment response assessment. Methods The primary endpoint is to evaluate the quantitative and spatial correlation between OE and BOLD MRI measurements and [18F]MISO values of uptake in the tumour. The secondary endpoints are to evaluate the repeatability of MRI biomarkers of hypoxia in a test-retest study, to estimate the potential clinical benefits of using MRI biomarkers of hypoxia to guide dose-painting radiotherapy, and to evaluate the ability of MRI biomarkers of hypoxia to assess treatment response. Twenty newly diagnosed GBM patients will be enrolled in this study. Patients will undergo standard of care treatment while receiving additional OE/BOLD MRI and [18F]MISO PET scans at several timepoints during treatment. The ability of OE/BOLD MRI to map hypoxic tumour regions will be evaluated by assessing spatial and quantitative correlations with areas of hypoxic tumour identified via [18F]MISO PET imaging. Discussion MANGO (Magnetic resonance imaging of hypoxia for radiation treatment guidance in glioblastoma multiforme) is a diagnostic/prognostic study investigating the role of imaging biomarkers of hypoxia in GBM management. The study will generate a large amount of longitudinal multimodal MRI and PET imaging data that could be used to unveil dynamic changes in tumour physiology that currently limit treatment efficacy, thereby providing a means to develop more effective and personalised treatments.
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Affiliation(s)
- Caterina Brighi
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - David E. J. Waddington
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Paul J. Keall
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Booth
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, Australia
| | | | - Shona Silvester
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jonathon Parkinson
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
| | - Marco Mueller
- Siemens Healthcare Pty Ltd, Brisbane, QLD, Australia
| | - Jackie Yim
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Dale L. Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
| | - James Drummond
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
- Department of Neuroradiology, Royal North Shore Hospital, Sydney, NSW, Australia
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Lau KS, Ruisi I, Back M. Association of MRI Volume Parameters in Predicting Patient Outcome at Time of Initial Diagnosis of Glioblastoma. Brain Sci 2023; 13:1579. [PMID: 38002539 PMCID: PMC10670247 DOI: 10.3390/brainsci13111579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Patients with glioblastoma (GBM) may demonstrate varying patterns of infiltration and relapse. Improving the ability to predict these patterns may influence the management strategies at the time of initial diagnosis. This study aims to examine the impact of the ratio (T2/T1) of the non-enhancing volume in T2-weighted images (T2) to the enhancing volume in MRI T1-weighted gadolinium-enhanced images (T1gad) on patient outcome. METHODS AND MATERIALS A retrospective audit was performed from established prospective databases in patients managed consecutively with radiation therapy (RT) for GBM between 2016 and 2019. Patient, tumour and treatment-related factors were assessed in relation to outcome. Volumetric data from the initial diagnostic MRI were obtained via the manual segmentation of the T1gd and T2 abnormalities. A T2/T1 ratio was calculated from these volumes. The initial relapse site was assessed on MRI in relation to the site of the original T1gad volume and surgical cavity. The major endpoints were median relapse-free survival (RFS) from the date of diagnosis and site of initial relapse (defined as either local at the initial surgical site or any distance more than 20 mm from initial T1gad abnormality). The analysis was performed for association between known prognostic factors as well as the radiological factors using log-rank tests for subgroup comparisons, with correction for multiple comparisons. RESULTS One hundred and seventy-seven patients with GBM were managed consecutively with RT between 2016 and 2019 and were eligible for the analysis. The median age was 62 years. Seventy-four percent were managed under a 60Gy (Stupp) protocol, whilst 26% were on a 40Gy (Elderly) protocol. Major neuroanatomical subsites were Lateral Temporal (18%), Anterior Temporal (13%) and Medial Frontal (10%). Median volumes on T1gd and T2 were 20 cm3 (q1-3:8-43) and 37 cm3 (q1-3: 17-70), respectively. The median T2/T1 ratio was 2.1. For the whole cohort, the median OS was 16.0 months (95%CI:14.1-18.0). One hundred and forty-eight patients have relapsed with a median RFS of 11.4 months (95%CI:10.4-12.5). A component of distant relapse was evident in 43.9% of relapses, with 23.6% isolated relapse. Better ECOG performance Status (p = 0.007), greater extent of resection (p = 0.020), MGMT methylation (p < 0.001) and RT60Gy Dose (p = 0.050) were associated with improved RFS. Although the continuous variable of initial T1gd volume (p = 0.39) and T2 volume (p = 0.23) were not associated with RFS, the lowest T2/T1 quartile (reflecting a relatively lower T2 volume compared to T1gd volume) was significantly associated with improved RFS (p = 0.016) compared with the highest quartile. The lowest T2/T1 ratio quartile was also associated with a lower risk of distant relapse (p = 0.031). CONCLUSION In patients diagnosed with GBM, the volumetric parameters of the diagnostic MRI with a ratio of T2 and T1gad abnormality may assist in the prediction of relapse-free survival and patterns of relapse. A further understanding of these relationships has the potential to impact the design of future radiation therapy target volume delineation protocols.
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Affiliation(s)
- Kin Sing Lau
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW 2250, Australia
| | - Isidoro Ruisi
- Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW 2250, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW 2250, Australia
- Genesis Care, Sydney, NSW 2015, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
- The Brain Cancer Group, Sydney, NSW 2065, Australia
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Wegener E, Horsley P, Wheeler H, Jayamanne D, Kastelan M, Guo L, Brown C, Back M. Leptomeningeal neuraxis relapse in glioblastoma is an uncommon but not rare event associated with poor outcome. BMC Neurol 2023; 23:328. [PMID: 37715122 PMCID: PMC10503008 DOI: 10.1186/s12883-023-03378-1] [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: 05/31/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Spinal neuraxis leptomeningeal metastasis (LM) relapse in glioblastoma is an uncommon event that is challenging to manage. This study aims to determine the incidence, associated factors, and outcome of LM relapse in patients with glioblastoma managed with radical intent. METHODS Patients managed for glioblastoma using the EORTC-NCIC (Stupp) Protocol from 2007 to 2019 were entered into a prospective ethics-approved database. Follow-up included routine cranial MRI surveillance with further imaging as clinically indicated. LM relapse was determined by MRI findings and/or cerebrospinal fluid analysis. The chi-square test of independence was used to evaluate clinico-pathologic factors associated with increased risk of subsequent LM relapse. Median survival post-LM relapse was calculated using Kaplan-Meier technique. RESULTS Four-hundred-and-seven patients were eligible, with median follow-up of 60 months for surviving patients. Eleven (2.7%) had LM at first relapse and in total 21 (5.1%) experienced LM in the entire follow-up period. Sites of LM relapse were 8 (38%) focal spinal, 2 (10%) focal brainstem medulla and 11 (52%) diffuse spinal. Median overall survival from initial diagnosis for the entire cohort was 17.6 months (95% CI 16.7-19.0). Median survival from LM relapse to death was 39 days (95% CI: 19-107). Factors associated with LM relapse were age less than 50 years (p < 0.01), initial disease located in the temporal lobe (p < 0.01) and tumours lacking MGMT promoter methylation (p < 0.01). CONCLUSIONS LM relapse is an uncommon but not rare event in patients managed radically for glioblastoma. It is associated with poor outcome with the majority of patients deceased within two months of recognition.
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Affiliation(s)
- Eric Wegener
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
| | - Patrick Horsley
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia.
| | - Helen Wheeler
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- The Brain Cancer group, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Dasantha Jayamanne
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Linxin Guo
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, NSW, 2065, Australia
- The Brain Cancer group, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Genesis Cancer Care, Sydney, Australia
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
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Koh ES, Gan HK, Senko C, Francis RJ, Ebert M, Lee ST, Lau E, Khasraw M, Nowak AK, Bailey DL, Moffat BA, Fitt G, Hicks RJ, Coffey R, Verhaak R, Walsh KM, Barnes EH, De Abreu Lourenco R, Rosenthal M, Adda L, Foroudi F, Lasocki A, Moore A, Thomas PA, Roach P, Back M, Leonard R, Scott AM. [ 18F]-fluoroethyl-L-tyrosine (FET) in glioblastoma (FIG) TROG 18.06 study: protocol for a prospective, multicentre PET/CT trial. BMJ Open 2023; 13:e071327. [PMID: 37541751 PMCID: PMC10407346 DOI: 10.1136/bmjopen-2022-071327] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/08/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Glioblastoma is the most common aggressive primary central nervous system cancer in adults characterised by uniformly poor survival. Despite maximal safe resection and postoperative radiotherapy with concurrent and adjuvant temozolomide-based chemotherapy, tumours inevitably recur. Imaging with O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) has the potential to impact adjuvant radiotherapy (RT) planning, distinguish between treatment-induced pseudoprogression versus tumour progression as well as prognostication. METHODS AND ANALYSIS The FET-PET in Glioblastoma (FIG) study is a prospective, multicentre, non-randomised, phase II study across 10 Australian sites and will enrol up to 210 adults aged ≥18 years with newly diagnosed glioblastoma. FET-PET will be performed at up to three time points: (1) following initial surgery and prior to commencement of chemoradiation (FET-PET1); (2) 4 weeks following concurrent chemoradiation (FET-PET2); and (3) within 14 days of suspected clinical and/or radiological progression on MRI (performed at the time of clinical suspicion of tumour recurrence) (FET-PET3). The co-primary outcomes are: (1) to investigate how FET-PET versus standard MRI impacts RT volume delineation and (2) to determine the accuracy and management impact of FET-PET in distinguishing pseudoprogression from true tumour progression. The secondary outcomes are: (1) to investigate the relationships between FET-PET parameters (including dynamic uptake, tumour to background ratio, metabolic tumour volume) and progression-free survival and overall survival; (2) to assess the change in blood and tissue biomarkers determined by serum assay when comparing FET-PET data acquired prior to chemoradiation with other prognostic markers, looking at the relationships of FET-PET versus MRI-determined site/s of progressive disease post chemotherapy treatment with MRI and FET-PET imaging; and (3) to estimate the health economic impact of incorporating FET-PET into glioblastoma management and in the assessment of post-treatment pseudoprogression or recurrence/true progression. Exploratory outcomes include the correlation of multimodal imaging, blood and tumour biomarker analyses with patterns of failure and survival. ETHICS AND DISSEMINATION The study protocol V.2.0 dated 20 November 2020 has been approved by a lead Human Research Ethics Committee (Austin Health, Victoria). Other clinical sites will provide oversight through local governance processes, including obtaining informed consent from suitable participants. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Results of the FIG study (TROG 18.06) will be disseminated via relevant scientific and consumer forums and peer-reviewed publications. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12619001735145.
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Affiliation(s)
- Eng-Siew Koh
- Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Hui K Gan
- Austin Health, Department of Medical Oncology, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Tumour Targeting Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Senko
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Tumour Targeting Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Martin Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Sze Ting Lee
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Tumour Targeting Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Eddie Lau
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Mustafa Khasraw
- Department of Neurosurgery and Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anna K Nowak
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Dale L Bailey
- Faculty of Medicine & Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Bradford A Moffat
- Melbourne Brain Centre Imaging Unit, Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Greg Fitt
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Rodney J Hicks
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Robert Coffey
- Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Roel Verhaak
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kyle M Walsh
- Department of Neurosurgery and Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Mark Rosenthal
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lucas Adda
- The Cooperative Trials Group for Neuro-Oncology (COGNO) Consumer Advisor Panel, National Health and Medical Research Council (NHMRC) Clinical Trials Centre (CTC), University of Sydney, Sydney, New South Wales, Australia
| | - Farshad Foroudi
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Department of Radiation Oncology, Austin Health, Melbourne, Victoria, Australia
| | - Arian Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisha Moore
- Trans Tasman Radiation Oncology Group (TROG), Newcastle, New South Wales, Australia
| | - Paul A Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Paul Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew M Scott
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Tumour Targeting Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
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9
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Yuile A, Satgunaseelan L, Wei JQ, Rodriguez M, Back M, Pavlakis N, Hudson A, Kastelan M, Wheeler HR, Lee A. CDKN2A/B Homozygous Deletions in Astrocytomas: A Literature Review. Curr Issues Mol Biol 2023; 45:5276-5292. [PMID: 37504251 PMCID: PMC10378679 DOI: 10.3390/cimb45070335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Genomic alterations of CDKN2A and CDKN2B in astrocytomas have been an evolving area of study for decades. Most recently, there has been considerable interest in the effect of CDKN2A and/or CDKN2B (CDKN2A/B) homozygous deletions (HD) on the prognosis of isocitrate dehydrogenase (IDH)-mutant astrocytomas. This is highlighted by the adoption of CDKN2A/B HD as an essential criterion for astrocytoma and IDH-mutant central nervous system (CNS) WHO grade 4 in the fifth edition of the World Health Organisation (WHO) Classification of Central Nervous System Tumours (2021). The CDKN2A and CDKN2B genes are located on the short arm of chromosome 9. CDKN2A encodes for two proteins, p14 and p16, and CDKN2B encodes for p15. These proteins regulate cell growth and angiogenesis. Interpreting the impact of CDKN2A/B alterations on astrocytoma prognosis is complicated by recent changes in tumour classification and a lack of uniform standards for testing CDKN2A/B. While the prognostic impact of CDKN2A/B HD is established, the role of different CDKN2A/B alterations-heterozygous deletions (HeD), point mutations, and promoter methylation-is less clear. Consequently, how these alternations should be incorporated into patient management remains controversial. To this end, we reviewed the literature on different CDKN2A/B alterations in IDH-mutant astrocytomas and their impact on diagnosis and management. We also provided a historical review of the changing impact of CDKN2A/B alterations as glioma classification has evolved over time. Through this historical context, we demonstrate that CDKN2A/B HD is an important negative prognostic marker in IDH-mutant astrocytomas; however, the historical data is challenging to interpret given changes in tumour classification over time, variation in the quality of evidence, and variations in the techniques used to identify CDKN2A/B deletions. Therefore, future prospective studies using uniform classification and detection techniques are required to improve the clinical interpretation of this molecular marker.
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Affiliation(s)
- Alexander Yuile
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
| | - Laveniya Satgunaseelan
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Joe Q Wei
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
| | - Michael Rodriguez
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
- Department of Pathology, Prince of Wales Hospital, Sydney, NSW 2065, Australia
| | - Michael Back
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
| | - Amanda Hudson
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
| | - Marina Kastelan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
| | - Helen R Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
| | - Adrian Lee
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Camperdown Campus, Sydney, NSW 2000, Australia
- The Brain Cancer Group, North Shore Private Hospital, Sydney, NSW 2065, Australia
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10
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Knight A, Horsley P, Yuile A, Yim J, Suh M, Venketesha V, Kastelan M, Wheeler H, Back M. Volumetric response and pattern of failure of histone altered high grade glioma in adults following management with radiation therapy. J Neurooncol 2023; 163:281-288. [PMID: 37184742 DOI: 10.1007/s11060-023-04332-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE H3K27M- and H3G34R-mutant gliomas are recently-classified subgroups of high-grade gliomas (HGGs) affecting younger adults. This study aimed to describe patterns of infiltration and failure, and the volumetric response of these tumours to radiotherapy. METHODS Patients with histone-mutant gliomas aged 16-50 years, managed from 2009 to 2021 were identified and clinical, radiological and histopathological characteristics collected. Tumour volume was assessed on MRI at diagnosis, pre-radiotherapy, month + 1, + 3 and + 5 post-radiation and at relapse. RESULTS Of 538 IDH1/2 wild-type HGGs, 18(15%) had a histone alteration. Eleven were H3K27M- and 7 H3G34R-mutant respectively. Median age at diagnosis was 20 years (range17-48 years). Median overall survival was 20 months (95%CI 14-29 months). Both H3K27M- and H3G34R-mutant tumours exhibited extensive T2F infiltration involving a median of 4 neuroanatomical subsites at diagnosis. Median volume of disease pre-radiotherapy on T1gd and T2F respectively was 0.5cm3 (IQR:0-1.7cm3) and 11.9 cm3 (IQR:7.5-29.6cm3) for H3K27M and 0.9cm3 (IQR:0-8.4cm3) and 43.8cm3 (IQR:25.2-86.6 cm3) for H3G34R tumours. T2F volume reduction > 50% was observed 3-months post-IMRT in 7(64%) patients with H3K27M and 1(14%) with H3G34R tumours. Fourteen patients had relapsed. Relapse was local-only, distant-only and both in 4(44%), 3(33%) and 2(22%) H3K27M-mutant and 1(20%), 2(40%), and 2(40%) H3G34R-mutant tumours. On last scan before death, leptomeningeal spread was present in 4/8(50%) and 1/5(20%) and subependymal spread in 4/8 (50%) and 0/5 H3K27M- and G34R-mutant cases respectively. CONCLUSION H3K27M-mutant gliomas are highly responsive to radiotherapy but exhibit high propensity for subsequent leptomeningeal and subependymal spread. H3G34R-mutant tumours exhibit lesser early volumetric response to radiotherapy and propensity for distant in-brain failure.
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Affiliation(s)
- A Knight
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - P Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - A Yuile
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Genesis Care, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - J Yim
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
| | - M Suh
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - V Venketesha
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Northern Sydney Local Health District Executive, St. Leonards, NSW, Australia
| | - M Kastelan
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- The Brain Cancer Group, Sydney, Australia
| | - H Wheeler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Genesis Care, Sydney, Australia
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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11
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Schuler T, King C, Matsveru T, Back M, Clark K, Chin D, Lilian R, Gallego B, Coiera E, Currow DC. Wearable-Triggered Ecological Momentary Assessments Are Feasible in People With Advanced Cancer and Their Family Caregivers: Feasibility Study from an Outpatient Palliative Care Clinic at a Cancer Center. J Palliat Med 2023. [PMID: 37134212 DOI: 10.1089/jpm.2022.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background: Emerging digital health approaches could play a role in better personalized palliative care. Aim: We conducted a feasibility study testing wearable sensor (WS)-triggered ecological momentary assessments (EMAs) and electronic patient-reported outcomes in community palliative care with patient-caregiver dyads. Design: All wore consumer-grade WS for five weeks. Sensor-detected "stress" (heart rate variability algorithm) that passed individualized thresholds triggered a short smartphone survey. Daily sleep surveys, weekly symptom surveys (Integrated Palliative care Outcome Scale), and a poststudy experience survey were conducted. Setting/Participants: Fifteen dyads (n = 30) were recruited from an outpatient palliative care clinic for people with cancer. Results: Daytime sensor wear-time had 73% adherence. Participants perceived value in this support. Quantity and severity of "stress" events were higher in patients. Sleep disturbance was similar but for different reasons: patients (physical symptoms) and caregivers (worrying about the patient). Conclusions: EMAs are feasible and valued in community palliative care.
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Affiliation(s)
- Thilo Schuler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire King
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Teresia Matsveru
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Clark
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dylan Chin
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ruth Lilian
- Sydney Partnership for Health, Education, Research and Enterprise, Sydney, New South Wales, Australia
| | - Blanca Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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12
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Blume O, Back M, Dinya E, Palkovics D, Windisch P. Efficacy and volume stability of a customized allogeneic bone block for the reconstruction of advanced alveolar ridge deficiencies at the anterior maxillary region: a retrospective radiographic evaluation. Clin Oral Investig 2023:10.1007/s00784-023-05015-0. [PMID: 37055540 DOI: 10.1007/s00784-023-05015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES The aim of this retrospective case series was to evaluate the efficacy and volume stability of a customized allogeneic bone block (CABB) for the hard tissue reconstruction of severely atrophied anterior maxillary ridges. MATERIALS AND METHODS Hard tissue alterations between baseline (T1), 2-month follow-up (T2), and 6-month follow-up (T3) cone-beam computed tomography scans were evaluated with semi-automatic segmentation. Following automatic spatial alignment of the datasets, 3D subtraction analysis was performed. The volume stability of the inserted allogeneic bone block was determined on the basis of the ratio of the T3 and T2 hard tissue volumes. RESULTS The newly formed hard tissue volume at T2 averaged at of 0.75 cm3 ± 0.57 cm3, whereas at T3, an average of 0.52 cm3 ± 0.42 cm3 volumetric hard tissue gain could be detected. The T3/T2 ratio was found to be 67.83% ± 18.72% on average. The dice similarity coefficient between the T2 and T3 hard tissue models averaged at 0.73 ± 0.15. CONCLUSIONS Cancellous CABBs are a reliable option for the reconstruction of severely atrophied alveolar ridges. The resorption rates of these grafts are similar to those found in the literature; however, with precise manufacturing and proper intraoperative flap management, the resorption rates may be reduced. CLINICAL RELEVANCE With precise knowledge of the resorption patterns, the shape of blocks can be altered in the future to compensate for the volumetric loss.
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Affiliation(s)
- Oliver Blume
- Private Practice Dres. Back & Blume, Tal 13, 80331, Munich, Germany
| | - Michael Back
- Private Practice Dres. Back & Blume, Tal 13, 80331, Munich, Germany
| | - Elek Dinya
- Institute of Digital Health Sciences, Faculty of Public Services, Semmelweis University, Ferenc sqr. 15, Budapest, 1094, Hungary
| | - Daniel Palkovics
- Department of Periodontology, Semmelweis University, Szentkirályi str. 47, Budapest, 1088, Hungary.
| | - Peter Windisch
- Department of Periodontology, Semmelweis University, Szentkirályi str. 47, Budapest, 1088, Hungary
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13
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Hammen C, Smolock A, Back M, Slowik S, Ste Marie J, Aguilar J, Puttre T, Dembny H, Unferth K, Weithaus M, Hohenwalter E. Abstract No. 526 Increasing Efficiency in Interventional Radiology: A QI Project Focused on First Case Start Times. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.384] [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: 02/27/2023] Open
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14
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Arnold MB, Back M, Crowell MD, Farooq N, Ghimire P, Obarein OA, Smart KE, Taucher T, VanderJeugdt E, Perry KI, Landis DA, Bahlai CA. Coexistence between similar invaders: The case of two cosmopolitan exotic insects. Ecology 2023; 104:e3979. [PMID: 36691998 DOI: 10.1002/ecy.3979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 01/25/2023]
Abstract
Biological invasions are usually examined in the context of their impacts on native species. However, few studies have examined the dynamics between invaders when multiple exotic species successfully coexist in a novel environment. Yet, long-term coexistence of now established exotic species has been observed in North American lady beetle communities. Exotic lady beetles Harmonia axyridis and Coccinella septempunctata were introduced for biological control in agricultural systems and have since become dominant species within these communities. In this study, we investigated coexistence via spatial and temporal niche partitioning among H. axyridis and C. septempunctata using a 31-year data set from southwestern Michigan, USA. We found evidence of long-term coexistence through a combination of small-scale environmental, habitat, and seasonal mechanisms. Across years, H. axyridis and C. septempunctata experienced patterns of cyclical dominance likely related to yearly variation in temperature and precipitation. Within years, populations of C. septempunctata peaked early in the growing season at 550 degree days, while H. axyridis populations grew in the season until 1250 degree days and continued to have high activity after this point. C. septempunctata was generally most abundant in herbaceous crops, whereas H. axyridis did not display strong habitat preferences. These findings suggest that within this region H. axyridis has broader habitat and abiotic environmental preferences, whereas C. septempunctata thrives under more specific ecological conditions. These ecological differences have contributed to the continued coexistence of these two invaders. Understanding the mechanisms that allow for the coexistence of dominant exotic species contributes to native biodiversity conservation management of invaded ecosystems.
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Affiliation(s)
- Matthew B Arnold
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | - Michael Back
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | | | - Nageen Farooq
- Department of Earth Sciences, Kent State University, Kent, Ohio, USA
| | - Prashant Ghimire
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | - Omon A Obarein
- Department of Geography, Kent State University, Kent, Ohio, USA
| | - Kyle E Smart
- Department of Earth Sciences, Kent State University, Kent, Ohio, USA
| | - Trixie Taucher
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | - Erin VanderJeugdt
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | - Kayla I Perry
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA
| | - Douglas A Landis
- Department of Entomology, and Great Lakes Bioenergy Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Christie A Bahlai
- Department of Biological Sciences, Kent State University, Kent, Ohio, USA.,Kellogg Biological Station, Michigan State University, Hickory Corners, Michigan, USA
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15
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Sim HW, Wachsmuth L, Barnes EH, Yip S, Koh ES, Hall M, Jennens R, Ashley DM, Verhaak RG, Heimberger AB, Rosenthal MA, Hovey EJ, Ellingson BM, Tognela A, Gan HK, Wheeler H, Back M, McDonald KL, Long A, Cuff K, Begbie S, Gedye C, Mislang A, Le H, Johnson MO, Kong BY, Simes JR, Lwin Z, Khasraw M. NUTMEG: A randomized phase II study of nivolumab and temozolomide versus temozolomide alone in newly diagnosed older patients with glioblastoma. Neurooncol Adv 2023; 5:vdad124. [PMID: 37841696 PMCID: PMC10576515 DOI: 10.1093/noajnl/vdad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background There is an immunologic rationale to evaluate immunotherapy in the older glioblastoma population, who have been underrepresented in prior trials. The NUTMEG study evaluated the combination of nivolumab and temozolomide in patients with glioblastoma aged 65 years and older. Methods NUTMEG was a multicenter 2:1 randomized phase II trial for patients with newly diagnosed glioblastoma aged 65 years and older. The experimental arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant nivolumab and temozolomide. The standard arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant temozolomide. The primary objective was to improve overall survival (OS) in the experimental arm. Results A total of 103 participants were randomized, with 69 in the experimental arm and 34 in the standard arm. The median (range) age was 73 (65-88) years. After 37 months of follow-up, the median OS was 11.6 months (95% CI, 9.7-13.4) in the experimental arm and 11.8 months (95% CI, 8.3-14.8) in the standard arm. For the experimental arm relative to the standard arm, the OS hazard ratio was 0.85 (95% CI, 0.54-1.33). In the experimental arm, there were three grade 3 immune-related adverse events which resolved, with no unexpected serious adverse events. Conclusions Due to insufficient evidence of benefit with nivolumab, the decision was made not to transition to a phase III trial. No new safety signals were identified with nivolumab. This complements the existing series of immunotherapy trials. Research is needed to identify biomarkers and new strategies including combinations.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
| | - Luke Wachsmuth
- The Brain Tumor Immunotherapy Program, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Eng-Siew Koh
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ross Jennens
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Epworth HealthCare Richmond, Melbourne, Victoria, Australia
| | - David M Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Roel G Verhaak
- The Jackson Laboratory for Genomic Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark A Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Elizabeth J Hovey
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, University of California Los Angeles, Los Angeles, California, USA
| | - Annette Tognela
- Department of Medical Oncology, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Hui K Gan
- Department of Medical Oncology, Austin Hospital, Melbourne, Victoria, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kerrie L McDonald
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Katharine Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stephen Begbie
- Department of Medical Oncology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Anna Mislang
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Margaret O Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Benjamin Y Kong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - John R Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- The Brain Tumor Immunotherapy Program, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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16
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Sim HW, Lwin Z, Barnes E, McDonald K, Koh ES, Rosenthal M, Foote M, Back M, Wheeler H, Buckland M, Walsh K, Fisher L, Leonard R, Hall M, Ashley D, Yip S, Simes J, Sulman E, Khasraw M. CTNI-42. GENOME-WIDE DNA METHYLATION PATTERNS IN VERTU: A RANDOMIZED PHASE II TRIAL OF VELIPARIB, RADIOTHERAPY AND TEMOZOLOMIDE IN PATIENTS WITH MGMT-UNMETHYLATED GLIOBLASTOMA. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.307] [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] Open
Abstract
Abstract
BACKGROUND
VERTU was a randomized phase II trial evaluating veliparib, a brain-penetrant PARP inhibitor, combined with radiotherapy and temozolomide, for patients with newly diagnosed MGMT-unmethylated glioblastoma. As part of planned correlative work after study completion, we assessed genome-wide DNA methylation patterns to predict methylation class, glioblastoma subtype and MGMT status.
METHODS
Patients were randomized 2:1 to experimental (60Gy/30 fractions with veliparib 200mg bid, then temozolomide 150-200mg/m2 D1-5 + veliparib 40mg bid D1-7 Q28D for 6 cycles) versus standard arm (60Gy/30 fractions with temozolomide 75mg/m2 daily, then temozolomide 150-200mg/m2 D1-5 Q28D for 6 cycles). The primary objective to improve 6-month progression-free survival (PFS-6m) was not met (doi: 10.1093/neuonc/noab111). Methylation data were generated using the Illumina Infinium Methylation EPIC bead chip array. Tumor tissues were categorized using the Heidelberg methylation-based classifier.
RESULTS
Methylation data were successfully generated for 98/125 patients (poor quality DNA [n = 12], no consent [n = 11], insufficient tissue [n = 4]). Those with classifier scores below 0.5 (n = 25), tumor microenvironment only (n = 6) and rediagnosis as pleomorphic xanthoastrocytoma (n = 1) were excluded, leaving n = 66. Methylation classes were GBM RTK II (n = 23, PFS-6m 43% [95%CI 23-62]), RTK I (n = 20, PFS-6m 50% [95%CI 27-69]), MES (n = 20, PFS-6m 40% [95%CI 19-60]), MID (n = 2) and G34 (n = 1). Glioblastoma subtypes were mesenchymal (n = 28, PFS-6m 50% [95%CI 30-66]), proneural (n = 24, PFS-6m 50% [95%CI 29-68]) and classical (n = 14, PFS-6m 36% [95%CI 13-59]). MGMT status were unmethylated (n = 58, PFS-6m 48% [95%CI 35-60]) and methylated (n = 8, PFS-6m 38% [95%CI 9-67]). There was no evidence of interaction between treatment arm and methylation class (excluding GBM MID and G34, P = 0.45), glioblastoma subtype (P = 0.68) or MGMT status (P = 0.52).
CONCLUSIONS
Genome-wide DNA methylation patterns in VERTU identified a spectrum of methylation-defined subgroups, reflecting tumoral heterogeneity. This may have utility for future clinical trials and practice. The effect of veliparib in VERTU appeared to be consistent across subgroups. ACTRN12615000407594.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | - Eng-Siew Koh
- Liverpool Hospital & South Western Sydney Clinical Campus, University of New South Wales , Sydney, New South Wales , Australia
| | | | | | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | | | | | - Kyle Walsh
- Duke University Medical Center , Durham , USA
| | - Lauren Fisher
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Erik Sulman
- NYU Grossman School of Medicine, Department of Radiation Oncology , New York, NY , USA
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
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17
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Yuile A, Satgunaseelan L, Alexander KL, Thavaneswaran S, Krasovitsky M, Buckland M, Lee M, Wei G, Kastelan M, Wong M, Wilson I, Bayly A, Varikat W, Sim HW, Kong B, Lwin Z, Turner C, Back M, Miller S, Lee A, Wheeler H. CSIG-13. CLINICAL IMPACT OF CDKN2A/B DELETIONS IN IDH-MUTANT ASTROCYTOMAS. Neuro Oncol 2022. [PMCID: PMC9660930 DOI: 10.1093/neuonc/noac209.162] [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] Open
Abstract
Abstract
BACKGROUND
IDH-mutant astrocytomas with CDKN2A/B homozygous deletions (HD) are now categorized as grade 4 astrocytomas. It is unclear how these HD astrocytomas should be treated. We aimed to compare 3-year outcomes for HD versus heterozygous deleted (HeD) IDH-mutant astrocytomas, describe the prognostic impact of deletions relative to histologic grade and describe differences in outcomes based on treatment regimen.
METHODS
Molecular and clinical data concerning IDH-mutant glioma patients +/-CDKN2A/B deletions were retrieved across four neuro-oncology centers and two tumor banks from 01/2016-07/2021.
RESULTS
48 patients with HD or HeD were identified. Median follow-up time was 4.0 years, median age 33 (range 20-74) years. Sixteen astrocytomas were histologic grade 4, remainder were grade 2 (n= 9) and grade 3 (n= 23). HD were detected in 16 patients. Survival data were unavailable in n= 1 HD and n= 2 HeD patients. 3-year OS for CDKN2A/B HD and HeD groups were 47% versus 67% (log-rank p= 0.004). For grades 2, 3 and 4, 3-year OS for HD were 100% (n= 1), 57% (n= 7) and 29% (n= 7) respectively, 3-year OS for HeD were 100% (n= 7), 56% (n= 16) and 57% (n= 7) respectively. In HD patients, six were treated with concurrent temozolomide-radiotherapy (3-year OS 50%) and five with radiotherapy and sequential temozolomide only (3-year OS 80%, log-rank p= 0.38). Treatment data were unavailable in two patients and three were treated with “other” regimens. Sequential regimens were preferentially used in histologic grade 2 and 3 cases.
CONCLUSION
Preliminary data are in keeping with current literature and are one of the first to describe outcomes based on clinical regimen. There was insufficient evidence of OS differences between concurrent and sequential therapy, though conclusions are limited by sample size and data maturity. Additional follow-up data are required to further define optimal treatment for these patients.
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Affiliation(s)
| | - Laveniya Satgunaseelan
- Department of Neuropathology, Royal Prince Alfred Hospital , Sydney, NSW
- Australia Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney , Sydney, NSW , Australia
| | | | | | | | | | - Maggie Lee
- Royal Prince Alfred Hospital , Sydney , Australia
| | - Grace Wei
- Royal Prince Alfred Hospital , Sydney , Australia
| | | | - Mark Wong
- Westmead Hospital , Sydney , Australia
| | | | | | | | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Ben Kong
- Royal North Shore Hospital , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Cassie Turner
- Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Samuel Miller
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Adrian Lee
- Royal North Shore Hospital , Sydney , Australia
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18
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Brighi C, Waddington D, Keall P, Booth J, O'Brien K, Parkinson J, Yim J, Bailey D, Back M, Drummond J. NIMG-70. MAGNETIC RESONANCE HYPOXIA IMAGING FOR RADIATION TREATMENT GUIDANCE IN GLIOBLASTOMA MULTIFORME - A DIAGNOSTIC/PROGNOSTIC CLINICAL IMAGING STUDY. Neuro Oncol 2022. [PMCID: PMC9660750 DOI: 10.1093/neuonc/noac209.688] [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] Open
Abstract
Abstract
Local recurrence in glioblastoma (GBM) patients is caused by the ability of tumour cells to develop treatment resistance mechanisms. Hypoxia, which is present in subregions of GBM tumours, is the leading cause of resistance to radiotherapy and is associated with worse clinical outcomes in GBM. Current standard of care treatment does not account for tumour hypoxia. The ability to image tumour hypoxia at various stages of treatment offers opportunities to personalise and improve treatment for GBM patients. Preoperative imaging of tumour hypoxia offers the opportunity for supramarginal resections in surgical planning beyond current neurosurgical standard of care guidelines. Imaging hypoxia prior to radiotherapy enables selective dose escalation strategies to radioresistant tumour regions, increasing the likelihood of local control. Identifying hypoxic tumour regions harbouring progression at follow up is key to intervening at an early stage of tumour recurrence and personalising therapy tailored to the tumour response to treatment. Imaging of tumour hypoxia in routine clinical practice is challenging, as it requires 18FMISO PET, which is not available in most clinical centres. In this clinical imaging study, we aim to investigate the role of oxygen enhanced (OE) and blood-oxygen level dependent (BOLD) MRI as imaging biomarkers of hypoxia in GBM. Aiming to recruit 20 GBM patients, this study involves the addition of OE/BOLD MRI and 18FMISO PET imaging at several timepoints during the course of treatment. The primary objective is to investigate the ability of OE/BOLD MRI to map tumour hypoxia on preoperative scans using 18FMISO PET as the ground truth. Secondary objectives include evaluating the role of hypoxia imaging biomarkers for dose-painting radiotherapy planning and treatment response assessment in GBM. Overall, by validating the role of MRI biomarkers of hypoxia we ought to provide a non-invasive and more accessible means to more effective, personalised treatment to GBM patients.
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Affiliation(s)
- Caterina Brighi
- ACRF Image X Institute, Sydney School of Health Sciences, The University of Sydney & Ingham Institute for Applied Medical Research, Sydney , Australia
| | | | - Paul Keall
- The University of Sydney , Sydney, New South Wales , Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Kieran O'Brien
- Siemens Healthcare Pty Ltd, Brisbane , Queensland , Australia
| | | | - Jackie Yim
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Dale Bailey
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - James Drummond
- Northern Sydney Cancer Centre, Royal North Shore Hospital , Sydney, New South Wales , Australia
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19
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Back M, Horsley P, Yim J, Drummond J. RADT-25. UNDERSTANDING PATTERNS OF TUMOUR INFILTRATION IN PATIENTS WITH MULTIFOCAL GLIOBLASTOMA AND IMPACT ON SURVIVAL OUTCOMES. Neuro Oncol 2022. [PMCID: PMC9660809 DOI: 10.1093/neuonc/noac209.215] [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] Open
Abstract
Abstract
BACKGROUND
Multifocal glioblastoma(MF-G) are often clustered with presumed uniform worse prognosis. This study explores varying patterns of infiltration of MF-G in relation to radiological features, including presence of contiguous MRI T2-weighted abnormalities and adjacent neural tract pathway involvement.
METHODS
Consecutive patients with glioblastoma from 2016-2020 managed under EORTC-NCI(Stupp60Gy) Protocol had manual tumour segmentation on T1gd and T2w sequences. Multifocal disease was defined as T1gd or solid T2w-abnormality a minimum of 10mm from the dominant lesion. Number of foci, maximum dimension, cortical/white matter site and distance from dominant lesion were recorded. Presence of contiguous T2w-abnormality was recorded, and correlated to ten major neural tract pathways. Progression-free(PFS) and overall survival(OS) were analysed.
RESULTS
Forty of 177 patients(23%) were identified with MF-G. These had less near-total resection(p = 0.001), but no difference in ECOG(p = 0.16), or MGMT-methylation(p=0.23). Foci had median size of 14.5mm (q1-3: 10-20); 73% enhancing and 58% solitary. Median distance from dominant lesion was 23mm (q1-3:15-25). Contiguous T2w abnormality and involvement of identified neural tract was evident in 78% and 83% respectively. The multifocal lesion was based in cortex in 33%, and white matter in 67%. Survival outcomes were worse with MF-G: OS (p < 0.01) was 16.0 months (95%CI: 13.6-18.4) versus 19.9 months (95%CI: 17.6-22.2); and PFS (p = 0.01) was 10.8 months (95%CI: 9.9-11.7) versus 13.6 months (95%CI: 11.1-16.1). Improved PFS was associated with larger lesion size(p = 0.04), and cortical lesions(0.04). Those MF-G with contiguous T2w-abnormality(p = 0.06); identified neural tract(p = 0.07) or enhancement(p = 0.08) had trend to worse PFS. MGMT(p = 0.10), ECOG(p = 0.62) and extent of resection(p = 0.07) were not associated with PFS, nor radiological factors of foci number(p = 0.19) and lesion distance(p = 0.16).
CONCLUSIONS
Radiological pattern of infiltration in MF-G is associated with different natural history. Improved PFS was associated with cortical foci without contiguous T2 abnormality or tract involvement. Recognising infiltration patterns may impact on RT target volume delineation and understanding prognosis.
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Affiliation(s)
- Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Patrick Horsley
- Northern Sydney Cancer Centre , Sydney, New South Wales , Australia
| | - Jackie Yim
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - James Drummond
- Northern Sydney Cancer Centre, Royal North Shore Hospital , Sydney, New South Wales , Australia
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20
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Sim HW, Lwin Z, Barnes E, McDonald K, Yip S, Verhaak R, Heimberger A, Hall M, Wong M, Jennens R, Ashley D, Rosenthal M, Hovey E, Ellingson B, Tognela A, Gan H, Back M, Koh ES, Long A, Cuff K, Begbie S, Gedye C, Mislang A, Le H, Johnson M, Kong B, Simes J, Khasraw M. CTIM-24. NUTMEG: A RANDOMIZED PHASE II STUDY OF NIVOLUMAB AND TEMOZOLOMIDE VERSUS TEMOZOLOMIDE ALONE IN NEWLY DIAGNOSED ELDERLY PATIENTS WITH GLIOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9660679 DOI: 10.1093/neuonc/noac209.256] [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] Open
Abstract
Abstract
BACKGROUND
Nivolumab is a PD-1 inhibitor with known safety profile. An increase in mutations as we age is well documented in glioblastoma and other cancers. Higher mutational load is associated with increased response to nivolumab in extracranial malignancies. NUTMEG examined the activity of nivolumab added to temozolomide in glioblastoma patients aged ≥ 65 years.
METHODS
NUTMEG was an international multicenter phase II trial for newly diagnosed glioblastoma patients aged ≥ 65 years, randomized 2:1 to experimental (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide 150-200mg/m2 D1-5 Q28D + nivolumab 240mg D1,15 Q28D C1-4 and 480mg D1 Q28D C5-6) versus standard arm (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide alone 150-200mg/m2 D1-5 Q28D), stratified by age, ECOG status, MGMT status and resection extent.
RESULTS
103 patients were enrolled (69 in experimental arm, 34 in standard arm). Median age was 73 years, 36% ECOG 0, 57% MGMT-unmethylated and 51% gross macroscopic resection. Median follow-up is 31 months to date, with 77 deaths (surviving patients to continue follow-up and final results will be presented). Median overall survival was 11.8 months in the experimental arm versus 12.0 months in the standard arm (HR 0.95 95%CI 0.59-1.53 for experimental relative to control). Six-month progression-free survival rate using mRANO was 64% in the experimental arm versus 49% in the standard arm (HR 0.81 95%CI 0.51-1.26). Grade 3/4 adverse events were reported in 46% of experimental arm (7% lung infection, 7% thromboembolic events, 6% fatigue, 6% muscle weakness) and in 29% of control arm (9% fatigue, 6% seizure, 6% thromboembolic events).
CONCLUSIONS
There was insufficient evidence of clinical benefit with nivolumab in this population. No new safety signals were identified. Central imaging review is underway and correlative studies will characterize the immune landscape, including mutational load, neoantigen and other immune markers. NCT04195139.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | | | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | | | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | | | | | | | | | - Hui Gan
- Olivia Newton John Cancer Research Institute , Melbourne , Australia
| | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Eng-Siew Koh
- Liverpool Hospital & South Western Sydney Clinical Campus, University of New South Wales , Sydney, New South Wales , Australia
| | - Anne Long
- Sir Charles Gairdner Hospital , Perth , Australia
| | | | | | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Hospital , Waratah, NSW , Australia
| | | | - Hien Le
- Royal Adelaide Hospital , Adelaide , Australia
| | - Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
| | - Benjamin Kong
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
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21
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Vavilis G, Back M, Barany P, Ruck A, Szummer K. Prognosis after aortic valve replacement in dialysis patients: results from the Swedish Renal Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The choice of aortic valve prosthesis in aortic stenosis patients is based on patient preference, preoperative age, life expectancy, need for anticoagulant therapy and valve durability. Major uncertainties remain regarding optimal prosthetic valve choice in dialysis patients.
Objectives
The aim of the study was to compare the clinical outcomes after aortic valve replacement with mechanical (MAV) or bioprosthetic valves (BAV) in dialysis patients.
Methods
We used the observational, prospective, multicenter cohort from the Swedish Renal Registry, which includes all dialysis patients in Sweden. The study included 294 dialysis patients with aortic stenosis who underwent aortic valve replacement with MAV or BAV (obtained from surgical procedure codes) between 2005 and 2018, either before (n=155) or after dialysis start (n=139). Comorbidities and net adverse clinical events (bleeding events, stroke and reoperation) were obtained from national registries and defined by International Classification of Diseases codes (ICD-10). The incidence rate (IR) of primary endpoint comprised of all-cause death, bleeding events, stroke and aortic valve reoperation, as well as only all-cause death rates between recipients of MAV or BAV were estimated with Kaplan – Meier curves.
Results
The median age was 72 years (interquartile range [IQR]: 63.9, 77.3), 77% were males and 60% received mechanical valves. During a median follow-up of 1.49 years (IQR: 0.66–2.83), the primary endpoint occurred in 202 patients. Compared to BAV-recipients, those who received MAV had comparable IR of the primary end-point (40.1/100 person-years; [95% Confidence Interval (CI): 33.7–47.7], vs 36.2/100 person-years; [95% CI: 28.9–45.4], P=0.322) (Figure 1).
Mortality rate at 1-year of follow-up was 28.9% without difference between recipients of MAV or BAV (68.8% in MAV-group and 57.6% with BAV; mortality rate MAV 33.3/100 person-year; (95% CI: 27.9–39.8) vs BAV 27.3/100 person-year; (95% CI: 21.5–34.6), P=0. 183)), (Figure 2). Additional statistical analysis of the secondary endpoint based on the occurrence of aortic valve intervention before or after dialysis start, was consistent with the main results.
Conclusion
There is no difference in mortality and complication rates in dialysis patients who underwent aortic valve replacement with MAV or BAV.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Vavilis
- Department of Medicine, Huddinge, Karolinska Institutet, Theme Heart and Vessels, Division of Coronary and Valvular Diseases; Karolinska University Hospital , Stockholm , Sweden
| | - M Back
- Karolinska University Hospital, Theme Heart and Vessels, Division of Coronary and Valvular Heart Disease, , Stockholm , Sweden
| | - P Barany
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm , Sweden
| | - A Ruck
- Karolinska University Hospital, Theme Heart and Vessels, Division of Coronary and Valvular Heart Disease, , Stockholm , Sweden
| | - K Szummer
- Department of Medicine, Huddinge, Karolinska Institutet, Theme Heart and Vessels, Division of Coronary and Valvular Diseases; Karolinska University Hospital , Stockholm , Sweden
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22
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Schuler T, Currow D, Clark K, Back M. Letter to the Editor: Sleep Disturbances in People with Advanced Cancer and Their Informal Caregivers: A Digital Health Exploration. J Palliat Med 2022; 25:850-851. [PMID: 35647641 DOI: 10.1089/jpm.2022.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thilo Schuler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Katherine Clark
- NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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23
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Gupta H, Dybul S, Back M, Eklund J, Smolock A, White S. Abstract No. 512 Cost analysis of embolic devices in common interventional radiology procedures. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.494] [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] Open
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24
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Yuile AK, Kastelan M, Lee APS, Back M, Drummond J, Wheeler HR. The use of Sonidegib in the adjuvant and advanced phases of Sonic Hedge Hog Mutant Medulloblastomas. Oxf Med Case Reports 2022; 2022:omac019. [PMID: 35316996 PMCID: PMC8931813 DOI: 10.1093/omcr/omac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Medulloblastomas are rare embryonal primary brain tumours originating in the cerebellum. Most medulloblastomas arising in adults are associated with mutations in the Sonic Hedge Hog (SHH) pathway. Patient 1 was prescribed Sonidegib for recurrent metastatic SHH mutated medulloblastoma multiple lines of treatment. His leptomeningeal disease responded after 3 months of therapy. The drug was continued for a further 3 months until progressive central nervous system (CNS) and leptomeningeal disease arose. Progression free survival (PFS) from initiation of Sonidegib of 3 months was observed (overall survival 8.8 years). Patient 2 presented with un-resectable SHH mutated meduloblastoma with high risk of relapse who received 14 months of adjuvant Sonidegib. Following biopsy she was treated with chemotherapy and cranio-spinal radiotherapy, followed by 14 months of adjuvant Sonigedib. She remains free of disease over 51 months later. Both clinical scenarios are poorly described in the literature or evaluated in clinical trials with Sonidegib.
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Affiliation(s)
- Alexander K Yuile
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Marina Kastelan
- The Brain Cancer Group, North Shore Private Hospital, Sydney 2065, Australia
| | - Adrian PS Lee
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Michael Back
- Radiation Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - James Drummond
- Radiology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Helen R Wheeler
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
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25
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Metz G, Jayamanne D, Wheeler H, Wong M, Cook R, Little N, Parkinson J, Kastelan M, Brown C, Back M. Large tumour volume reduction of IDH-mutated anaplastic glioma involving the insular region following radiotherapy. BMC Neurol 2022; 22:24. [PMID: 35027006 PMCID: PMC8756697 DOI: 10.1186/s12883-021-02548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background The impact of near-total resection of IDH-mutated anaplastic glioma (IDHmutAG) is well-established but there remains uncertainty of benefit in tumours of the insular cortex where the extent of safe resection may be limited. This study aimed to assess tumour volume reduction in patients following IMRT and impact of residual post-surgical volume. Methods and materials Patients with IDHmutAG involving insular cortex managed with IMRT from 2008 to 2019 had baseline patient, tumour and treatment factors recorded. Volumetric assessment of residual disease on MRI was performed at baseline, month+ 3 and month+ 12 post-IMRT. Potential prognostic factors were analysed for tumour reduction and relapse-free survival, and assessed by log-rank and Cox regression analyses. Results Thirty two patients with IDHmutAG of the insular cortex were managed with median follow-up post-IMRT of 67.2 months. Pathology was anaplastic astrocytoma (AAmut) in 20, and anaplastic oligodendroglioma (AOD) in 12 patients. Median pre-IMRT volume on T1 and T2Flair was 24.3cm3 and 52.2cm3. Twenty-seven patients were alive with 5-year relapse-free survival of 80%. There was a median 67 and 64% reduction from baseline occurring at 3 months post-IMRT for T1 and T2Flair respectively; and subsequent median 78 and 73% at 12 months. At 12 months AOD patients had median 83% T1 volume reduction compared to 63% in AAmut (p < 0.01). There was no difference on T2Flair volume (p = 0.64). No other pathological factors influenced volume reduction at 12 months. No factors were associated with relapse-free survival including baseline T1 (p = 0.52) and T2Flair (p = 0.93) volume. Conclusion IMRT provides large tumour volume reduction in IDHmutAG of the insular cortex. While maximal safe debulking remains standard of care when feasible, this patient cohort reported no significant negative impact of residual disease volume on relapse-free survival.
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Affiliation(s)
- Gabrielle Metz
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
| | - Dasantha Jayamanne
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Genesis Cancer Care, Sydney, Australia
| | - Helen Wheeler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Matthew Wong
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Raymond Cook
- The Brain Cancer Group, Sydney, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Nicholas Little
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Jonathon Parkinson
- The Brain Cancer Group, Sydney, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Marina Kastelan
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Chris Brown
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Genesis Cancer Care, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
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Schuler T, Wong S, Bergamin S, Hruby G, Back M, Roderick S, Eade T. In Regard to Roos et al. al. "?>. Int J Radiat Oncol Biol Phys 2022; 112:260-261. [PMID: 34919874 DOI: 10.1016/j.ijrobp.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Thilo Schuler
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney, Australia; Australian Institute of Health Innovation, Macquarie University, North Ryde, Sydney, Australia
| | - Shelley Wong
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Sarah Bergamin
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - George Hruby
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Michael Back
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Stephanie Roderick
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Thomas Eade
- Radiation Oncology Unit, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, Australia; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, Australia
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27
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O’Toole J, Picton M, Perez M, Back M, Jayamanne D, Le A, Wu K, Brown C, Atyeo J. Improving efficiency in the radiation management of multiple brain metastases using a knowledge-based planning solution for single-isocentre volumetric modulated arc therapy (VMAT) technique. J Med Radiat Sci 2021; 68:364-370. [PMID: 34310846 PMCID: PMC8655885 DOI: 10.1002/jmrs.526] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION This study aimed to develop a single-isocentre volumetric modulated arc therapy (si-VMAT) technique for multiple brain metastases using knowledge-based planning software, comparing it with a multiple-isocentre stereotactic radiosurgery (mi-SRS) planning approach. METHODS Twenty-six si-VMAT plans were created and uploaded into RapidPlanTM (RP) to create a si-VMAT model. Ten patients, with 2 to 6 metastases (mets), were planned with a si-VMAT technique utilising RP, and a mi-SRS technique on Brainlab iPlan. Paddick Conformity Index (PCI) was used to compare conformity. The volumes of the brain receiving 15Gy, 12Gy, 10Gy, 7.5Gy and 3Gy were also compared. Retrospective treatment times from the last eight patients treated were averaged for pre-imaging and beam on time to calculate treatment times for both techniques. RESULTS There was a significant difference in the PCI scores for the mi-SRS plans (M = 0.667, SD = 0.114) and si-VMAT plans (M = 0.728, SD = 0.088), with PCI values suggesting better prescription dose conformity with the si-VMAT technique (P = 0.014). Percentage of total brain volume receiving low-dose wash at four of the five different dose levels was significantly less (P < 0.05) with mi-SRS. Average time to treat a single met with current mi-SRS technique is 25.7 min, with each additional met requiring this same amount of time. The average time to treat 2-3 mets using si-VMAT would be 25.3 min and 4+ metastases 33.5 min. CONCLUSION A knowledge-based si-VMAT approach was efficient in planning and treating multi metastases while achieving clinically acceptable dosimetry with respect to dose conformity and low-dose fall off.
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Affiliation(s)
- James O’Toole
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- Genesis CareSydneyNew South WalesAustralia
| | - Maddison Picton
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- Genesis CareSydneyNew South WalesAustralia
| | - Mario Perez
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Michael Back
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- Genesis CareSydneyNew South WalesAustralia
- The Brain Cancer GroupNorth Shore Private HospitalSydneyNew South WalesAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Dasantha Jayamanne
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- Genesis CareSydneyNew South WalesAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Andrew Le
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Kenny Wu
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Chris Brown
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- National Health and Medical Research CouncilClinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
| | - John Atyeo
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
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28
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Koh ES, Francis RJ, Ebert M, Gan H, Lee ST, Lau E, Moore A, Grose A, Rossi A, Ng SP, Yap J, Ly T, Lin P, Pinkham MB, Ngai S, Yu C, Gorayski P, Le H, Kirkwood ID, Vallat W, Syed F, Krishna D, Khan S, Gill S, Thomas E, Back M, Barnes EH, Moffat BA, Scott F, Adda L, Foroudi F, Lourenco RDA, Nowak AK, Bailey DL, Scott AM. NIMG-49. A PROSPECTIVE, MULTI-CENTRE TRIAL OF FET-PET IN GLIOBLASTOMA PATIENTS - THE TROG 18.06 FIG STUDY: KEY ASPECTS OF IMAGING AND RADIATION ONCOLOGY CREDENTIALING. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.547] [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: 11/14/2022] Open
Abstract
Abstract
The FIG study is a prospective non-randomised study now recruiting up to 210 newly diagnosed GBM participants across ten Australian sites. Study outcomes will address the role of [18F] fluoroethyl-L-tyrosine positron emission tomography (FET-PET) in radiotherapy (RT) planning, evaluation of post-treatment changes versus disease progression and prognostication. We describe here the methodology and preliminary outcomes for site credentialing. Eligible participants with GBM undergo FET-PET imaging at three time-points: FET-PET1-post-operative pre-chemo-RT, FET-PET2 acquired one month post-chemo-RT and FET-PET3 (+/-FDG-PET) triggered when clinical and/or radiological (MRI) progression is suspected. Dynamic and static FET-PET images are analysed qualitatively and quantitatively. Radiotherapy is as per standard care with the treating Radiation Oncologist (RO) blinded to FET-PET1. Site nuclear medicine (NM) physicians are required to delineate a biological target volume (BTV) based on FET-PET1 with hybrid RT volumes derived post-hoc. Pre-trial NM quality assurance comprises certification from the Australasian Radiopharmaceutical Trials Network encompassing FET-PET radiochemistry Quality Control and PET camera calibration. Site and central integrated workflows incorporating multi-modality image registration, target volume/region of interest contouring and analysis have been developed. NM benchmarking involves delineation of FET-PET BTVs in 3 cases with another 3 cases addressing response criteria interpretation harmonized across FET-PET, FDG-PET and MRI. Site ROs complete 3 cases involving standard and hybrid target volume delineation based on pre-derived FET-PET volumes. All NM and RO credentialing cases undergo central expert review. To date, of six sites which have submitted full credentialing data, 19/21 RO and 6/6 planning cases were passed. Of 72 NM cases, 18/72 (25%) required resubmission, primarily related to ensuring standardisation of background regions and time activity curve interpretation. The FIG study will be pivotal in establishing the role of FET-PET in GBM management. The robust NM and RO credentialing program will build capacity and expertise in FET-PET production, acquisition and image interpretation.
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Affiliation(s)
- Eng-Siew Koh
- Liverpool Hospital, Sydney, Liverpool, NSW, Australia
| | - Roslyn J Francis
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Martin Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
| | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
| | - Sze Ting Lee
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
| | - Eddie Lau
- Dept. of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
| | - Alisha Moore
- Trans Tasman Radiation Oncology Group (TROG Cancer Research), Newcastle, NSW, Australia
| | - Andrew Grose
- Trans Tasman Radiation Oncology Group (TROG Cancer Research), Newcastle, NSW, Australia
| | - Alana Rossi
- Trans Tasman Radiation Oncology Group (TROG Cancer Research), Newcastle, NSW, Australia
| | - Sweet Ping Ng
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
| | - June Yap
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, Sydney, NSW, Australia
| | - Tam Ly
- Department of Nuclear Medicine and PET, Liverpool, NSW, Australia
| | - Peter Lin
- Department of Nuclear Medicine and PET, Liverpool, NSW, Australia
| | | | - Stanley Ngai
- Department of Radiology, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Christopher Yu
- Department of Radiology, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ian D Kirkwood
- Department of Nuclear Medicine, Royal Adelaide Hospital, SA Medical Imaging, Adelaide, SA, Australia
| | - Wilson Vallat
- Department of Nuclear Medicine, Royal Adelaide Hospital, SA Medical Imaging, Adelaide, SA, Australia
| | - Farhan Syed
- Canberra Region Cancer Centre, Canberra Health Services, Woden, Canberra, ACT, Australia
| | - Dayanethee Krishna
- Medical Imaging Department, Canberra Hospital, Canberra Health Services, Woden, Canberra, ACT, Australia
| | - Shahroz Khan
- Medical Imaging Department, Canberra Hospital, Canberra Health Services, Woden, Canberra, ACT, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Perth, WA, Australia
| | - Elizabeth Thomas
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Perth, WA, Australia
| | - Michael Back
- Royal North Shore Hospital, St Leonards, NSW, Sydney, New South Wales, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bradford A Moffat
- National Imaging Fellow, MBCIU, Department of Radiology, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Scott
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
| | | | - Farshad Foroudi
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Dale L Bailey
- Royal North Shore Hospital, St Leonards, NSW, Sydney, New South Wales, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
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Plunde O, Sarajlic P, Franco-Cereceda A, Back M. Atherosclerosis associated pathways are upregulated in stenotic aortic valves from patients with severe concomitant coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aortic valve stenosis (AVS) share pathobiology and risk factors with atherosclerosis. However, medical treatment effective against atherosclerosis lack ability to halt the progression of AVS. The aims of this study were to (i) determine the prevalence of coronary artery disease (CAD) in surgical AVS patients and (ii) to establish predictors of CAD in AVS patients and (iii) to identify differential aortic valve transcriptomic profiles depending on concomitant CAD.
The study cohort consisted of 256 consecutive AVS patients with surgically verified tricuspid aortic valves, of which 74 aortic valves were collected. CAD defined as coronary artery stenosis requiring concomitant bypass surgery or previous acute coronary syndrome or percutaneous coronary intervention Transcriptomic data were obtained from microarray analysis of tissues from three different stages of AVS process (healthy, intermediate, and calcified tissue). All comparisons were sex and tissue adjusted. Non-coding probes were removed and a variance filter was applied prior to analysis which yielded 5121 genes.
The prevalence of CAD in AVS was 49%. A logistic regression model revealed male sex, claudication, diabetes and current smoking as significant predictors of CAD when age, sex, peak transaortic velocity, hsCRP, eGFR and BMI were held constant.
28 genes were significantly (q<0.05) differentially expressed when aortic valves from patients with (n=43) and without (n=31) CAD were compared. A comparison of patients with concomitant multi vessel disease (2–3 affected vessel territories, n=20) and patients without CAD or single vessel disease (n=54) revealed 189 significantly expressed genes and an optimal visual separation on heatmap (Figure 2). Active-subnetwork-oriented-enrichment analysis identified upregulated aortic valve atherosclerosis associated pathways in multi vessel disease patients related to reactive oxygen species and cytokine signaling.
This study provides a novel observation of differential aortic valve gene expression profile depending on concomitant severe CAD. The results revealed that patients with concomitant severe CAD exhibited underlying atherosclerosis-related mechanisms to their aortic valve disease. Therefore, future precision medicine against AVS may be facilitated by assessing concomitant CAD.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Karolinska Institute - Clinical Science Training ProgrammeSwedish Heart Lung Foundation Predictors of concomitant CADDEGs in AVs stratified on severe CAD
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Affiliation(s)
- O Plunde
- Karolinska Institute, Unit of Cardiovascular Medicine, Department of Medicine, Stockholm, Sweden
| | - P Sarajlic
- Karolinska Institute, Unit of Cardiovascular Medicine, Department of Medicine, Stockholm, Sweden
| | - A Franco-Cereceda
- Karolinska University Hospital, Theme Heart and Vessels, Devision of Valvular and Coronary Disease, Stockholm, Sweden
| | - M Back
- Karolinska University Hospital, Theme Heart and Vessels, Devision of Valvular and Coronary Disease, Stockholm, Sweden
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30
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Ogmundsdottir Michelsen H, Henriksson P, Wallert J, Back M, Sjolin I, Schlyter M, Hagstrom E, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman MJ, Leosdottir M. Organizational and patient-level predictors for reaching key risk factor targets in cardiac rehabilitation after myocardial infarction – the perfect-CR study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2538] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The benefits of specific cardiac rehabilitation (CR) programme components on patient outcomes after myocardial infarction (MI) remain unclear, as does their relative predictive strength compared to patient-level predictors.
Purpose
To identify CR organizational and patient-level predictors for reaching risk factor targets at one-year post-MI.
Methods
This was an observational survey- and registry-based study. Data on CR organization at all 78 CR centres in Sweden was collected in 2016 and merged with individual patient data from nationwide registries (n=7549, median age 64 years, 24% females). Cross-validation resampled orthogonal partial least squares discriminant analysis identified predictors for reaching treatment targets for low-density lipoprotein-cholesterol (LDL-C<1.8 mmol/L), blood pressure (BP<140/90 mmHg) and smoking abstinence (yes/no). Predictors with Variables of Importance for the Projection (VIP) value >0.8 and 95% confidence intervals (CI) excluding zero, were considered meaningful.
Results
Of the 71 analysed organizational variables, 36 were identified as meaningful predictors for reaching LDL-C and 35 for BP targets (Figure 1). The strongest predictors (VIP [95% CI]) for LDL-C and BP were: offering psychosocial management at initial CR assessment 2.09 [1.70–2.49]; 2.34 [1.90–2.78], having a CR team psychologist 1.59 [1.28–1.91]; 2.00 [1.46–2.55], having extended CR centre opening hours 2.17 [1.95–2.40]; 1.51 [1.03–2.00], staff reporting satisfaction with CR centre facilities 1.55 [1.07–2.04]; 1.96 [1.64–2.28], having a medical director 1.71 [1.45–1.97]; 1.47 [1.07–1.87], nurses using protocols for antihypertensive and/or lipid lowering medication adjustment 1.58 [1.35–1.81]; 1.56 [1.03–2.08], having operational team meetings 1.36 [1.08–1.64]; 1.34 [0.99–1.70], and using audit data for quality improvement 1.00 [0.79–1.20]; 1.27 [0.99–1.56]. Offering pre-exercise-based CR (exCR) assessment and different modes of exCR were predictors for reaching both targets. The strongest patient-level predictor of reaching LDL-C target was low baseline LDL-C 3.90 [3.25–4.56], and for BP it was having no history of hypertension 2.93 [2.74–3.12]. Second, participation in exCR was the strongest predictor for both outcomes 1.60 [0.83–2.37]; 1.50 [1.15–1.86]. For smoking abstinence, 5 organizational variables were identified as meaningful predictors, the strongest being prescription of varenicline by the centre physicians 1.98 [0.13–3.84] (Figure 2). The strongest patient-level predictors were exCR participation 2.51 [2.24–2.79] and socioeconomic status variables e.g., income 1.67 [1.28–2.06], living with partner 1.47 [0.84–2.09] and education 0.80 [0.48–1.12].
Conclusion
The study identified multiple CR organizational and patient-level predictors for reaching key risk factor targets one-year post-MI. The results might contribute to defining the optimal composition of comprehensive CR programmes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) The Swedish Research Council for Health, Working Life and Welfare (FORTE)2) The Swedish Heart and Lung Foundation (Hjärt Lung Fonden)
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Affiliation(s)
| | - P Henriksson
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - J Wallert
- Karolinska Institute, Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
| | - M Back
- Sahlgrenska University Hospital, Department of Occupational therapy and Physiotherapy, Gothenburg, Sweden
| | - I Sjolin
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - M Schlyter
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - A Kiessling
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - E Hag
- Ryhov County Hospital, Department of Internal Medicine, Jonkoping, Sweden
| | - L Nilsson
- Linkoping University, Department of Health Medicine and Caring Sciences, Linkoping, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M J Zaman
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - M Leosdottir
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
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31
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Oh B, Boyle F, Pavlakis N, Clarke S, Guminski A, Eade T, Lamoury G, Carroll S, Morgia M, Kneebone A, Hruby G, Stevens M, Liu W, Corless B, Molloy M, Libermann T, Rosenthal D, Back M. Emerging Evidence of the Gut Microbiome in Chemotherapy: A Clinical Review. Front Oncol 2021; 11:706331. [PMID: 34604043 PMCID: PMC8481611 DOI: 10.3389/fonc.2021.706331] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/25/2021] [Indexed: 01/28/2023] Open
Abstract
Increasing evidence suggests that the gut microbiome is associated with both cancer chemotherapy (CTX) outcomes and adverse events (AEs). This review examines the relationship between the gut microbiome and CTX as well as the impact of CTX on the gut microbiome. A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for "cancer" and "chemotherapy" and "microbiome/microbiota". The relevant literature was selected for use in this article. Seventeen studies were selected on participants with colorectal cancer (CRC; n=5), Acute Myeloid Leukemia (AML; n=3), Non-Hodgkin's lymphoma (n=2), breast cancer (BCa; n=1), lung cancer (n=1), ovarian cancer (n=1), liver cancer (n=1), and various other types of cancers (n=3). Seven studies assessed the relationship between the gut microbiome and CTX with faecal samples collected prior to (n=3) and following CTX (n=4) showing that the gut microbiome is associated with both CTX efficacy and toxicity. Ten other prospective studies assessed the impact of CTX during treatment and found that CTX modulates the gut microbiome of people with cancer and that dysbiosis induced by the CTX is related to AEs. CTX adversely impacts the gut microbiome, inducing dysbiosis and is associated with CTX outcomes and AEs. Current evidence provides insights into the gut microbiome for clinicians, cancer survivors and the general public. More research is required to better understand and modify the impact of CTX on the gut microbiome.
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Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,University of Kansas Medical Center, Kansas City, KS, United States
| | - Frances Boyle
- Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Alex Guminski
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Towia Libermann
- Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | | | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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32
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Oh B, Boyle F, Pavlakis N, Clarke S, Eade T, Hruby G, Lamoury G, Carroll S, Morgia M, Kneebone A, Stevens M, Liu W, Corless B, Molloy M, Kong B, Libermann T, Rosenthal D, Back M. The Gut Microbiome and Cancer Immunotherapy: Can We Use the Gut Microbiome as a Predictive Biomarker for Clinical Response in Cancer Immunotherapy? Cancers (Basel) 2021; 13:cancers13194824. [PMID: 34638308 PMCID: PMC8508052 DOI: 10.3390/cancers13194824] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The current review assessed the effects of the gut microbiome on clinical outcomes of immunotherapy and related adverse events (AEs) in cancer patients. Studies (n = 10) consistently reported that the gut microbiome prior to administering immune checkpoint inhibitors (ICIs) was associated with enhanced efficacy of ICIs and reduced AEs. Recent fecal microbiome transplant (FMT) studies demonstrated the modulatory effects of FMT on the composition and diversity of the gut microbiome in patients with refractory cancers and the potential to improve the efficacy of ICIs. Abstract Background: Emerging evidence suggests that gut microbiota influences the clinical response to immunotherapy. This review of clinical studies examines the relationship between gut microbiota and immunotherapy outcomes. Method: A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for “cancer” and “immunotherapy/immune checkpoint inhibitor” and “microbiome/microbiota” and/or “fecal microbiome transplant FMT”. The relevant literature was selected for this article. Results: Ten studies examined patients diagnosed with advanced metastatic melanoma (n = 6), hepatocellular carcinoma (HCC) (n = 2), non-small cell lung carcinoma (NSCLC) (n = 1) and one study examined combination both NSCLC and renal cell carcinoma (RCC) (n = 1). These studies consistently reported that the gut microbiome profile prior to administering immune checkpoint inhibitors (ICIs) was related to clinical response as measured by progression-free survival (PFS) and overall survival (OS). Two studies reported that a low abundance of Bacteroidetes was associated with colitis. Two studies showed that patients with anti-PD-1 refractory metastatic melanoma experienced improved response rates and no added toxicity when receiving fecal microbiota transplant (FMT) from patients with anti-PD-1 responsive disease. Conclusions: Overall, significant differences in the diversity and composition of the gut microbiome were identified in ICIs responders and non-responders. Our findings provide new insights into the value of assessing the gut microbiome in immunotherapy. Further robust randomized controlled trials (RCTs) examining the modulatory effects of the gut microbiome and FMT on ICIs in patients not responding to immunotherapy are warranted.
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Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
- Correspondence:
| | - Frances Boyle
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Benjamin Kong
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Towia Libermann
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
- BIDMC Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - David Rosenthal
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Blume O, Back M, Martin K, Windisch P. A customized allogenic bone block for alveolar reconstruction quantitated by a 3D matching technique: A case report. Clin Case Rep 2021; 9:e04771. [PMID: 34532047 PMCID: PMC8435223 DOI: 10.1002/ccr3.4771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
After initial resorption, the bone volume showed long-term stability following loading of the implant. Furthermore, 3D matching was a suitable quantification method to analyze the volume development of bone augmentation.
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Affiliation(s)
- Oliver Blume
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Michael Back
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Kim Martin
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Péter Windisch
- Department of PeriodontologySemmelweis UniversityBudapestHungary
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Jang A, Brown C, Lamoury G, Morgia M, Boyle F, Marr I, Clarke S, Back M, Oh B. The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis. Integr Cancer Ther 2021; 19:1534735420949679. [PMID: 32996339 PMCID: PMC7533944 DOI: 10.1177/1534735420949679] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Several studies have identified fatigue as one of the major symptoms experienced during and after cancer treatment. However, there are limited options to manage cancer related fatigue (CRF) with pharmacological interventions. Several acupuncture studies suggested that acupuncture has a positive impact on CRF. This review aims to assess the evidence of acupuncture for the treatment of CRF. Method Electronic database searches were conducted on 4 English databases (Medline, PubMed, Embase, and ScienceDirect). Search keywords were; “acupuncture” and “cancer,” or “cancer related fatigue.” Studies published as full text randomized controlled trials (RCTs) in English were included. Estimates of change in fatigue cores were pooled using a random effects meta-analysis where randomized comparisons were available for true acupuncture versus sham acupuncture and true acupuncture versus usual care. The quality of original papers were assessed using the Cochrane Collaboration’s tool for assessing risk of bias (ROB). Results Nine RCTs were selected for review with a total of 809 participants and a range of 13 to 302 participants within the studies. Six RCTs reported significant improvement of CRF for the acupuncture intervention compared to the control groups. Pooled estimates suggest Brief Fatigue Inventory scores are 0.93 points lower 95% CI (−1.65, −0.20) in true acupuncture versus sham acupuncture and 2.12 points lower 95% C (−3.21, −1.04) in true acupuncture versus usual care. Six studies had low risk of bias (ROB) and 3 studies had a moderate ROB predominantly in blinding of participants, blinding of assessors and incomplete data outcomes. Among the 9 RCTs, 2 studies have reported the occurrence of minor adverse effects (spot bleeding and bruising) related to acupuncture treatment. No serious adverse reactions related to acupuncture were reported. Conclusion The current literature review suggests that acupuncture has therapeutic potential in management of CRF for cancer survivors. Promotion of acupuncture in cancer care to manage CRF may improve the quality of life of cancer survivors.
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Affiliation(s)
- Andrew Jang
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Chris Brown
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Lamoury
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Marita Morgia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Frances Boyle
- University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Isobel Marr
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Stephen Clarke
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael Back
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
| | - Byeongsang Oh
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, North Sydney, New South Wales, Australia
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Sim HW, McDonald KL, Lwin Z, Barnes EH, Rosenthal M, Foote MC, Koh ES, Back M, Wheeler H, Sulman EP, Buckland ME, Fisher L, Leonard R, Hall M, Ashley DM, Yip S, Simes J, Khasraw M. A randomized phase II trial of veliparib, radiotherapy and temozolomide in patients with unmethylated MGMT glioblastoma: the VERTU study. Neuro Oncol 2021; 23:1736-1749. [PMID: 33984151 PMCID: PMC8485443 DOI: 10.1093/neuonc/noab111] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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] [Indexed: 01/03/2023] Open
Abstract
Background Temozolomide offers minimal benefit in patients with glioblastoma with unmethylated O6-methylguanine-DNA methyltransferase (MGMT) promoter status, hence, the need for novel therapies. This study evaluated whether veliparib, a brain-penetrant poly(ADP-ribose) polymerase (PARP) inhibitor, acts synergistically with radiation and temozolomide. Methods VERTU was a multicenter 2:1 randomized phase II trial in patients with newly diagnosed glioblastoma and MGMT-unmethylated promotor status. The experimental arm consisted of veliparib and radiotherapy, followed by adjuvant veliparib and temozolomide. The standard arm consisted of concurrent temozolomide and radiotherapy, followed by adjuvant temozolomide. The primary objective was to extend the progression-free survival rate at six months (PFS-6m) in the experimental arm. Results A total of 125 participants were enrolled, with 84 in the experimental arm and 41 in the standard arm. The median age was 61 years, 70% were male, 59% had Eastern Cooperative Oncology Group (ECOG) performance status of 0, and 87% underwent macroscopic resection. PFS-6m was 46% (95% confidence interval [CI]: 36%-57%) in the experimental arm and 31% (95% CI: 18%-46%) in the standard arm. Median overall survival was 12.7 months (95% CI: 11.4-14.5 months) in the experimental arm and 12.8 months (95% CI: 9.5-15.8 months) in the standard arm. The most common grade 3-4 adverse events were thrombocytopenia and neutropenia, with no new safety signals. Conclusion The veliparib-containing regimen was feasible and well tolerated. However, there was insufficient evidence of clinical benefit in this population. Further information from correlative translational work and other trials of PARP inhibitors in glioblastoma are still awaited.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kerrie L McDonald
- Cure Brain Cancer Neuro-Oncology Lab, University of New South Wales, Sydney, Australia
| | - Zarnie Lwin
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia
| | - Matthew C Foote
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia.,Department of Radiation Oncology, Liverpool Hospital, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine and Brain and Spine Tumors, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, USA
| | - Michael E Buckland
- Neuropathology Department, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Lauren Fisher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - David M Ashley
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,Duke University School of Medicine, Duke University, Durham, NC, USA
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Bastos L, Al-Khalili F, Back M, Manouras A, Engdahl J, Shahgaldi K. Elevated echocardiographic markers for left atrial stiffness and fibrosis in patients with paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.120] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital
Background
Atrial fibrillation (AF) is associated with atrial disease expressing left atrial (LA) structural remodeling with increased fibrosis and stiffness. Transthoracic echocardiography (TTE) is the first imaging modality of choice for the evaluation of LA volume index (LAVI) and function. However TTE allows new approaches for LA anatomical and functional analysis such as LA stiffness index (LASI) calculation based on LA global longitudinal strain (GLS), LA activation time and LA Integrated Backscatter (IBS). LA activation time is a novel parameter, considered as an echocardiographic surrogate analysis for LA fibrosis. Echocardiographic derived IBS can noninvasively quantify myocardial fibrosis in the left ventricle, allowing a similar alternative analysis for LA fibrosis.
Purpose
To investigate potential LA structural and functional changes in paroxysmal AF patients by measuring LA activation time, LASI and LA IBS compared with age-matched control group.
Methods
In total, 75 paroxysmal AF patients and 99 age-matched control group patients (mean age 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NTproBNP levels ( ≤ 900 ng/L) was an enrollment criterium. LA activation time was acquired by measuring the time delay between the onset of the P-wave on ECG and the peak of the Á –wave on the Tissue Doppler (TD) tracing in the lateral LA wall. LASI was calculated as the ratio of E/é to LA-GLS. LA IBS was obtained as the intensity difference between the LA lateral wall and the pericardium, at QRS peak.
Results
There was a significant increase of LASI (0.53 ± 0.21 vs. 0.41 ± 0.22, P < 0.05) and LA IBS (14 ± 7.1 dB vs. 11 ± 6.3 dB, P < 0.05) in the AF group compared to the control group. Feasibility for LASI resulted as 64 %, respectively 91 % for LA IBS. LA activation time was significantly prolonged in the AF group (157 ± 34 ms vs. 134 ± 18 ms, P < 0.05) with a feasibility of 44 %. In the AF group, 45 patients (60 %) expressed normal LAVI <34 ml/m2. No significant difference was revealed concerning LAVI (P > 0.05) between the groups (AF group with normal LAVI). Although LASI, LA IBS and LA activation time remained significant increased in the AF group (P < 0.05). No significant difference was shown regarding NT-proBNP levels. (P > 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L.
Conclusions
Indices reflecting LA stiffness and echocardiographic parameters associated with LA fibrosis, were elevated in patients with paroxysmal AF compared to age-matched controls. These findigs might non-invasively provide additional information in paroxysmal AF patients with normal LA size.
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Affiliation(s)
- L Bastos
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
| | - F Al-Khalili
- Karolinska Institute, Department of Clinical Sciences Danderyds Hospital, Stockholm, Sweden
| | - M Back
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - A Manouras
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - J Engdahl
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
| | - K Shahgaldi
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
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Bastos L, Al-Khalili F, Back M, Manouras A, Engdahl J, Shahgaldi K. Echocardiographic speckle tracking provides incremental value for left atrial function in patients with paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital
Background
Atrial fibrillation (AF) is associated with progression of left atrial (LA) structural and functional changes. It is well acknowledged that AF over time promotes LA enlargement. Transthoracic echocardiography (TTE) is important in decision making for further treatment. Initially, new onset of AF such as paroxysmal AF can occur in the absence of LA enlargement. Therefore assessment of LA volume index (LAVI) as follow-up can mislead LA evaluation. LA global longitudinal strain (LA-GLS) is a novel parameter assessed with two-dimensional (2D) speckle tracking (ST). LA-GLS allows quantification of LA myocardial deformation by measuring reservoir function which reflects LA compliance during left ventricular systole.
Purpose
Our aim is to study potential differences in LA myocardial deformation as assessed by LA-GLS in paroxysmal AF patients compared with aged-matched control group.
Methods
A total of 75 paroxysmal AF patients and 99 control aged-matched patients (mean age, 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NT-proBNP ≤ 900 ng/L was an inclusion criteria. Besides conventional echocardiographic parameters, LA-GLS was measured using 2D-ST in biplane during systole.
Results
There was a significant LA-GLS reduction in the paroxysmal AF group compared to the control group (19 ± 6.1 % vs. 28 ± 7.2 %, P < 0.001) with a feasibility of 70 %. In the AF group, 45 patients (60 %) expressed normal LAVI <34 ml/m2. No significant difference was revealed concerning LAVI (P > 0.05) between the groups (AF group with normal LAVI), yet LA-GLS remained significant reduced in the AF group (P < 0.001). No significant difference was shown regarding NT-proBNP levels (P > 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L.
Conclusion
LA-GLS allows early detection of LA myocardial deformation dysfunction before LA enlargement in patients with paroxysmal AF. This findig provides incremental information to conventional echocardiographic parameters of LA. Whether early detection of LA dysfunction using LA-GLS can contribute to better risk stratification and cardiac therapy improvement requires to be further investigated.
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Affiliation(s)
- L Bastos
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
| | - F Al-Khalili
- Karolinska Institute, Department of Clinical Sciences Danderyds Hospital, Stockholm, Sweden
| | - M Back
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - A Manouras
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - J Engdahl
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
| | - K Shahgaldi
- Danderyd University Hospital, Department of Cardiology and Clinical Physiology, Stockholm, Sweden
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Oh B, Van Der Saag D, Morgia M, Carroll S, Boyle F, Back M, Lamoury G. An Innovative Tai Chi and Qigong Telehealth Service in Supportive Cancer Care During the COVID-19 Pandemic and Beyond. Am J Lifestyle Med 2020; 15:475-477. [PMID: 34366746 DOI: 10.1177/1559827620983762] [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] [Indexed: 12/20/2022] Open
Abstract
Supportive cancer care services, including acupuncture and Tai Chi and Qigong (TQ), are offered to cancer patients to manage cancer symptoms and/or treatment-related adverse effects and improve quality of life during and after standard care. Normal face-to-face acupuncture and TQ group services were suspended during the coronavirus (COVID-19) pandemic to reduce the risk of transmission of infection and meet social distancing restriction guidelines. This led to a sudden shift from face-to-face sessions to telehealth sessions in the health care system. We report patients' experiences of TQ telehealth services as a new initiative developed for cancer care. We found that delivery of TQ telehealth is feasible and resulted in increased overall patient satisfaction with cancer care services during the lockdown. The delivery of TQ telehealth experiences and challenges are discussed.
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Affiliation(s)
- Byeongsang Oh
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | | | - Morita Morgia
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Susan Carroll
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care, Mater Hospital, North Sydney, New South Wales, Australia
| | - Michael Back
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
| | - Gillian Lamoury
- GenesisCare, Mater Hospital, North Sydney, New South Wales, Australia
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Schuler T, Back M, Hruby G, Carroll S, Jayamanne D, Kneebone A, Stevens M, Lamoury G, Morgia M, Wong S, Grimberg K, Roderick S, Booth J, Eade T. Introducing Computed Tomography Simulation-Free and Electronic Patient-Reported Outcomes-Monitored Palliative Radiation Therapy into Routine Care: Clinical Outcomes and Implementation Experience. Adv Radiat Oncol 2020; 6:100632. [PMID: 33851063 PMCID: PMC8039552 DOI: 10.1016/j.adro.2020.100632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Our purpose was to report outcomes of a novel palliative radiation therapy protocol that omits computed tomography simulation and prospectively collects electronic patient-reported outcomes (ePROs). Methods and Materials Patients receiving extracranial, nonstereotactic, linear accelerator-based palliative radiation therapy who met inclusion criteria (no mask-based immobilization and a diagnostic computed tomography within 4 weeks) were eligible. Global pain was scored with the 11-point numerical pain rating scale (NPRS). Patients were coded as having osseous or soft tissue metastases and no/mild versus severe baseline pain (NPRS ≥ 5). Pain response at 4 weeks was measured according to the international consensus (no analgesia adjustment). Transition to ePRO questionnaires was completed in 3 phases. Initially, pain assessments were collected on paper for 11 months, then pilot ePROs for 1 month and then, after adjustments, revised ePROs from 1 year onwards. ePRO feasibility criteria were established with reference to the paper-based process and published evidence. Results Between May 2018 and November 2019, 542 consecutive patients were screened, of whom 163 were eligible (30%), and 160 patients were successfully treated. The proportion of patients eligible for the study improved from approximately 20% to 50% by study end. Routine care pain monitoring via ePROs was feasible. One hundred twenty-seven patients had a baseline NPRS recording. Ninety-five patients had osseous (61% severe pain) and 32 had soft tissue (25% severe pain) metastases. Eighty-four patients (66%) were assessable for pain response at 4 weeks. In the 41 patients with severe osseous pain, overall and complete pain response was 78% and 22%, respectively. Conclusions By study completion, 50% of patients receiving palliative extracranial radiation therapy avoided simulation, streamlining the treatment process and maximizing patient convenience. Pain response for patients with severe pain from osseous lesions was equivalent to published evidence.
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Affiliation(s)
- Thilo Schuler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Dasantha Jayamanne
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Shelley Wong
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Kylie Grimberg
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Stephanie Roderick
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
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Yuile A, De Silva M, Kastelan M, Cheung V, Sy J, Buckland M, Drummond J, Back M, Wheeler H. PATH-18. A MULTI-CENTER CASE SERIES OF ADULT K27M MUTATED DIFFUSE MIDLINE GLIOMAS REVEALING A POPULATION UNIQUE FROM PAEDIATRIC CASES. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.700] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Histone mutations in the K27M gene were first described in 2014, and incorporated into the WHO CNS tumour classification system in 2016. They are typically associated with diffuse midline gliomas (DMG). Presenting symptoms vary greatly, with some experiencing significant delay in diagnosis. Median survival is only 9-12 months for these patients. Biopsy samples are small, and in some due to location, not performed. Although data is predominately based on the paediatric population, DMGs are seen in both adolescence and adults. In this multi-site retrospective study, we describe 11 adult patients with K27M DMG gliomas across two tertiary Neuro-Oncology services in Sydney, Australia. To the authors’ knowledge we present the largest known collection of adult K27M cases in the Asia-Pacific region with correlation of treatment, clinicopathologic and radiologic features with outcomes.
METHODS
The glioma databases of Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2009 and March 2020 were interrogated to identify patients. Selection criteria included patients aged ≥ 18 years who presented with a DMG, had undergone biopsy, and had confirmed K27M via next generation sequencing. Clinicopathologic, radiologic and treatment outcomes were extracted for correlation.
RESULTS
Eleven patients fitting the selection criteria were identified and reported. The median age at diagnosis was 30 years and 4 were female. Five presented with hydrocephalus, the most common presenting symptoms were headaches and nausea and/or vomiting (n= 4 and n= 2 respectively). The median progression-free survival was 13 months (4-31 months) and the median overall survival was 23 months (4-59 months).
CONCLUSION
This case series reports the outcomes of older patients with K27M. The clinical course demonstrated suggests a divergence from paediatric biology. Ongoing studies are required to further characterise the histopathological and clinical differences of these tumours in older patients.
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Affiliation(s)
- Alexander Yuile
- Department of Medical Oncology, Northern Sydney Cancer Center, Royal North Shore Hospital, Sydney, Australia
| | - Madhawa De Silva
- Department of Medical Oncology, Northern Sydney Cancer Center, Royal North Shore Hospital, Sydney, Australia
| | - Marina Kastelan
- Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Veronica Cheung
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Joanne Sy
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jamie Drummond
- Department of Medical Oncology, Northern Sydney Cancer Center, Royal North Shore Hospital, Sydney, Australia
| | - Michael Back
- Department of Medical Oncology, Northern Sydney Cancer Center, Royal North Shore Hospital, Sydney, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
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Wijetunga A, Jayamanne D, Cook R, Parkinson J, Little N, Curtis J, Brown C, Back M. Hypofractionated adjuvant surgical cavity radiotherapy following resection of limited brain metastasis. J Clin Neurosci 2020; 82:155-161. [PMID: 33317725 DOI: 10.1016/j.jocn.2020.10.041] [Citation(s) in RCA: 2] [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] [Received: 05/29/2020] [Revised: 09/09/2020] [Accepted: 10/18/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Following surgical resection of oligometastatic disease to the brain there is a high rate of local relapse which is reduced by the addition of focal radiation therapy, often delivered as single fraction stereotactic radiosurgery (SRS) to the surgical cavity. This study audited the outcomes of an alternative approach using hypofractionated radiation therapy (HFRT) to the surgical resection cavity. METHODS AND MATERIALS Seventy-nine patients who received surgical resection and focal radiation therapy to the surgical cavity using HFRT with intensity modulated radiation therapy with or without stereotactic radiotherapy were identified. Doses were delivered in five fractions every second day for 10 days. Follow-up involved MRI surveillance with three-monthly MRI scans post resection. The major endpoints were local control at the surgical cavity site, and presence of radiation necrosis at the treated site. RESULTS Seventy-nine patients were included for the analysis with a median follow-up of 10.8 months. Of the cohort, 56% experienced intracranial progression, with all patients progressing distant to the resection cavity, and 7% progressing locally in addition. The one-year local control rate was 89.8%. The median progression-free survival was 10.0 months and median overall survival was 14.3 months. There was one CTCAE grade 3 toxicity of symptomatic radiation necrosis with no grade 4-5 toxicities seen. CONCLUSIONS The rate of local relapse following HFRT to the surgical cavity is low with minimal risk of radiation necrosis. HFRT can be considered as an alternative to SRS for focal radiotherapy after brain metastasis resection.
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Affiliation(s)
- A Wijetunga
- Sydney Medical School, Northern Clinical School, Reserve Road, St Leonards 2065, Australia.
| | - D Jayamanne
- Sydney Medical School, Northern Clinical School, Reserve Road, St Leonards 2065, Australia; Department of Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia
| | - R Cook
- Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia; The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards 2065, Australia
| | - J Parkinson
- Sydney Medical School, Northern Clinical School, Reserve Road, St Leonards 2065, Australia; Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia; The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards 2065, Australia
| | - N Little
- Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia
| | - J Curtis
- Department of Neurosurgery, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia
| | - C Brown
- NHMRC Clinical Trials Centre, University of Sydney, 92-94 Parramatta Rd, Camperdown 2050, Australia
| | - M Back
- Sydney Medical School, Northern Clinical School, Reserve Road, St Leonards 2065, Australia; Department of Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards 2065, Australia; The Brain Cancer Group, North Shore Private Hospital, Westbourne Street, St Leonards 2065, Australia; Central Coast Cancer Centre, Gosford Hospital, Holden Street, Gosford 2250, Australia
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Leosdottir M, Hagstrom E, Hadziosmanovic N, Norhammar A, Lindahl B, Hambraeus K, Jernberg T, Back M. Time trends in risk factor control and use of secondary preventive medication among patients with myocardial infarction attending cardiac rehabilitation: data from the SWEDEHEART registry 2006–2017. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1416] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Systematically monitoring results within cardiac rehabilitation (CR) has been highlighted as a possible way to improve CR outcomes. The nationwide SWEDEHEART registry has monitored quality of care post myocardial infarction (MI) in Sweden since the 1990s. Follow-up data describing treatment and outcomes within CR has been collected since 2006.
Purpose
To describe changes in risk factor control and use of secondary preventive medication for post MI patients after completion of CR in Sweden 2006–2017, and to compare with trends in the EUROASPIRE surveys.
Methods
All patients who suffered an MI and attended a one-year CR follow-up visit registered in SWEDEHEART 2006–2017 were included (n=66 666, 18–74 years, 75% men). Trends in risk factor control and secondary preventive medication were collected yearly and analyzed over the time period using Cochran-Armitage trend test. Comparisons were made to data from the EUROASPIRE III (2006–2007), IV (2012–2013) and V (2016–2017) surveys, where patients with coronary artery events or interventions were interviewed at approximately 1.2 years after the index event (n=25 225, 18–80 years, 74% men).
Results
Trends in blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) control, smoking, and central obesity are shown in the Figure. The proportion of patients achieving BP goal <140/90 mmHg and LDL-C goal <1.8 mmol/L increased by 16% and 29% from 2006 to 2017 in SWEDEHEART (p for trend <0.0001 for both), compared to 14% and 8% between EUROASPIRE III and V. Of patients who were active smokers at the time of the index event, the proportion still smoking at one-year remained unchanged in SWEDEHEART (43% in 2006 and 2017) while increasing from 52% to 55% in the EUROASPIRE surveys. An increase in prevalence of central obesity from approximately 50% to 60% was observed in both cohorts. The proportion of patients with obesity (BMI ≥30kg/m2) and diabetes increased in SWEDEHEART during the observed period from 23% to 29% (obesity) and 18% to 25% (diabetes) (p for trend <0.0001 for both). The proportions in 2017 were considerably lower than in EUROASPIRE V (2016–2017), where 38% were obese and 29% had diabetes. The use of statins increased from 89% to 93%, ezetimibe from 5% to 21%, and ACE/ARB from 65% to 82% in SWEDEHEART (p for trend <0.0001 for all). In comparison, in EUROASPIRE V the proportion treated with lipid lowering medication of any kind was 84% and with ACE/ARB was 75%.
Conclusion
Between 2006–2017, considerable improvements were achieved in risk factor control and use of secondary preventive medication for MI patients completing CR in Sweden, where all patients were monitored through the SWEDEHEART registry. The improvements were larger than observed in the EUROASPIRE surveys during the same time period. Continuous and nationwide auditing of CR outcomes, as well as local review of performance, could be possible explanations for some of the observed differences.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Leosdottir
- Skane University Hospital, Dept of Cardiology, Malmo, Sweden
| | - E Hagstrom
- Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - A Norhammar
- Karolinska Institute, Department of Medicine, Stockholm, Sweden
| | - B Lindahl
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - K Hambraeus
- Falun Hospital, Department of Cardiology, Falun, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Stockholm, Sweden
| | - M Back
- Sahlgrenska Academy, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden
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Ogmundsdottir Michelsen H, Sjolin I, Back M, Gonzalez M, Olsson A, Sandberg C, Schiopu A, Leosdottir M. Effect of a lifestyle-focused electronic patient support application on risk factor management in post-myocardial infarction patients – a randomized controlled trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation (CR) is central in reducing morbidity and mortality after myocardial infarction (MI). However, the fulfillment of guideline recommended CR targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.
Purpose
The aim of this study was to assess the efficacy of a mobile device application to support adherence to lifestyle advice and self-control of risk factors as a complement to traditional CR after MI.
Method
This unblinded multi-centre randomized controlled trial included 150 patients with MI (81% men, 60.4±8.8 years). All patients in the intervention (INT) and control (CON) groups participated in a 1-year CR program. Additionally, INT patients (n=101) received access to the mobile device application for 25 weeks post-MI where information about lifestyle (i.e., diet, physical activity, smoking), modifiable risk factors (i.e., weight, blood pressure (BP)), and symptoms could be registered. The software provided direct positive feedback and lifestyle advice. Data was reviewed twice weekly by the CR nurse. The primary outcome was change in sub-maximal exercise capacity (W) between an exercise test 2-weeks post MI and at follow-up 4 month later. Secondary outcomes included changes in lifestyle and modifiable risk factors including body mass index, waist circumference, blood-lipids, fasting glucose and HbA1c, between baseline and 2-week, 2-month and 1-year follow-up visits. Regression analysis was used, adjusting for relevant baseline variables.
Results
Participation in CR was high, with 96% of INT patients and 98% of the CON patients attending the 1-year follow-up visit. Forty-six percent of the INT patients and 57% of the CON patients attended centre-based exercise training (p=0.1). In the INT group 86% logged data in the application at least once. Adherence, defined as logging data at least twice per week, was 92% in week 1 and 57% in week 25. There was a numerical trend toward better exercise capacity improvement in the INT group (INT +14.4±19.0 vs. CON +10.3±16.1 W, p=0.2) although differences were non-significant. INT patients achieved larger BP reduction at 2-weeks (systolic) and 2-months (systolic and diastolic) (Figure). At 2-months 70% vs. 46% of smokers in the INT vs CON groups had quit smoking, and at 1-year the respective percentages were 57% vs. 36%. The number of smokers in the study was however low (n=33) and the differences non-significant. For other secondary endpoints no differences were observed.
Conclusion
Complementing CR with a mobile device application improved BP during the first months after MI, and non-significant trends towards better exercise capacity and higher smoking cessation rates were observed. Even though the differences were non-significant in our small study sample, they indicate that using eHealth in the form of a mobile device application could clinically benefit post-MI patients participating in CR.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Governmental funding of clinical research within the National Health Services in Sweden.
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Affiliation(s)
| | - I Sjolin
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M Back
- Linkoping University, Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linkoping, Sweden
| | - M Gonzalez
- Umea University, Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden
| | - A Olsson
- Skane University Hospital, Department of Cardiology, Clinical Sciences, Lund, Sweden
| | - C Sandberg
- Umea University, Department of Public Health and Clinical Medicine, Cardiology, Umea, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M Leosdottir
- Lund University, Department of Clinical Sciences, Malmo, Sweden
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Back M, Brosved M, Albertsson P, Karlsson T, Philip Wigh J, Sundberg H, Ziden L, Hirlekar G. Effects of exercise-based cardiac rehabilitation in patients with acute coronary syndrome aged 80 years and older. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3095] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The beneficial effects of exercise-based cardiac rehabilitation (exCR) in patients with acute coronary syndromes (ACS) are well known. Patients aged 80+ have, however, been underrepresented in randomized controlled trials.
Purpose
The primary aim was to evaluate effects of exCR in patients with ACS 80+ in terms of maximum aerobic capacity, compared with a control group. Secondary aims were to evaluate effects of exCR between groups regarding muscular endurance, submaximal aerobic capacity, physical function and self-reported health.
Methods
A total of 26 patients (58% men), with ACS, median age 82.5 (25th-75th percentiles, 81–84) years, were included at a university hospital. Patients were randomized to hospital-based exCR, including aerobic, resistance- and balance exercises 2 times/week and a home-based exercise program 1 time/week or to a control group (C-group) for 4 months. We report differences in changes (0–4 months) between the groups regarding maximum aerobic capacity (exercise ECG), 6MWT, muscle endurance tests (shoulder flexion and heel-lifts), timed-up and go (TUG), Short Physical Performance Battery (SPPB), one leg stand test and self-reported health (one item question). T-tests, Mann-Whitney U tests and Chi2-tests were used as appropriate to describe differences between groups.
Results
There were no significant differences between groups at baseline, except for age with the exCR-group being older. At 4 months, we found no significant differences between the groups in maximum aerobic capacity. However, the exCR-group significantly improved their 6-min walking distance more, with a median of 39 m (17–57.5), compared to 16.5 m (−15.5–33) in the C-group, p=0.04. In addition, the exCR-group significantly improved in muscle endurance (maximum reps) while the C-group declined; heel-lift right, mean 2.3±3.8 vs −1.6±4.5, p=0.04 and left, mean 2.9±3.9 vs −4.6±4.6, p=0.001, shoulder flexion mean 5.5±4.5 vs −3.1±3.1, p≤0.001. Moreover, the exCR-group significantly improved their physical function in terms of SPPB total score with in median 1.5 (1–2) points, compared to 0 (−1–1) in the C-group, p=0.02 and one leg stand test 1.5 (0–2) points, compared to a decline with −0.5 (−2–0) points in the C-group, p<0.001. There were no significant differences between groups in shoulder abduction, TUG and self-reported health.
Conclusions
We report introductory results that patients with ACS, aged 80+, participating in an exCR program can improve walking distance, muscle endurance and physical function, however not maximum aerobic capacity. Therefore, we encourage an increased referral to exCR of this increasing group of patients to potentially enable more elderly to preserve mobility and independence in their daily living. These results must, however, be confirmed in larger studies.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Swedish Heart- and Lung Association
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Affiliation(s)
- M Back
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - M Brosved
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Albertsson
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - T Karlsson
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
| | - J Philip Wigh
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Sundberg
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Ziden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Hirlekar
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden
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Blume O, Schnödt EM, Back M, Wildenhof JIR, Probst FA, Otto S. Long-Term Efficacy of Variable-Thread Tapered Implants-A Retrospective, Clinical and Radiological Evaluation. Medicina (Kaunas) 2020; 56:medicina56110564. [PMID: 33121056 PMCID: PMC7693379 DOI: 10.3390/medicina56110564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022]
Abstract
Background and Objective: There is multifaceted evidence that variable-thread tapered implants (VTTIs) offer high primary stability but few regarding the long-term success. This retrospective clinical and radiological cohort study assessed the long-term outcome of VTTIs. Material and Methods: All patients treated in an OMFS practice with NobelActive Internal® VTTI between October 2007 and September 2011 were invited for clinical examination. The outcome variables were (i) survival rate, (ii) implant success according to the “Health Scale for Dental Implants” and (iii) prevalence of peri-implantitis. Furthermore, the effect of local and systemic risk factors was investigated. Results: In 81 subjects (46 females and 35 males, mean age 65.6 years) 270 implants (157 VTTIs and 113 others as a control group) were analyzed. In 7 out of 81 patients (8.6%), 8 out of 157 VTTIs (5.1%) and 5 out of 113 other implants (4.4%) were lost. Peri-implantitis, defined as (i) presence of bleeding on gentle probing (0.25 N) or exudation and (ii) radiographic bone loss exceeding 0.5 mm since implant insertion to last follow-up, was the most common reason for implant loss (11 out of 13, 84.6%). Sixty-six out of 87 VTTIs (75.9%) were successful. Seventeen out of 42 patients (40.5%) developed peri-implantitis on 29 out of 79 VTTI sites (36.7%). Plaque and missing keratinized peri-implant mucosa were identified as potential risk factors for the development of peri-implantitis. Conclusion: Variable-thread tapered implants showed good long-term results, even in low bone quality. Peri-implantitis was the most common reason for implant failure and may be connected to certain risk factors.
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Affiliation(s)
- Oliver Blume
- Maxillofacial Surgeon, Praxis Dres. Back & Blume, 80331 Munich, Germany
- Correspondence: (O.B.); (E.M.S.)
| | - Eva Maria Schnödt
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (F.A.P.); (S.O.)
- Correspondence: (O.B.); (E.M.S.)
| | - Michael Back
- Oral Surgeon, Praxis Dres. Back & Blume, 80331 Munich, Germany;
| | - Jan IR Wildenhof
- Dentist, Privatzahnklinik Schloss Schellenstein, 59939 Olsberg, Germany;
| | - Florian A. Probst
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (F.A.P.); (S.O.)
| | - Sven Otto
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, 80337 Munich, Germany; (F.A.P.); (S.O.)
- Department of Oral- and Maxillofacial Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Horsley PJ, Back M, Lamoury G, Porter B, Booth J, Eade TN. Radiation oncology during COVID-19: Strategies to avoid compromised care. Asia Pac J Clin Oncol 2020; 17:24-28. [PMID: 32894820 DOI: 10.1111/ajco.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic will present a range of challenges to radiation oncology departments. Early data suggest that cancer patients carry a higher than average, but still low absolute risk of hospitalization from COVID-19. The risk of severe events for those who are hospitalized however, is high. Resources for usual cancer care will likely be limited. Decisions to alter, delay or omit treatment during this period should consider both the risk of the cancer and of COVID-19 to the patient, as well as resource constraints. There is a need for departments to adapt with goals of maintaining an uninterrupted, high quality service and of minimizing compromise to oncologic care.
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Affiliation(s)
- Patrick J Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Gillian Lamoury
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Brian Porter
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Jeremy Booth
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, New South Wales, Australia
| | - Thomas N Eade
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
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Oh B, Bae K, Lamoury G, Eade T, Boyle F, Corless B, Clarke S, Yeung A, Rosenthal D, Schapira L, Back M. The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis. Medicines (Basel) 2020; 7:E39. [PMID: 32629903 PMCID: PMC7400467 DOI: 10.3390/medicines7070039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/13/2022]
Abstract
Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: "Tai Chi or Qigong" and "immune system, immune function, immunity, Immun*, inflammation and cytokines". Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, -0.15; 95% CI, -0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.
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Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Kyeore Bae
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- Center for Immunity and Pain, Kwanghye Hospital, Seoul 06174, Korea
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Frances Boyle
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Albert Yeung
- Harvard Medical School, Boston, MA 02115, USA; (A.Y.); (D.R.)
| | - David Rosenthal
- Harvard Medical School, Boston, MA 02115, USA; (A.Y.); (D.R.)
| | - Lidia Schapira
- Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
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48
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Chan J, Jayamanne D, Wheeler H, Khasraw M, Wong M, Kastelan M, Guo L, Back M. The role of large volume re-irradiation with Bevacizumab in chemorefractory high grade glioma. Clin Transl Radiat Oncol 2020; 22:33-39. [PMID: 32195378 PMCID: PMC7075764 DOI: 10.1016/j.ctro.2020.03.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Large volume reRT is a viable treatment for refractory recurrent high-grade glioma. Bevacizumab facilitates large volume reRT by reducing the risk of CNS radionecrosis. Patient selection for reRT needs more work but should be guided by performance status.
Background and purpose Current practice in re-irradiation (reRT) of previously treated high-grade gliomas (HGG) has generally been limited to small volume reRT with stereotactic procedures. Less evidence exists for large volume reRT involving treatment volumes equivalent to that used at initial diagnosis. The primary aim of this study was to investigate the outcome of large volume reRT delivered in combination with Bevacizumab (BEV) in patients with recurrent chemorefractory HGG. Methods and materials Patients with HGG managed with reRT were entered prospectively into a database. Clinicopathological features were recorded including timing of reRT, use of BEV and Dosimetric data. Median survival following reRT was the primary endpoint and association with clinicopathological factors was assessed with cox regression models. Results Sixty seven patients in total were managed with reRT, 51 patients had glioblastoma and 16 had anaplastic glioma. The median PTV was 145.3 cm3. Median OS post reRT was 7.8 months (95% CI 6.3–9.2 months) in the total cohort and 7.5 months (95% CI: 6.6–8.3 months) for GBM patients. In multivariate analysis of the whole cohort, IDH1 mutation status (p = 0.041) and ECOG status prior to reRT (<0.001) were significantly associated with OS. In terms of safety and toxicity, the majority of patients (66.5%) were ECOG 0–2 three months after treatment. In total, four episodes of suspected radiation necrosis occurred, all in patients treated without upfront BEV. Conclusion Large volume reRT with bevacizumab is a feasible late salvage option in patients with recurrent HGG and offers meaningful prolongation of survival with low toxicity.
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Affiliation(s)
- Joseph Chan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Dasantha Jayamanne
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Helen Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Mustafa Khasraw
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Matthew Wong
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Lesley Guo
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia.,Genesis Cancer Care, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
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49
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Anderson KJ, Tan AC, Parkinson J, Back M, Kastelan M, Newey A, Brewer J, Wheeler H, Hudson AL, Amin SB, Johnson KC, Barthel FP, Verhaak RGW, Khasraw M. Molecular and clonal evolution in recurrent metastatic gliosarcoma. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a004671. [PMID: 31896544 PMCID: PMC6996521 DOI: 10.1101/mcs.a004671] [Citation(s) in RCA: 8] [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: 08/09/2019] [Accepted: 11/01/2019] [Indexed: 01/25/2023] Open
Abstract
We discuss the molecular evolution of gliosarcoma, a mesenchymal type of glioblastoma (GBM), using the case of a 37-yr-old woman who developed two recurrences and an extracranial metastasis. She was initially diagnosed with isocitrate dehydrogenase (IDH) wild-type gliosarcoma in the frontal lobe and treated with surgery followed by concurrent radiotherapy with temozolomide. Five months later the tumor recurred in the left frontal lobe, outside the initially resected area, and was treated with further surgery and radiotherapy. Six months later the patient developed a second left frontal recurrence and was again treated with surgery and radiotherapy. Six weeks later, further recurrence was observed in the brain and bone, and biopsy confirmed metastases in the pelvic bones. To understand the clonal relationships between the four tumor instances and the origin of metastasis, we performed whole-genome sequencing of the intracranial tumors and the tumor located in the right iliac bone. We compared their mutational and copy-number profiles and inferred the clonal phylogeny. The tumors harbored shared alterations in GBM driver genes, including mutations in TP53, NF1, and RB1, and CDKN2A deletion. Whole-genome doubling was identified in the first recurrence and the extracranial metastasis. Comparisons of the metastatic to intracranial tumors highlighted a high similarity in molecular profile but contrasting evidence regarding the origin of the metastasis. Subclonal reconstruction suggested a parallel evolution of the recurrent tumors, and that the metastatic tumor was largely derived from the first recurrence. We conclude that metastasis in glioma can be a late event in tumorigenesis.
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Affiliation(s)
- Kevin J Anderson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Aaron C Tan
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,National Cancer Centre Singapore, Singapore, 169610 Singapore
| | - Jonathon Parkinson
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
| | - Michael Back
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
| | - Marina Kastelan
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia
| | - Allison Newey
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia
| | - Janice Brewer
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia
| | - Helen Wheeler
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales 2065, Australia
| | - Amanda L Hudson
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales 2065, Australia
| | - Samirkumar B Amin
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Kevin C Johnson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA.,Department of Pathology, VU University Medical Center/Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Mustafa Khasraw
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
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50
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Khasraw M, Leanne McDonald K, Rosenthal M, Lwin Z, Ashley D, Wheeler H, Barnes E, Foote M, Koh ES, Sulman E, Back M, Buckland M, Sim HW, Fisher L, Leonard R, Hall M, Yip S, Simes J. ACTR-24. A RANDOMIZED PHASE II TRIAL OF VELIPARIB (V), RADIOTHERAPY (RT) AND TEMOZOLOMIDE (TMZ) IN PATIENTS (PTS) WITH UNMETHYLATED MGMT (uMGMT) GLIOBLASTOMA (GBM): THE VERTU STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
TMZ offers minimal benefit in pts with de novo uMGMT GBM. V is synergistic with RT and TMZ in uMGMT preclinical GBM models, safe when combined with either RT or TMZ clinically, but the triplet (V+RT+TMZ) is poorly tolerated. VERTU tested V in pts with uMGMT GBM.
METHODS
VERTU is a randomized Phase 2 trial comparing Standard Arm (Arm A), RT (60Gy/30 fractions) + TMZ (75mg/m2 daily) followed by TMZ (150–200mg/m2D 1–5) every 28 days for 6 cycles vs Experimental Arm (Arm B), RT (60Gy/30 fractions) + V (200mg PO BID) followed by TMZ (150–200mg/m2D 1–5) + V (40mg bid, D 1–7) every 28 days for 6 cycles in pts with de novo uMGMT GBM according to centralised testing.
RESULTS
125 pts were randomized 1:2 (41:84). The 2 groups were matched for age, sex, performance status and extent of resection. Median follow-up was 25.8 months and 91 pts had died. The 6-month Progression-Free Survival (6mPFS) for Arms A and B were 34% (95% CI 20–48) and 46% (95% CI 36–57) respectively. The median PFS for Arms A and B were 4.2m (95% CI 2.5–6.0) and 5.7m (95% CI 4.1–6.6) respectively (HR = 0.80, 95%CI 0.55–1.18). 55% of pts in both arms experienced Grade 3/4 adverse events (AEs) with no significant differences in frequency or severity between the arms. Most common Grade 3/4 AEs were thrombocytopenia, seizures, hyperglycaemia and diarrhoea.
CONCLUSION
VERTU demonstrated that a novel treatment strategy for patients with de novo uMGMT GBM was feasible and tolerable. The observed 6mPFS and PFS were similar in both arms. Overall survival and other endpoints will be presented. Central MRI review, biomarker analyses, including DNA repair and methylation signature analyses are ongoing.
(ANZCTR#ACTRN12615000407594).
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Affiliation(s)
- Mustafa Khasraw
- Royal North Shore Hospital / University of Sydney, St Leonards, NSW, Australia
| | | | | | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | | | - Helen Wheeler
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Matthew Foote
- Princess Alexandra Hospital/University of Queensland, Brisbane, QLD, Australia
| | - Eng-Siew Koh
- Liverpool Hospital/University of NSW, Liverpool, NSW, Australia
| | - Erik Sulman
- NYU Langone School of Medicine, New York, NY, USA
| | - Michael Back
- Royal North Shore Hospital / University of Sydney, St Leonards, NSW, Australia
| | | | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney/The Kinghorn Cancer Centre, Darlinghurst/St Vincent’s Hospital, Sydney, Camperdown, NSW, Australia
| | - Lauren Fisher
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Robyn Leonard
- COGNO Consumer Advisory Panel, Sydney, NSW, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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