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Hu J, Schild SE, Liu W, Li J, Fatyga M. Improving Dose Volume Histogram (DVH) Based Analysis of Clinical Outcomes Using Modern Statistical Techniques: A Systematic Answer to Multiple Comparisons Concerns. Int J Radiat Oncol Biol Phys 2023; 117:S20. [PMID: 37784451 DOI: 10.1016/j.ijrobp.2023.06.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) DVH constraints are essential in the clinical practice of radiation therapy. Historically, DVH constraints were found through sparse sampling of all possible DVH indices to find one that appeared to be most predictive for clinical toxicity. This approach can lead to inconsistent results among studies and to multiple comparison concerns. We aim to solve both problems by examining a full array of DVH indices using statistical methods that account for strong correlations among DVH indices and incorporate radiobiological knowledge constraints. MATERIALS/METHODS We extracted a dense array of V%_D indices from a treatment planning system using ESAPI interface, with V%_D corresponding to the volume fraction irradiated to dose D, or higher. We used Fused Lasso as the base model to compensate for correlations among DVH indices because it applies a penalty on the difference between DVH variables with adjacent dose. The base model was augmented with additional constraints based on radiobiological considerations: the positivity constraint (beta_i > 0) which assumes that any tissue irradiation cannot reduce the risk of toxicity, and monotonicity constraint (beta_i+1 > = beta_i) which assumes that higher dose to a fixed volume fraction cannot be associated with a lower risk of toxicity. We called the hybrid model KC-Lasso (Knowledge Constrained Lasso) and applied it to two clinical examples: grade 2 acute rectal toxicity in conventionally fractionated RT for 79 prostate cancer patients (77.4 Gy + MR based boost to 81-83 Gy) and cardiac toxicity in conventionally fractionated RT for 119 locally advanced Non-small Cell Lung Cancer (NSCLC) patients (Median prescribed dose 62 Gy). We further examined alternative data driven models to determine the importance of knowledge constraints. RESULTS KC-Lasso detected two distinct dose thresholds for grade 2 rectal toxicity, at 35 Gy and 78 Gy. A threshold of 51 Gy was detected for reduced overall survival due to cardiac irradiation in NSCLC patients. An examination of KC-Lasso models at varying step size suggested that a single mid-range index can be used as a treatment planning constraint while full model can be used for confirmatory, final plan evaluation. Alternative models which lack knowledge constraints show patterns of negative and isolated coefficients which are difficult to interpret and are not likely to be generalizable. CONCLUSION A more systematic approach to the analysis of correlations between DVH constraints and clinical toxicity can lead to greater consistency of results among different studies, better understanding of true dose thresholds and results which are more generalizable.
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Affiliation(s)
- J Hu
- Arizona State university, Tempe, AZ
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - W Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - J Li
- Georgia Institute of Technology, Atlanta, GA
| | - M Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
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Rades D, Staackmann C, Lomidze D, Jankarashvili N, Lopez F, Navarro A, Segedin B, Groselj B, Kristiansen C, Dennis K, Schild SE, Fernandez JC. Radiotherapy for Metastatic Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S74. [PMID: 37784567 DOI: 10.1016/j.ijrobp.2023.06.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate the outcomes of precision-radiotherapy (RT) with 15 × 2.633 Gy (EQD2 = 41.6 Gy for tumor cell kill, α/β = 10 Gy) or 18 × 2.333 Gy (EQD2 = 43.2 Gy) in patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses (>35 points on a validated survival score). In addition, these patients were compared to a historical control group of patients with favorable prognoses treated with 10 × 3 Gy (EQD2 = 32.5 Gy). MATERIALS/METHODS In a multi-center phase 2 study (RAMSES-01), patients with MSCC and favorable survival prognoses receiving 15 × 2.633 Gy or 18 × 2.333 Gy of precision-RT alone (no upfront surgery) were mainly evaluated for local progression-free survival (LPFS), defined as no deterioration of motor function during RT and no in-field recurrence of MSCC following RT, at 12 months (primary endpoint). Secondary endpoints included improvement of motor and sensory functions, post-RT ambulatory status, relief of pain and distress, toxicity, and survival (OS). The maximum relative doses allowed to the spinal cord were 101.5 % of the prescribed dose for 18 × 2.333 Gy and 101.2% for 15 × 2.633 Gy, respectively (both representing an EQD2 of 46.6 Gy for myelopathy, α/β = 2 Gy). In addition, the RAMSES-cohort was compared to a historical control group (N = 266) irradiated with 10 × 3 Gy (propensity score adjusted Cox regression). RESULTS In the RAMSES-cohort, 50 (of 62 planned) patients were evaluable for LPFS and included in the analyses. Since OS was worse than expected, a new survival score was developed, which was more precise in predicting OS than a previous tool. As a consequence, the RAMSES-trial, which was based on the previous score, was terminated. In the 50 patients included so far, 12-month rates of LPFS and OS were 97.6% and 69.9%, respectively. Improvement of motor function occurred in 28 patients (56.0%), and 47 patients (94.0%) were ambulatory following RT. Within 3 months following RT, 12 of 21 patients (57.2%) with pre-RT sensory deficits improved, 38 of 45 patients (84.4%) with pre-RT pain experienced at least partial relief, and 39 of 50 patients (78.0%) reported relief of distress. Ten of 50 patients (20.0%) experienced grade 2 toxicities (mainly esophagitis/dysphagia) and another two patients (4.0%) grade 3 toxicities (1 diarrhea, 1 esophagitis). After propensity score adjustment, the RAMSES-cohort showed significantly better LPFS than the control group (hazard ratio = 0.125, 95% confidence interval = 0.016 - 0.962, p = 0.046) and a strong trend regarding improvement of motor function (hazard ratio = 1.943, 95% confidence interval = 0.981 - 3.850, p = 0.057). Post-RT ambulatory rates (p = 0.56) and OS rates (p = 0.62) were not significantly different. CONCLUSION Precision-RT with 15 × 2.633 Gy or 18 × 2.333 Gy was sufficiently well tolerated and resulted in significantly better long-term LPFS than 10 × 3 Gy in patients with MSCC and favorable survival prognoses. Thus, the dose-fractionation regimens of the RAMSES-01 trial appear preferable for these patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - C Staackmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Lomidze
- Radiation Oncology Department, Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic, Tbilisi, Georgia
| | - N Jankarashvili
- Department of Radiation Oncology, Acad. F. Todua Medical Center - Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - F Lopez
- Department of Radiation Oncology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Navarro
- Department of Radiation Oncology, Instituto Catalán de Oncología, Barcelona, Spain
| | - B Segedin
- Department of Radiotherapy and Faculty of Medicine, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - B Groselj
- Department of Radiotherapy, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - C Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Veijle, Denmark
| | - K Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, ON, Canada
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - J Cacicedo Fernandez
- Department of Radiation Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Sperduto W, Voss MM, Laughlin B, Toesca DAS, Wong WW, Keole SR, Rwigema JC, Yu NY, Schild SE, James SE, Daniels TB, DeWees TA, Vargas CE. Oncologic Outcomes of Conventionally Fractionated, Hypofractionated, and Stereotactic Body Spot-Scanned Proton Radiation Therapy for Prostate Cancer: The Mayo Clinic Experience. Int J Radiat Oncol Biol Phys 2023; 117:e440. [PMID: 37785429 DOI: 10.1016/j.ijrobp.2023.06.1616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spot/pencil beam scanned proton therapy is a relatively new technology with fundamental differences from double scattered or IMRT. We aimed to report the long-term oncologic outcomes of a contemporary prospective series of patients treated with spot-scanned proton therapy (SSPT). MATERIALS/METHODS An IRB-approved prospective registry identified patients with prostate cancer treated with proton therapy between January 2016 and December 2018. Descriptive statistics were calculated for all patients. Clinical, demographic, and treatment characteristics were gathered and analyzed. Kaplan-Meier curves were generated to estimate survival and recurrence rates. Outcomes assessed included 5-year overall survival (OS), 5-year local control (LC), biochemical failure (BF), regional and distant failures, and physician-reported adverse events (AEs). Biochemical failure was defined as rise in PSA ≥ 2.0 ng/mL above nadir PSA. Acute and chronic gastrointestinal (GI) and genitourinary (GU) grade 2+ and grade 3+ baseline-adjusted AEs were assigned using CTCAE v5.0. All failures were re-staged with PET C-11 or PSMA. RESULTS With a median follow up of 4.4 years (IQR 3.7 - 5), two hundred and eighty-six prostate cancer patients with a median age of 72 (IQR 67.5 - 77) were treated with spot-scanned proton radiation. The median Gleason grade group was 3 (IQR 2 - 4). The median pre-RT PSA was 6.9 ng/mL (IQR 4.3 - 10.5). Median T-stage was T1c. Nearly 64% of all patients were on androgen deprivation therapy at the time of initiating radiation treatment. The median total radiation dose was 79.2 Gy delivered over 44 fractions, 70 Gy over 28 fractions, and 38 Gy over 5 fractions for CF, HF, and SBRT regimens, respectively. The BF rate for all patients was 8.4%. The 5-year LC rates for CF, HF, and SBRT were 100% (95% CI: 100 - 100), 100% (95% CI: 100 - 100), and 97.3% (95% CI: 92.2 - 100), respectively (p = 0.07). Regional recurrences occurred in 12 (4.2%) patients: 8 (5.6%) treated with CF, 2 (2.1%) with HF, and 2 (4.3%) with SBRT (p = 0.62). Distant metastatic failures occurred in 12 patients (4.2%): 5 (3.5%) treated with CF, 7 (7.4%) with HF, and none with SBRT (0%) (p = 0.052). The 5-year OS for patients treated with CF, HF, and SBRT SSPT were 88.2% (95% CI: 81.8 - 95), 86.2% (95% CI: 77.6 - 95.6), and 97.2% (95% CI: 92 - 100), respectively (p = 0.1). Acute and chronic grade 2+ GI baseline-adjusted AEs occurred in 8 (2.8%) and 51 (17.8%) patients, respectively. Acute and chronic grade 3+ GI baseline-adjusted AEs occurred in 3 (1%) and 4 (1.4%) patients, respectively. Acute and chronic grade 2+ GU-related AEs were observed in 72 (25.2%) and 63 (22%) patients, respectively. Acute and chronic grade 3+ GU toxicity was observed in 3 (1%) and 6 (2.1%) patients, respectively. CONCLUSION Spot-scanned proton radiation therapy provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.
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Affiliation(s)
- W Sperduto
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - M M Voss
- Department of Quantitative Health Sciences, Mayo Clinic, Arizona, Phoenix, AZ
| | - B Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - D A S Toesca
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - W W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - J C Rwigema
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - N Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | | | | | - T A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
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Bhangoo RS, Cheng TW, Petersen MM, Thorpe CS, DeWees TA, Anderson JD, Vargas CE, Patel SH, Halyard MY, Schild SE, Wong WW. Radiation recall dermatitis: A review of the literature. Semin Oncol 2022; 49:152-159. [DOI: 10.1053/j.seminoncol.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
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Liu X, Li J, Schild SE, Schild MH, Wong W, Vora S, Herman MG, Fatyga M. Modeling of Acute Rectal Toxicity to Compare Two Patient Positioning Methods for Prostate Cancer Radiotherapy: Can Toxicity Modeling be Used for Quality Assurance? ACTA ACUST UNITED AC 2019; 7. [PMID: 30775161 PMCID: PMC6376967 DOI: 10.4172/2167-7964.1000302] [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] [Indexed: 11/09/2022]
Abstract
Purpose: Intensity Modulated Radiation Therapy (IMRT) allows for significant dose reductions to organs at risk in prostate cancer patients. However, the accurate delivery of IMRT plans can be compromised by patient positioning errors. The purpose of this study was to determine if the modeling of grade ≥ 2 acute rectal toxicity could be used to monitor the quality of IMRT protocols. Materials and Methods: 79 patients treated with Image and Fiducial Markers Guided IMRT (FMIGRT) and 302 patients treated with trans-abdominal ultrasound guided IMRT (USGRT) was selected for this study. Treatment plans were available for the FMIGRT group, and hand recorded dosimetric indices were available for both groups. We modeled toxicity in the FMIGRT group using the Lyman Kutcher Burman (LKB) and Univariate Logistic Regression (ULR) models, and we modeled toxicity in USGRT group using the ULR model. We performed Receiver Operating Characteristics (ROC) analysis on all of the models and compared the Area under the ROC curve (AUC) for the FMIGRT and the USGRT groups. Results: The observed Incidence of grade ≥ 2 rectal toxicity was 20% in FMIGRT patients and 54% in USGRT patients. LKB model parameters in the FMIGRT group were TD50=56.8 Gy, slope m=0.093, and exponent n=0.131. The most predictive indices in the ULR model for the FMIGRT group were D25% and V50 Gy. AUC for both models in the FMIGRT group was similar (AUC=0.67). The FMIGRT URL model predicted less than a 37% incidence of grade ≥ 2 acute rectal toxicity in the USGRT group. A fit of the ULR model to USGRT data did not yield a predictive model (AUC=0.5). Conclusion: Modeling of acute rectal toxicity provided a quantitative measure of the correlation between planning dosimetry and this clinical endpoint. Our study suggests that an unusually weak correlation may indicate a persistent patient positioning error.
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Affiliation(s)
- X Liu
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - J Li
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, USA
| | - S E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M H Schild
- Department of Pathology, Duke University School of Medicine, USA
| | - W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - S Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M G Herman
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | - M Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
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Abstract
This study aims to identify predictors of survival and contribute to treatment personalization in patients with brain metastases from gastric cancer. Twelve patients received whole-brain radiotherapy (WBRT), four stereotactic radiosurgery and six neurosurgery plus WBRT. Treatment regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, tumor site, number of brain metastases, extra-cranial metastases and interval between cancer diagnosis and brain metastases were evaluated for survival. On univariate analyses, more intensive treatment (p=0.003), ECOG-score 0-1 (p<0.001), cardiac location (p=0.025) and single brain metastasis (p=0.023) were associated with better survival. On multivariate analysis, ECOG-score maintained significance (p<0.001). Patients with all three positive factors on univariate analysis had a 12-month survival rate of 100%, patients with three negative factors a 3-month survival rate of 0%. Predictors of survival were identified that can guide physicians selecting personalized treatment approaches for patients with brain metastases from gastric cancer.
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Schild SE, Vokes EE. Pathways to improving combined modality therapy for stage III nonsmall-cell lung cancer. Ann Oncol 2015; 27:590-9. [PMID: 26712904 DOI: 10.1093/annonc/mdv621] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 09/22/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths, having caused an estimated 1.6 million deaths worldwide in 2012 [Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386]. MATERIALS AND METHODS Although the majority of patients are not cured with currently available therapies, there have been significant improvements in stage-specific outcomes over time [Videtic G, Vokes E, Turrisi A et al. The survival of patients treated for stage III non-small cell lung cancer in North America has increased during the past 25 years. In The 39th Annual Meeting of the American Society of Clinical Oncology, ASCO 2003, Chicago, IL. Abstract 2557. p. 291]. This review focuses on past progress and ongoing research in the treatment of locally advanced, inoperable nonsmall-cell lung cancer (NSCLC). RESULTS In the past, randomized trials revealed advantages to the use of thoracic radiotherapy (TRT) and then, the addition of induction chemotherapy. This was followed by studies that determined concurrent chemoradiotherapy to be superior to sequential therapy. A recent large phase III trial found that the administration of 74 Gy of conventionally fractionated photon-based TRT provided poorer survival than did the standard 60 Gy. However, further research on other methods of applying radiotherapy (hypofractionation, adaptive TRT, proton therapy, and stereotactic TRT boosting) is proceeding and may improve outcomes. The molecular characterization of tumors has provided more effective and less toxic targeted treatments in the stage IV setting and these agents are currently under investigation for earlier stage disease. Similarly, immune-enhancing therapies have shown promise in stage IV disease and are also being tested in the locally advanced setting. CONCLUSION For locally advanced, inoperable NSCLC, standard therapy has evolved from TRT alone to combined modality therapy. We summarize the recent clinical trial experience and outline promising areas of investigation in an era of greater molecular and immunologic understanding of cancer care.
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Affiliation(s)
- S E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale
| | - E E Vokes
- Department of Medicine and Comprehensive Cancer Center, University of Chicago Medicine and Biologic Sciences, Chicago, USA
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Rades D, Segedin B, Nagy V, Schild SE, Trang NT, Khoa MT. Predicting the presence of extracranial metastases in patients with brain metastases upon first diagnosis of cancer. Strahlenther Onkol 2014; 190:405-7. [PMID: 24429480 DOI: 10.1007/s00066-013-0516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine factors allowing the prediction of extracranial metastases in patients presenting with brain metastases at the first diagnosis of cancer. MATERIALS AND METHODS Data from 659 patients with brain metastases upon first diagnosis of cancer were retrospectively analyzed. The parameters age, gender, Karnofsky performance score (KPS), primary tumor type and number of brain metastases were compared between 359 patients with extracranial metastases and 300 patients without extracranial metastases. Additional analyses were performed for patients with the most unfavorable and those with the most favorable characteristics. RESULTS The comparison of patients with versus without extracranial metastases revealed significant differences between the groups in terms of KPS (p < 0.001) and number of brain metastases (p < 0.001). Of the study patients, 113 had both most unfavorable characteristics, i.e. KPS ≤ 50 and ≥ 4 brain metastases. The sensitivity for identifying patients with extracranial metastases was 82 %; specificity was 51 %. A total of 50 patients had KPS ≥ 90 and only one brain metastasis. The sensitivity for identifying patients without extracranial metastases was 86 %; specificity was 58 %. CONCLUSION The combination of KPS and the number of brain metastases can help to predict the presence or absence of extracranial metastases.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Rades D, Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F. Androgen receptor expression: prognostic value in locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2014; 189:849-55. [PMID: 23959264 DOI: 10.1007/s00066-013-0389-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of androgen receptor (AR) expression of tumor cells in patients treated with surgery and subsequent radio(chemo)therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS The impact of AR and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively studied in 163 patients with nonmetastatic stage III/IV SCCHN. Additional factors included age, gender, ECOG performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, HPV status, extent of resection, and concurrent chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with pre-RT hemoglobin levels≥12 g/dl (risk ratio [RR] 2.22; 95% confidence interval [CI] 1.19–4.13; p=0.013), tumor site (RR 1.39; 95% CI 1.14–1.70; p=0.001), lower T category (RR 1.67; 95% CI 1.18–2.44; p=0.003), and lower N category (RR 4.18; 95% CI 1.90–10.55; p<0.001). Improved MFS was associated with AR expression (RR 2.21; 95% CI 1.01–5.41; p=0.048), better ECOG performance status (RR 3.19; 95% CI 1.50–7.14; p=0.003), lower T category (RR 2.24; 95% CI 1.47–3.65; p<0.001), and lower N category (RR 5.33; 95% CI 2.07–16.63; p<0.001). OS was positively associated with AR expression (RR 1.99; 95% CI 1.06–4.00; p=0.032), better ECOG performance status (RR 2.20; 95% CI 1.20–4.09; p=0.010), pre-RT hemoglobin levels≥12 g/dl (RR 2.13; 95% CI 1.19–3.82; p=0.012), lower T category (RR 1.81; 95% CI 1.30–2.62; p<0.001), and lower N category (RR 3.41; 95% CI: 1.65–7.80; p<0.001). CONCLUSION Tumor cell expression of AR was an independent prognostic factor for MFS and OS and should be considered in future prospective trials.
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Rades D, Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE. Brain metastasis. Prognostic value of the number of involved extracranial organs. Strahlenther Onkol 2013; 189:996-1000. [PMID: 24104872 DOI: 10.1007/s00066-013-0442-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study was performed to evaluate the prognostic role for survival of the number and the type of involved extracranial organs in patients with brain metastasis. MATERIAL AND METHODS The data of 1146 patients who received whole-brain radiotherapy (WBRT) alone for brain metastasis have been retrospectively analyzed. In addition to the number of involved extra cranial organs, seven potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), primary tumor type, number of brain metastases, and the interval from cancer diagnosis to WBRT. Additionally, subgroup analyses were performed for patients with involvement of one (lung vs. bone vs. liver vs. other metastasis) and two (lung + lymph nodes vs. lung + bone vs. lung + liver vs. liver + bone vs. other combinations) extracranial organs. RESULTS The 6-month survival rates for the involvement of 0, 1, 2, 3, and ≥4 extracranial organs were 51, 30, 16, 13, and 10%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs maintained significance (risk ratio 1.26; 95% confidence interval 1.18-1.34; p<0.001). According to the multivariate analysis, age (p<0.001), gender (p=0.002), and KPS (p<0.001) were also independent prognostic factors for survival. In the subgroup analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the extracranial organ involved. CONCLUSION The number of involved extracranial organs proved to be an independent prognostic factor in patients with brain metastasis, regardless of the organs involved. The number of involved extracranial organs should be considered in future trials designed for patients with brain metastasis.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Gerdan L, Segedin B, Nagy V, Khoa MT, Trang NT, Schild SE, Rades D. Brain metastasis from non-small cell lung cancer (NSCLC): prognostic importance of the number of involved extracranial organs. Strahlenther Onkol 2013; 190:64-7. [PMID: 24104871 DOI: 10.1007/s00066-013-0439-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the potential prognostic value of the number of involved extracranial organs in patients with brain metastasis from non-small cell lung cancer (NSCLC). MATERIAL AND METHODS A total of 472 patients who received whole-brain radiotherapy (WBRT) alone with 5 × 4 Gy or 10 × 3 Gy for brain metastasis from NSCLC were included in this retrospective study. In addition to the number of involved extracranial organs, 6 further potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), number of brain metastases, and the interval from cancer diagnosis to WBRT. Subgroup analyses were performed for patients with metastatic involvement of one (lung vs. bone vs. other metastasis) and two (lung + bone vs. lung+lymph nodes vs. other combinations) extracranial organs. RESULTS The survival rates at 6 months of the patients with involvement of 0, 1, 2, 3, and ≥ 4 extracranial organs were 52, 27, 17, 4, and 14%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs remained significant (risk ratio 1.32; 95% confidence interval 1.19-1.46; p<0.001). Age <65 years (p=0.004), KPS ≥ 70 (p<0.001), and only 1-3 brain metastases (p=0.022) were also significantly associated with survival in the multivariate analysis. In the separate analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the pattern of extracranial organ involvement. CONCLUSION The number of involved extracranial organs is an independent prognostic factor of survival in patients with brain metastasis from NSCLC, irrespective of the pattern of extracranial organ involvement.
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Affiliation(s)
- L Gerdan
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Rades D, Seibold ND, Hoffmann A, Gebhard MP, Noack F, Thorns C, Schild SE. Impact of the HPV-positivity definition on the prognostic value of HPV status in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:856-60. [PMID: 23868550 DOI: 10.1007/s00066-013-0377-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE This study re-evaluated the prognostic value of HPV status for loco-regional control (LRC), metastases-free survival (MFS), and survival (OS) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). A modified definition of HPV positivity was used in the current study compared to the authors' previous study. PATIENTS AND METHODS In the previous study of the same 170 patients, a tumor was defined as HPV-positive if it showed a positive in situ hybridization result in ≥10% of tumor cells and/or positive p16 immunostaining. In the current analysis, tumors were considered HPV-positive only if they showed positive results for both in situ hybridization and p16 immunostaining. In addition to HPV status, the same 11 potential prognostic factors were investigated for treatment outcomes as in the preceding study. RESULTS In the multivariate analysis of the current study, HPV positivity was significantly associated with improved LRC [risk ratio (RR) 9.78; p<0.001], MFS (RR 7.17; p=0.008), and OS (RR 6.61; p<0.001). In the previous study, HPV positivity was associated with LRC (RR 2.34; p=0.014) and OS (RR 2.19; p=0.019), but not with MFS (RR 2.04; p=0.11). CONCLUSIONS Applying the new definition of HPV positivity, the impact of HPV status on the prognosis of patients irradiated for locally advanced SCCHN was more prominent than in our previous study and associated with all three investigated endpoints.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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Seibold ND, Schild SE, Bruchhage KL, Gebhard MP, Noack F, Rades D. Prognostic impact of VEGF and FLT-1 receptor expression in patients with locally advanced squamous cell carcinoma of the head and neck. Strahlenther Onkol 2013; 189:639-46. [PMID: 23748230 DOI: 10.1007/s00066-013-0341-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic value of tumor cell expression of vascular endothelial growth factor (VEGF) and its receptor fms-related tyrosine kinase 1 (FLT-1) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) who had been treated with adjuvant radiotherapy or radiochemotherapy. MATERIAL AND METHODS The impact of tumor cell VEGF and FLT-1 expression plus 11 additional factors on loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) was retrospectively evaluated in 157 patients. The additional factors were age, gender, performance status, pre-radiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T-category, N-category, human papillomavirus (HPV) status, extent of resection and chemotherapy. RESULTS On multivariate analysis, improved LRC was significantly associated with an absence of VEGF expression (risk ratio, RR: 5.02; p = 0.009), lower T-category (RR: 2.00; p < 0.001), lower N-category (RR: 3.75; p < 0.001) and pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.20; p = 0.029). Improved MFS was significantly associated with an absence of VEGF expression (RR: 7.46; p = 0.002), lower T-category (RR: 1.97; p = 0.002), lower N-category (RR: 3.29; p = 0.005) and a favorable tumor location (RR: 1.34; p = 0.033); HPV positivity showed a trend towards improved MFS (RR: 1.43; p = 0.09). Improved OS was significantly associated with an absence of VEFG expression (RR: 3.22; p = 0.041), pre-RT hemoglobin levels ≥ 12 g/dl (RR: 2.47; p = 0.009), lower T-category (RR: 1.92; p < 0.001) and lower N-category (RR: 3.39; p < 0.001). FLT-1 expression was significantly associated with LRC and OS in the univariate but not in the multivariate analysis. CONCLUSION VEGF expression proved to be an independent negative predictor for LRC, MFS and OS in patients treated for locally advanced SCCHN with adjuvant radiotherapy or radiochemotherapy. FLT-1 expression was not significant in multivariate analyses.
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Affiliation(s)
- N D Seibold
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany
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Rades D, Dziggel L, Segedin B, Oblak I, Nagy V, Marita A, Schild SE, Trang NT, Khoa MT. A simple survival score for patients with brain metastases from breast cancer. Strahlenther Onkol 2013; 189:664-7. [PMID: 23740157 DOI: 10.1007/s00066-013-0367-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Personalized cancer treatment considers the patient's survival prognosis. Therefore, it is important to be able to estimate the patient's survival time, particularly in a palliative situation such as brain metastasis. This study aimed to create and validate a survival score for patients with brain metastasis from breast cancer, which is the second most common primary tumor in these patients. PATIENTS AND METHODS Data of 230 patients treated with whole-brain radiotherapy (WBRT) alone for brain metastasis from breast cancer were retrospectively analyzed. Patients were assigned to a test (n = 115) or a validation group (n = 115). According to the results of the multivariate analysis of the test group, Karnofsky Performance Score and extracranial metastases were included in the scoring system. The score for each factor was obtained from the 6-month survival rate (in %) divided by 10. Total scores represented the sum of these scores and were 4, 7, 9, or 12 points. Three prognostic groups were formed. RESULTS The 6-month survival rates in the test group were 10 % for 4-7 points, 55 % for 9 points, and 78 % for 15 points (p < 0.001). In the validation group the corresponding 6-month survival rates were 11, 54, and 75 %, respectively (p < 0.001). The comparisons between the prognostic groups of the test and the validation group did not show significant differences. CONCLUSION This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Schild SE, Keole SR, Foote RL. Re: Proton vs Intensity-Modulated Radiotherapy for Prostate Cancer: Patterns of Care and Early Toxicity. J Natl Cancer Inst 2013; 105:748-748. [DOI: 10.1093/jnci/djt074] [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: 08/30/2023] Open
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Rades D, Veninga T, Bajrovic A, Karstens JH, Schild SE. A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlenther Onkol 2013; 189:462-6. [PMID: 23604188 DOI: 10.1007/s00066-013-0342-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to develop and validate a scoring system to identify long-term survivors after conventional radiotherapy (RT) for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 1,125 patients who had received long-course RT for MSCC were included in this study. Of these patients, 344 survived for over 12 months and 781 died within a year following RT. Based on differences between the distributions of patient characteristics in the two groups, a scoring system was developed. Scores ranged from 0 to 18 points and 15 points was selected as the cutoff for identifying long-term survivors. Data from the 1,125 long-course RT patients (test group) were compared to data from 773 patients receiving short-course RT (validation group). RESULTS A score of ≥ 15 points was associated with a 94 % proportion of long-term survivors. The 15-point cutoff resulted in a specificity of 98 % and a positive predictive value of 94 % for identification of long-term surviving patients. The proportions of long-term survivors for each scoring point in the validation group were very similar to those in the test group. CONCLUSION This new scoring system enabled identification of long-term survivors after RT for MSCC with very high specificity and positive predictive value. The score proved to be valid and reproducible.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, Lubeck, Germany.
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Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D. Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 2013; 189:364-6. [PMID: 23519358 DOI: 10.1007/s00066-013-0308-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to validate a scoring system published in 2008 to predict the survival of patients receiving whole-brain radiotherapy (WBRT) alone for brain metastases. METHODS The scoring system included four independent prognostic factors: age, performance status, extracranial metastases, and interval between first diagnosis of cancer and WBRT. The score for each prognostic factor was determined by dividing the 6-month survival rate (in %) by 10. The total score represented the sum of the scores for each prognostic factor. Total scores ranged from 9-18 points, and patients were divided into four groups. In the present study, 350 new patients were evaluated in order to validate the previously developed score. RESULTS In the present validation study, the 6-month survival rates were 8 % for patients with a score of 9-10 points (group A), 24 % for those with a score of 11-13 points (group B), 51 % for those with a score of 14-16 points (group C), and 82 % for those with scores of 17-18 points (group D), respectively (p < 0.001). In our previous study published in 2008, the 6-month survival rates were 6 %, 15 %, 43 %, and 76 %, respectively (p < 0.001). The comparisons between each of the four prognostic groups of both series did not reveal a significant difference. CONCLUSION In this study, the 6-month survival rates of the four prognostic groups were not significantly different from those of the preceding study. This demonstrates the validity and reproducibility of this score. The score can help select the appropriate treatment for the individual patient and help design prospective trials.
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Affiliation(s)
- L Dziggel
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Rades D, Douglas S, Schild SE. A validated survival score for breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 189:41-6. [PMID: 23138773 DOI: 10.1007/s00066-012-0230-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/27/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND To create a validated scoring system predicting survival of breast cancer patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Of 510 patients, one half were assigned to either the test or the validation group. In the test group, eight pretreatment factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time of developing motor deficits) plus the radiation regimen were retrospectively investigated. Factors significantly associated with survival in the multivariate analysis were included in the scoring system. The score for each factor was determined by dividing the 6-month survival rate (%) by ten. The total score was the sum of the scores for each factor. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and time of developing motor deficits were significant for survival and included in the score. Total scores ranged from 30 to 50 points. In the test group, the 6-month survival rates were 12% for 30-35 points, 41% for 36-40 points, 74% for 41-45 points, and 98% for 46-50 points (p < 0.0001). In the validation group, the 6-month survival rates were 14%, 46%, 77%, and 99%, respectively (p < 0.0001). CONCLUSION The survival rates of the validation group were similar to the test group. Therefore, this score was reproducible and can help when selecting the appropriate radiotherapy regimen for each patient taking into account her survival prognosis.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Schild SE, Foster NR, Meyers JP, Ross HJ, Stella PJ, Garces YI, Olivier KR, Molina JR, Past LR, Adjei AA. Prophylactic cranial irradiation in small-cell lung cancer: findings from a North Central Cancer Treatment Group Pooled Analysis. Ann Oncol 2012; 23:2919-2924. [PMID: 22782333 PMCID: PMC3577038 DOI: 10.1093/annonc/mds123] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This pooled analysis evaluated the outcomes of prophylactic cranial irradiation (PCI) in 739 small-cell lung cancer (SCLC patients with stable disease (SD) or better following chemotherapy ± thoracic radiation therapy (TRT) to examine the potential advantage of PCI in a wider spectrum of patients than generally participate in PCI trials. PATIENTS AND METHODS Three hundred eighteen patients with extensive SCLC (ESCLC) and 421 patients with limited SCLC (LSCLC) participated in four phase II or III trials. Four hundred fifty-nine patients received PCI (30 Gy/15 or 25 Gy/10) and 280 did not. Survival and adverse events (AEs) were compared. RESULTS PCI patients survived significantly longer than non-PCI patients {hazard ratio [HR] = 0.61 [95% confidence interval (CI): 0.52-0.72]; P < 0.0001}. The 1- and 3-year survival rates were 56% and 18% for PCI patients versus 32% and 5% for non-PCI patients. PCI was still significant after adjusting for age, performance status, gender, stage, complete response, and number of metastatic sites (HR = 0.82, P = 0.04). PCI patients had significantly more grade 3+ AEs (64%) compared with non-PCI patients (50%) (P = 0.0004). AEs associated with PCI included alopecia and lethargy. Dose fractionation could be compared only for LSCLC patients and 25 Gy/10 was associated with significantly better survival compared with 30 Gy/15 (HR = 0.67, P = 0.018). CONCLUSIONS PCI was associated with a significant survival benefit for both ESCLC and LSCLC patients who had SD or a better response to chemotherapy ± TRT. Dose fractionation appears important. PCI was associated with an increase in overall and specific grade 3+ AE rates.
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Affiliation(s)
- S E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale.
| | - N R Foster
- Section of Biomedical Statistics and Informatics, Mayo Clinic, Rochester
| | - J P Meyers
- Section of Biomedical Statistics and Informatics, Mayo Clinic, Rochester
| | - H J Ross
- Division of Medical Oncology, Mayo Clinic
| | - P J Stella
- Michigan Cancer Research Consortium, Ann Arbor
| | - Y I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester
| | - K R Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester
| | - J R Molina
- Department of Medical Oncology, Mayo Clinic, Rochester
| | - L R Past
- Department of Radiation Oncology, Luther Hospital Eau Claire
| | - A A Adjei
- Department of Radiation Oncology, Mayo Clinic, Rochester
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Rades D, Hakim SG, Bajrovic A, Karstens JH, Veninga T, Rudat V, Schild SE. Impact of zoledronic acid on control of metastatic spinal cord compression. Strahlenther Onkol 2012; 188:910-6. [PMID: 22903395 DOI: 10.1007/s00066-012-0158-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Zoledronic acid was demonstrated to reduce the rate of skeletal-related events, a hypernym including various outcomes, in patients with bone metastases. In contrast to other studies, this matched-pair analysis focused solely on the impact of zoledronic acid on metastatic spinal cord compression (MSCC). PATIENTS AND METHODS Data from 98 patients with MSCC receiving radiotherapy plus zoledronic acid were matched 1:2 to 196 patients receiving radiotherapy alone for ten potential prognostic factors. Both groups were compared for local control of MSCC within the irradiated region, overall control of MSCC (local and distant MSCC control), and survival. RESULTS The 1-year local control rates were 90% after radiotherapy plus zoledronic acid and 81%, after radiotherapy alone (p = 0.042). The 1-year overall control rates were 87% and 75%, respectively (p = 0.016), and the 1-year survival rates were 60% and 52%, respectively (p = 0.17). Results were significant in the Cox proportional hazards model regarding local control (p = 0.024) and overall control (p = 0.008). CONCLUSION According to the results of this study, zoledronic acid was associated with improved control of MSCC in irradiated patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
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Rades D, Douglas S, Veninga T, Bajrovic A, Stalpers LJA, Hoskin PJ, Rudat V, Schild SE. A survival score for patients with metastatic spinal cord compression from prostate cancer. Strahlenther Onkol 2012; 188:802-6. [PMID: 22526228 DOI: 10.1007/s00066-012-0106-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to develop and validate a survival scoring system for patients with metastatic spinal cord compression (MSCC) from prostate cancer. PATIENTS AND METHODS Of 436 patients, 218 patients were assigned to the test group and 218 patients to the validation group. Eight potential prognostic factors (age, performance status, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits) plus the fractionation regimen were retrospectively investigated for associations with survival. Factors significant in the multivariate analysis were included in the survival score. The score for each significant prognostic factor was determined by dividing the 6-month survival rate (%) by 10. The total score represented the sum of the scores for each factor. The prognostic groups of the test group were compared to the validation group. RESULTS In the multivariate analysis of the test group, performance status, ambulatory status, other bone metastases, visceral metastases, and interval from cancer diagnosis to radiotherapy were significantly associated with survival. Total scores including these factors were 20, 21, 22, 24, 26, 28, 29, 30, 31, 32, 33, 35, 37, or 39 points. In the test group, the 6-month survival rates were 6.5% for 20-24 points, 44.6% for 26-33 points, and 95.8% for 35-39 points (p < 0.0001). In the validation group, the 6-month survival rates were 7.4%, 45.4%, and 94.7%, respectively (p < 0.0001). CONCLUSIONS Because the survival rates of the validation group were almost identical to the test group, this score can be considered valid and reproducible.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Germany.
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Rades D, Schild SE. Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlenther Onkol 2012; 188:702-6. [PMID: 22418589 DOI: 10.1007/s00066-012-0093-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT. METHODS Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered. RESULTS Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases. CONCLUSION The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2 years are needed to help customize the treatment for individual patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Rades D, Douglas S, Veninga T, Stalpers LJA, Bajrovic A, Rudat V, Schild SE. Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 2012; 188:340-5. [PMID: 22354333 DOI: 10.1007/s00066-011-0061-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was performed to identify new significant prognostic factors in breast cancer patients irradiated for metastatic spinal cord compression (MSCC). PATIENTS AND METHODS The data of 504 patients with breast cancer patients with MSCC were retrospectively analyzed with respect to posttreatment motor function, local control of MSCC, and survival. The investigated potential prognostic factors included age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, other bone metastases, visceral metastases, pretreatment ambulatory status, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits before radiotherapy, and the radiation schedule. RESULTS On multivariate analysis, better functional outcome was associated with ambulatory status prior to RT (estimate - 1.29, p < 0.001), no visceral metastases (estimate - 0.52, p = 0.020), and slower development of motor deficits (estimate + 2.47, p < 0.001). Improved local control was significantly associated with no other bone metastases (risk ratio (RR) 4.33, 95% confidence interval (CI) 1.36-14.02, p = 0.013) and no visceral metastases (RR 3.02, 95% CI 1.42-6.40, p = 0.005). Improved survival was significantly associated with involvement of only 1-2 vertebrae (RR 1.27, 95% CI 1.01-1.60, p = 0.044), ambulatory status before radiotherapy (RR 1.75, 95% CI 1.23-2.50, p = 0.002), no other bone metastases (RR 1.93, 95% CI 1.18-3.13, p = 0.009), no visceral metastases (RR 7.60, 95% CI 5.39-10.84, p < 0.001), and time developing motor deficits before radiotherapy (RR 1.55, 95% CI 1.30-1.86, p < 0.001). CONCLUSION Several new independent prognostic factors were identified for treatment outcomes. These prognostic factors should be considered in future trials and may be used to develop prognostic scores for breast cancer patients with MSCC.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lubeck, Germany.
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Rades D, Huttenlocher S, Evers JN, Bajrovic A, Karstens JH, Rudat V, Schild SE. Do elderly patients benefit from surgery in addition to radiotherapy for treatment of metastatic spinal cord compression? Strahlenther Onkol 2012; 188:424-30. [PMID: 22349635 DOI: 10.1007/s00066-011-0058-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/23/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND Treatment of elderly cancer patients has gained importance. One question regarding the treatment of metastatic spinal cord compression (MSCC) is whether elderly patients benefit from surgery in addition to radiotherapy? In attempting to answer this question, we performed a matched-pair analysis comparing surgery followed by radiotherapy to radiotherapy alone. PATIENTS AND METHODS Data from 42 elderly (age > 65 years) patients receiving surgery plus radiotherapy (S + RT) were matched to 84 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for ten potential prognostic factors and compared regarding motor function, local control, and survival. Additional matched-pair analyses were performed for the subgroups of patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS, n = 81) and receiving laminectomy (LE, n = 45). RESULTS Improvement of motor function occurred in 21% after S + RT and 24% after RT (p = 0.39). The 1-year local control rates were 81% and 91% (p = 0.44), while the 1-year survival rates were 46% and 39% (p = 0.71). In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred in 22% after DDSS + RT and 24% after RT alone (p = 0.92). The 1-year local control rates were 95% and 89% (p = 0.62), and the 1-year survival rates were 54% and 43% (p = 0.30). In the matched-pair analysis of patients receiving LE, improvement of motor function occurred in 20% after LE + RT and 23% after RT alone (p = 0.06). The 1-year local control rates were 50% and 92% (p = 0.33). The 1-year survival rates were 32% and 32% (p = 0.55). CONCLUSION Elderly patients with MSCC did not benefit from surgery in addition to radiotherapy regarding functional outcome, local control of MSCC, or survival.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany.
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Rades D, Kueter JD, Gliemroth J, Veninga T, Pluemer A, Schild SE. Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. Strahlenther Onkol 2012; 188:143-7. [PMID: 22234538 DOI: 10.1007/s00066-011-0024-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal treatment for patients with a single brain metastasis is controversial. This study investigated the value of a radiation boost given in addition to neurosurgerical resection and whole-brain irradiation (WBI). PATIENTS AND METHODS In this retrospective study, outcome data of 105 patients with a single brain metastasis receiving metastatic surgery plus WBI (S + WBI) were compared to 90 patients receiving the same treatment plus a boost to the metastatic site (S + WBI + B). The outcomes that were compared included local control of the resected metastasis (LC) and overall survival (OS). In addition to the treatment regimen, eight potential prognostic factors were evaluated including age, gender, performance status, extent of metastatic resection, primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from first diagnosis of cancer to metastatic surgery. RESULTS The LC rates at 1 year, 2 years, and 3 years were 38%, 20%, and 9%, respectively, after S + WBI, and 67%, 51%, and 33%, respectively, after S + WBI + B (p = 0.002). The OS rates at 1 year, 2 years, and 3 years were 52%, 25%, and 19%, respectively, after S + WBI, and 60%, 40%, and 26%, respectively, after S + WBI + B (p = 0.11). On multivariate analyses, improved LC was significantly associated with OP + WBI + B (p = 0.006) and total resection of the metastasis (p = 0.014). Improved OS was significantly associated with age ≤ 60 years (p = 0.028), Karnofsky Performance Score > 70 (p = 0.015), breast cancer (p = 0.041), RPA class 1 (p = 0.012), and almost with the absence of extracerebral metastases (p = 0.05). CONCLUSION A boost in addition to WBI significantly improved LC but not OS following resection of a single brain metastasis.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, Lubeck, Germany.
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Schild SE, Foster NR, Meyers JP, Olivier KR, Ross HJ, Molina JR, Stella PJ, Past LR, Garces YI, Adjei AA. Prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC): Findings from a North Central Cancer Treatment Group (NCCTG) pooled analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7074] [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: 11/20/2022] Open
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Mandrekar SJ, Qi Y, Allen-Ziegler K, Hillman SL, Redman MW, Schild SE, Gandara DR, Adjei AA. Systematic evaluation of the impact of disease progression (DP) date determination on progression-free survival (PFS) in advanced lung cancer: A joint North Central Cancer Treatment Group (NCCTG) and Southwest Oncology Group (SWOG) investigation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7005] [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: 11/20/2022] Open
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Molina JR, Dy GK, Foster NR, Allen Ziegler KL, Adjei A, Rowland KM, Aubry M, Flynn PJ, Mandrekar SJ, Schild SE, Adjei AA. A randomized phase II study of pemetrexed (PEM) with or without sorafenib (S) as second-line therapy in advanced non-small cell lung cancer (NSCLC) of nonsquamous histology: NCCTG N0626 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jatoi A, Schild SE, Foster N, Henning GT, Dornfeld KJ, Flynn PJ, Fitch TR, Dakhil SR, Rowland KM, Stella PJ, Soori GS, Adjei AA. A phase II study of cetuximab and radiation in elderly and/or poor performance status patients with locally advanced non-small-cell lung cancer (N0422). Ann Oncol 2010; 21:2040-2044. [PMID: 20570832 DOI: 10.1093/annonc/mdq075] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is a disease of the elderly. Seeking a tolerable but effective regimen, we tested cetuximab + radiation in elderly and/or poor performance status patients with locally advanced NSCLC. PATIENTS AND METHODS Older patients [≥ 65 years with an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2] or younger patients (performance status of 2) received cetuximab 400 mg/m(2) i.v. on day 1 followed by weekly cetuximab 250 mg/m(2) i.v. with concomitant radiation of 6000 cGy in 30 fractions. The primary end point was the percentage who lived 11+ months. RESULTS This 57-patient cohort had a median age (range) of 77 years (60-87), and 12 (21%) had a performance status of 2. Forty of 57 (70%) lived 11+ months, thus exceeding the anticipated survival rate of 50%. The median survival was 15.1 months [95% confidence interval (CI) 13.1-19.3 months], and the median time to cancer progression was 7.2 months (95% CI 5.8-8.6 months). No treatment-related deaths occurred, but 31 patients experienced grade 3+ adverse events, most commonly fatigue, anorexia, dyspnea, rash, and dysphagia, each of which occurred in <10% of patients. CONCLUSION This combination merits further study in this group of patients.
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Affiliation(s)
- A Jatoi
- Mayo Clinic Rochester, Rochester, MN.
| | | | - N Foster
- Mayo Clinic Rochester, Rochester, MN
| | | | - K J Dornfeld
- Duluth City Clinical Oncology Program, Duluth, MN
| | - P J Flynn
- Metro-Minnesota Community Oncology Program, St Louis Park, MN
| | | | - S R Dakhil
- Wichita Community Clinical Oncology Program, Wichita, KS
| | - K M Rowland
- Carle Cancer Center City Clinical Oncology Program, Urbana, IL
| | - P J Stella
- Michigan Cancer Consortium, Ann Arbor, MI
| | - G S Soori
- Missouri Valley Cancer Consortium, Omaha, NE
| | - A A Adjei
- Roswell Park Cancer Institute, Buffalo, NY, USA
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Halyard MY, Tan A, Callister MD, Ashman JB, Vora SA, Wong W, Schild SE, Atherton PJ, Sloan JA. Assessing the clinical significance of real-time quality of life (QOL) data in cancer patients treated with radiation therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Mandrekar SJ, Hillman SL, Allen-Ziegler K, Jatoi A, Jett JR, Schild SE, Adjei AA. Impact of the algorithm for declaring exact progression date on progression-free survival (PFS) estimates in advanced lung cancer clinical trials. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7629] [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: 11/20/2022] Open
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Schild SE, Molina JR, Dy GK, Rowland KM, Sarkaria JN, Thomas SP, Northfelt DW, Kugler JW, Foster NR, Adjei AA. N0321: A phase I study of bortezomib, paclitaxel, carboplatin (CBDCA), and radiotherapy (RT) for locally advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7085] [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: 11/20/2022] Open
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Dy GK, Mandrekar SJ, Nelson GD, Ross HJ, Ansari RH, Lyss AP, Stella PJ, Schild SE, Molina JR, Adjei AA. A randomized phase II study of gemcitabine (G) and carboplatin (C) with or without cediranib (AZD2171 [CED]) as first-line therapy in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Foster NR, Qi Y, Shi Q, Krook JE, Kugler JW, Jett JR, Molina JR, Schild SE, Adjei AA, Mandrekar SJ. Tumor response and progression-free survival (PFS) as potential surrogate endpoints for overall survival (OS) in extensive-stage small cell lung cancer (ES-SCLC): Findings based on North Central Cancer Treatment Group (NCCTG) trials. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7637] [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: 11/20/2022] Open
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35
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Qi Y, Dy GK, Nelson GD, Schild SE, Mandrekar SJ, Adjei AA. Incidence of bleeding and thrombosis among elderly patients (pts) undergoing systemic chemotherapy in advanced non-small cell lung cancer (NSCLC): An analysis of North Central Cancer Treatment Group (NCCTG) trials. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, Rudat V, Schild SE. Final results of a study comparing short-course and long-course radiotherapy (RT) for local control of metastatic spinal cord compression (MSCC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9522] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
9522 Background: Many MSCC patients live long enough to develop a recurrence in the irradiated spinal area. This is the first prospective study comparing different RT schedules for local control (LC) of MSCC. Methods: 265 patients treated with RT alone (1/06–12/07) were included in this prospective non-randomized study. The primary goal was to compare short-course (1×8 Gy/5×4 Gy, N=131) and long-course RT (10×3 Gy/15×2.5 Gy/20×2 Gy, N=134) for 1-year LC. Secondary endpoints were motor function and 1-year survival (OS). Dutch patients received short-course, and German patients long-course RT. The analysis of LC (no MSCC recurrence in the irradiated spinal area) included the 224 patients with improvement or no change of motor deficits during RT. The difference in 1-year LC was previously reported to be 14% between short- and long-course RT. For a statistical power of 90 % (significance level 5%), ≥218 patients were required to detect this difference. Univariate analyses (UVA) for LC and OS were performed with Kaplan-Meier-method and log-rank test, multivariate analyses (MVA) with the Cox proportional hazards model. UVA and MVA for motor function were performed with the ordered-logit-model. Eleven additional factors were evaluated. Results: 1-year LC was 61% after short-course RT and 81% after long-course RT (P=0.005). On MVA, improved LC was only associated with long-course RT (P=0.018). Motor function improved in 37% after short- and 39% after long-course RT (P=0.95). Improved motor function was associated with better performance status (P=0.015), favorable tumor (P=0.034), and slower development of motor deficits (P<0.001). 1-year OS was 23% after short- and 30% after long-course RT (P=0.28). On MVA, improved OS was associated with better performance status (P<0.001), no visceral metastases (P<0.001), involvement of 1–3 vertebrae (P=0.040), ambulatory status (P=0.038), and bisphosphonates (P<0.001). Conclusions: Long-course RT was associated with better LC, similar functional outcome, and similar OS compared to short-course RT. Patients with a favorable OS prognosis should receive long-course RT, and those with a poor OS prognosis should receive short-course RT. [Table: see text]
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Affiliation(s)
- D. Rades
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - M. Lange
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - T. Veninga
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - L. J. Stalpers
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - A. Bajrovic
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - I. A. Adamietz
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - V. Rudat
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
| | - S. E. Schild
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; Academic Medical Centre, Amsterdam, Netherlands; University of Hamburg, Hamburg, Germany; Ruhr University, Bochum, Germany; Saad Specialist Hospital, Al Khobar, Saudi Arabia; Mayo Clinic, Scottsdale, AZ
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Dziggel L, Veninga T, Haatanen T, Lohynska R, Schild SE, Schild SE, Rades D. Scoring systems predictive of survival and local control of patients irradiated for brain metastases. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2075 Background: This study was performed to create and validate scoring systems to estimate survival and intracerebral local control at 6 months of patients irradiated for brain metastases. Methods: Data of 1,797 patients irradiated for brain metastases (1,346 whole-brain radiotherapy [WBRT], 131 radiosurgery [RS], 61 WBRT + RS, 259 resection + WBRT) were retrospectively analyzed. Patients were randomly assigned to the test group (N = 1,198) or the validation group (N = 599). In the test group, multivariate analyses (MVA, Cox proportional hazards model) were performed for survival (OS) and local control (LC). Based on the MVA results, two scoring systems were developed, one for OS and another for LC. The scores included the prognostic factors found significant on MVA. Age, performance status, extracranial metastases, interval from tumor diagnosis to RT, and number of brain metastases were significant for OS. Tumor type, performance status, interval from tumor diagnosis to RT, and number of brain metastases were significant for LC. The score for each factor was determined by dividing the 6-month OS or LC rate (%) by 10. The total score represented the sum of the scores for each factor. For OS, total scores ranged from 15–30 points, and patients were divided into three groups (15–19, 20–25, and 26–30 points). For LC, total scores ranged from 14–27 points, and patients were divided into three groups (14–18, 19–23, and 24–27 points). Results: In the test group, the 6-month OS rates were 9 ± 1% for patients with scores of 15–19 points, 41 ± 2% for those with 20–25 points, and 78 ± 2% for those with 26–30 points (p < 0.0001). The corresponding OS rates in the validation group were 7 ± 2%, 39 ± 3%, and 79 ± 3%, respectively (p < 0.0001).In the test group, the 6-month LC rates were 17 ± 3% for patients with 14–18 points, 49 ± 3% for those with 19–23 points, and 77 ± 2% for those with 24–27 points (p < 0.0001). The corresponding LC rates in the validation group were 19 ± 4%, 52 ± 4%, and 77 ± 3%, respectively (p < 0.0001). Conclusions: Patients irradiated for brain metastases can be grouped with these scores to estimate OS and LC. The OS and LC rates of the validation group were almost identical to the test group, which demonstrates the high validity and reproducibility of both scores. No significant financial relationships to disclose.
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Affiliation(s)
- L. Dziggel
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - T. Veninga
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - T. Haatanen
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - R. Lohynska
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - S. E. Schild
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - S. E. Schild
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
| | - D. Rades
- University of Lubeck, Lubeck, Germany; Dr. Bernard Verbeeten Institute, Tilburg, Netherlands; University of Hamburg, Hamburg, Germany; University of Prague, Prague, Czech Republic; Mayo Clinic, Scottsdale, AZ
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Bohlen G, Raabe A, Dahm-Daphi J, Dikomey E, Schild SE, Dunst J, Rades D. Development of a new micro-injection-system for adenoviral gene delivery (MAGD). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22167 Background: Safe and effective delivery of viral vectors is important for gene therapy. Local application of such vectors is more efficient than systemic application. However, currently available injection systems are not optimal because placement of the injection needle and the vector application itself are generally not reproducibile. We developed a new injection system providing controlled injection of adenoviral vectors in tumors (xeno-transplants) in nude mice (NMRI nu/nu). Methods: The new MAGD consists of two fixation devices mounted on a 40x40cm plexi-glass plate, four injection units, and one pump unit with 4 infusion-pumps (Bee hive, Bioanalytical, Chesire, UK). Each injection unit is linked to a pump with commercially available plastic tube. Because the injection arms can be moved in x-,y- and z-direction, virus injection can easily performed for irregular tumor volumes. The entire injection volume is equally distributed to the 4 injection pumps allowing precise and steady injection rates between 0.1μl/min and 100μl/min. Success was confirmed with MRI-scans (Magnetom symphony, Siemens, Erlangen, Germany) 10 min after the injection. The efficacy of the MAGD was tested in 4 human squamous cell carcinoma cell lines from oro-/hypopharynx (FaDu, UD- SCC2, UD-SCC6, and UD-SCC7a). Virus transfection was performed with an adenovirus (serotype 5) expressing enhanced green fluorescent protein (eGFP). Transfection rates were quantified with flow cytometry. Successfully transfected cells expressed eGFP resulting in green fluorescence. In-vitro cell lines (concentration: 10 particles per cell, MOI 10) of FaDu, UD-SCC2, UD-SCC6 and UD-SCC7a served as controls. Results: The MAGD was easy to handle. Injection of 100μl (25μl per infusion pump) at an injection rate of 5μl/min took only 5 min. The in-vivo transfection rates achieved with the MAGD were 9±1% for FaDu, 39±2% for UD- SCC, 54±1% for UD-SCC6 and 54±9% for UD-SCC7a, respectively. The in-vitro transfection rates (controls) for these 4 cell lines were 2±1%, 23±4%, 29±4% and 3±2%, respectively. Conclusions: The new MAGD provided controlled injection of adenoviral vectors in tumors in nude mice. It proved to be effective, as it resulted in comparably high transfection rates. No significant financial relationships to disclose.
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Affiliation(s)
- G. Bohlen
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - A. Raabe
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - J. Dahm-Daphi
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - E. Dikomey
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - S. E. Schild
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - J. Dunst
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
| | - D. Rades
- University of Lubeck, Lubeck, Germany; University of Hamburg, Hamburg, Germany; Mayo Clinic, Scottsdale, AZ
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Foster NR, Qi Y, Krook JE, Kugler JW, Kuross SA, Jett JR, Molina JR, Schild SE, Adjei AA, Mandrekar SJ. Comparison of progression-free survival (PFS) and tumor response as endpoints for predicting overall survival (OS) in untreated extensive-stage small cell lung cancer (ED-SCLC): Findings based on North Central Cancer Treatment Group (NCCTG) trials. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8085 Background: Historically, tumor response has been the primary endpoint in phase II (P2) trials in ED-SCLC. We investigated the suitability of alternate PFS based endpoints to predict OS as early evidence of efficacy in the P2 setting. Methods: Individual patient (pt) data from 942 pts from 11 previously untreated ED-SCLC P2 and phase III (P3) platinum- or paclitaxel-based treatment trials were pooled. Best response (BR), response confirmed (RC), objective status at 16 weeks (RR16), and PFS rate at 5 and 6 months were considered. Percent agreement (PA) and kappa (k) for PFS5, PFS6, BR, RC, and RR16 with OS at 12 months (OS12) was calculated on a per-pt basis and predictive utility was assessed using the area under the receiver operating characteristic (A- ROC) curve in logistic models. Cox models were used to assess the prognostic impact of the endpoints on subsequent survival, using landmark analysis. Results: The median OS and PFS were 9.6 m and 5.5 m, respectively. PFS5 and PFS6 had the highest PA, k, and A-ROC values, and were predictive of subsequent survival in the landmark analysis (p <0.0001; c-statistics ≥ 0.60). While RR16 and BR were significantly associated with subsequent survival (p<0.0001, c-statistics of 0.61 and 0.57, respectively) the PA, k, and A-ROC values were lower. Conclusions: PFS rate at 5 and 6 months is more predictive of 12-month OS and subsequent survival than tumor response in untreated ED-SCLC. PFS based endpoints should be routinely used as primary endpoints in P2 trials within ED-SCLC. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- N. R. Foster
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - Y. Qi
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. E. Krook
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. W. Kugler
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - S. A. Kuross
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. R. Jett
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. R. Molina
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - S. E. Schild
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - A. A. Adjei
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - S. J. Mandrekar
- Mayo Clinic, Rochester, MN; Duluth Clinic, Duluth, MN; Illinois CancerCare, Peoria, IL; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
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Sengpiel C, König IR, Rades D, Noack F, Duchrow M, Schild SE, Ludwig D, Homann N. p53 Mutations in carcinoma of the esophagus and gastroesophageal junction. Cancer Invest 2009; 27:96-104. [PMID: 19160092 DOI: 10.1080/07357900802161047] [Citation(s) in RCA: 3] [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: 12/15/2022]
Abstract
BACKGROUND Recent studies suggested p53 mutations as a prognostic factor. Tumors of the esophagus and gastroesophageal (GE) junction show raising incidence with a general poor prognosis. METHODS p53 Mutational spectra in 103 patients (68 squamous cell carcinoma/SCC and 35 adenocarcinoma/AC) were compared to clinical and pathologic data. RESULTS AND CONCLUSIONS p53 Mutations were found in 26 of 68 SSC (38.2%) and in 12 of 35 AC (34.5%). We only found G > T transversions in smokers with SCC. The survival of patients was not affected by p53 mutational status. In our study, the frequency and mutational spectrum of mutant p53 is similar in both histological types without prognostic relevance.
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Affiliation(s)
- C Sengpiel
- Department of Gastroenterology, University Hospital Schleswig-Holstein, Campus Lubeck, Germany
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Markovic SN, Erickson LA, Flotte TJ, Kottschade LA, McWilliams RR, Jakub JW, Farley DR, Tran NV, Schild SE, Olivier KR, Vuk-Pavlovic S, Sekulic A, Weenig RH, Pulido JS, Quevedo JF, Vile RG, Wiseman GA, Stoian I, Pittelkow MR. Metastatic malignant melanoma. GIORN ITAL DERMAT V 2009; 144:1-26. [PMID: 19218908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Metastatic malignant melanoma is an incurable malignancy with extremely poor prognosis. Patients bearing this diagnosis face a median survival time of approximately 9 months with a probability of surviving 5 years after initial presentation at less than 5%. This is contrasted by the curative nature of surgical resection of early melanoma detected in the skin. To date, no systemic therapy has consistently and predictably impacted the overall survival of patients with metastatic melanoma. However, in recent years, a resurgence of innovative diagnostic and therapeutic developments have broadened our understanding of the natural history of melanoma and identified rational therapeutic targets/strategies that seem poised to significantly change the clinical outcomes in these patients. Herein we review the state-of-the-art in metastatic melanoma diagnostics and therapeutics with particular emphasis on multi-disciplinary clinical management.
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Affiliation(s)
- S N Markovic
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Mandrekar SJ, Hillman SL, Ziegler KLA, Reuter NF, Rowland KM, Marks RS, Schild SE, Adjei AA. Comparison of progression-free survival (PFS) with best or confirmed response (BR, CR) as an endpoint for overall survival (OS) in advanced non small cell lung cancer (A-NSCLC): A North Central Cancer Treatment Group (NCCTG) investigation. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schild SE, Qi Y, Tan AD, Mandrekar SJ, Adjei AA, Krook JE, Rowland KM, Garces YI, Soori GS, Sloan JA. Baseline quality of life (QOL) as a prognostic factor for overall survival (OS) in patients (Pts) with advanced stage non-small cell lung cancer (A-NSCLC): An analysis of NCCTG studies. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Foster NR, Mandrekar SJ, Schild SE, Nelson GD, Rowland Jr KM, Deming RL, Kozelsky TF, Jett JR, Marks RS, Adjei AA. Prognostic importance of performance status (PS) in small cell lung cancer (SCLC): A North Central Cancer Treatment Group (NCCTG) investigation. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19041] [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: 11/20/2022] Open
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Schild SE, Mandrekar SJ, Jatoi A, McGinnis WL, Stella PJ, Deming RL, Jett JR, Garces YI, Allen KL, Adjei AA. The value of combined modality therapy in elderly patients with stage III non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19503 Background: This study was performed to assess the value of combined modality therapy in elderly patients by comparing the differences in outcome of those who received radiotherapy (RT) alone or RT plus chemotherapy for stage III NSCLC. Methods: North Central Cancer Treatment Group (NCCTG) performed 2 recent phase III trials for stage III NSCLC. The first trial, 90–24–51, included 3 arms: once-daily radiotherapy (QDRT) alone, twice daily RT (BIDRT) alone, and concurrent chemotherapy plus BIDRT. The second trial, 94–24- 52 included 2 arms and compared concurrent chemotherapy with either QDRT or BIDRT. The chemotherapy arms of both trials included etoposide and cisplatin administered concurrently with RT. Only the patients ≥65 years of age (elderly) who participated in these trials were included in this analysis. Results: Of the 166 elderly patients included in this analysis, 37 received RT alone and 129 received concurrent chemotherapy plus RT. The median and 5-year survival rates were 10.5 months and 5.4% for the RT alone group compared to 13.7 months and 14.7% for the RT plus chemotherapy group (log-rank p=0.05). Patients who received RT plus chemotherapy experienced significantly greater severe (grade ≥3) toxicity than those who received RT alone (89.9% versus 32.4%, p < 0.01). Conclusions: Elderly patients who participated in these trials appear to gain a survival advantage from RT and chemotherapy compared to RT alone. As is the case with younger patients, this benefit comes at the cost of additional toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- S. E. Schild
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - S. J. Mandrekar
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - A. Jatoi
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - W. L. McGinnis
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - P. J. Stella
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - R. L. Deming
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - J. R. Jett
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - Y. I. Garces
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - K. L. Allen
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
| | - A. A. Adjei
- Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; Iowa Oncology Research Association CCOP, Des Moines, IA; Michigan Cancer Research Consortium, Ann Arbor, MI; Iowa Oncology Research Association CCOP, Des Moines, IA
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Adjei AA, Molina JR, Hillman SL, Luyun RF, Reuter NF, Rowland KM, Jett JR, Mandrekar SJ, Schild SE. A front-line window of opportunity phase II study of sorafenib in patients with advanced non-small cell lung cancer: A North Central Cancer Treatment Group study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7547] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7547 Background: Sorafenib is a multikinase inhibitor with single-agent activity in previously treated NSCLC. In an effort to evaluate its single agent activity in previously untreated NSCLC, the NCCTG undertook a front-line “window of opportunity” study. Materials and Methods: Patients with stage IIIB (pleural effusion) or stage IV NSCLC received sorafenib dosed at 400 mg BID continuously, with a cycle defined as 4 weeks. Patients were evaluated weekly during the first 2 cycles with those who progressed rapidly going on to receive standard chemotherapy. Based on a two-stage Fleming design, if only at most 1 confirmed response was observed in the first 20 patients enrolled to stage I, the regimen would be considered ineffective. If 2 or more responses were observed, the study would proceed to stage 2 and accrue an additional 22 patients. If 5 or more confirmed responses were observed, the regimen would be recommended for further testing. Results: The study did not meet the stage I efficacy criteria (only 1 confirmed partial response in the first 20 patients) and was permanently closed after enrolling 25 evaluable patients [15 females, 10 males; 4 stage IIIB, 21 stage IV; median age 67 (45–85)]. 2 patients are still receiving treatment (14 and 15 months). No grade 3 or higher hematologic adverse events were observed. Thirteen (52%) patients had a grade 3 non-hematologic adverse event with fatigue (20%), diarrhea (8%), and dyspnea (8%) being the most common. There was one grade 4 pulmonary hemorrhage. A total of 3 (12%) PRs; and 7 (28%) SD were observed in the 25 patients 7 (28%) patients were progression- free at 24 weeks. Median survival and median time to progression were 8.8 and 2.9 months respectively. Conclusion: While the pre- specified efficacy endpoints were not met, the objective response rate of 12% and median survival of 8.8 months suggest that single agent sorafenib has activity similar to two-drug combinations. The feasibility and utility of the “window of opportunity” design in estimating the activity of novel compounds was demonstrated. Finally, the single-agent activity of sorafenib argues for combination studies with standard chemotherapy agents. No significant financial relationships to disclose.
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Affiliation(s)
- A. A. Adjei
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - J. R. Molina
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - S. L. Hillman
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - R. F. Luyun
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - N. F. Reuter
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - K. M. Rowland
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - J. R. Jett
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - S. J. Mandrekar
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
| | - S. E. Schild
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Carle Cancer Center, Urbana, IL; CentraCare Clinic, St. Cloud, MN; Mayo Clinic College of Medicine, Scottsdale, AZ
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Foster NR, Mandrekar SJ, Schild SE, Nelson GD, Jett JR, Adjei AA. Age, gender, performance status and stage outperformed stage alone in predicting overall survival (OS) in patients with small cell lung cancer: A pooled analysis of 1,623 patients from the North Central Cancer Treatment Group. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7723] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
Abstract
7723 Background: It is critical that we understand the impact of patient, tumor, and treatment-related factors on patient prognosis for the proper design and analysis of Small Cell Lung Cancer (SCLC) trials. An analysis of 15 SCLC trials was performed to investigate and improve our understanding of several factors on OS. Methods: Data from 1623 patients (pts) were used. Age, gender, performance status (PS), tumor stage, body mass index (BMI), creatinine levels, hemoglobin levels, white blood cell counts (WBC), platelet counts, and bilirubin levels were tested for prognostic significance for OS both univariately and multivariately using a Cox Proportional Hazards Model. Models were stratified by protocol, and analyses carried out on the complete data available based on the selected covariates. Model discrimination (i.e., ability to discriminate patients with different survival times) was evaluated using the concordance index (COI). Results: Median follow-up was 63.1 months (range: 1.9 to 155.7). 58% and 42% of pts had extensive-stage or limited-stage SCLC, respectively. Patients with extensive-stage disease, PS>0, increased age, and male gender had significantly worse OS both univariately and multivariately. Patients with increased WBC had significantly worse OS univariately, however, WBC was not a significant predictor when adjusted for other factors. None of the other factors were prognostic for OS. Model discrimination improved by 6.3% when age, gender, PS, and stage were included in a model compared to a model with stage alone (COI improved from 0.63 to 0.67). Conclusions: Age, gender, PS and stage did better at predicting OS than stage alone. Further refinement of this model, including the addition of number of metastatic sites at baseline and treatment related factors, is currently underway. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- N. R. Foster
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - S. J. Mandrekar
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - S. E. Schild
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - G. D. Nelson
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - J. R. Jett
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
| | - A. A. Adjei
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Roswell Park Cancer Institute, Buffalo, NY
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Abstract
Ovarian cancer patients developing metastatic spinal cord compression (MSCC) are extremely rare and account for only 0.4% of MSCC patients. Only very few case reports are available in the literature. This analysis evaluates seven ovarian cancer patients treated for MSCC with radiotherapy alone. Data of 1,852 MSCC patients irradiated between 1992 and 2005 were retrospectively reviewed. Seven patients were identified with epithelial ovarian cancer. These seven patients were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. The patients received either short-course radiotherapy (1 × 8 Gy or 5 × 4 Gy, n= 2) or long-course radiotherapy (10 × 3 Gy, 15 × 2.5 Gy, or 20 × 2 Gy, n= 5). Improvement of motor function occurred in three of the seven patients, in three of the five patients after long-course radiotherapy, and none of the two patients after short-course radiotherapy. Two of the five nonambulatory patients regained the ability to walk after radiotherapy. No further deterioration of motor function was seen in another three of the seven patients, in two of the five patients after long-course radiotherapy, and one of the two patients after short-course radiotherapy. Deterioration occurred in one of the seven patients, in none of the five patients after long-course radiotherapy, and one of the two patients after short-course radiotherapy. Patients died after a median interval of 4 months (range 1–7 months) following radiotherapy. A recurrence of MSCC did not occur. Radiotherapy alone is effective in improving or maintaining motor function in MSCC patients with ovarian cancer and should be administered if decompressive surgery is not indicated.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.
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Rades D, Lang S, Schild SE, Alberti W. Prognostic Value of Haemoglobin Levels During Concurrent Radio-chemotherapy in the Treatment of Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2006; 18:139-44. [PMID: 16523815 DOI: 10.1016/j.clon.2005.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS To evaluate the prognostic value of haemoglobin levels during radio-chemotherapy for overall survival, metastases-free survival (MFS) and locoregional control in patients with locally advanced oesophageal cancer. MATERIALS AND METHODS Age, gender, performance status, tumour location, tumour length, histology, histologic grading, T-stage, N-stage, UICC-stage and weekly haemoglobin levels during concurrent radio-chemotherapy were retrospectively investigated and related to outcome in 108 patients, who received radio-chemotherapy for stage II/III oesophageal cancer. Radio-chemotherapy consisted of 59.4-60 Gy irradiation, two to four courses of cisplatin (75 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2 on days 1-5). Haemoglobin levels during radio-chemotherapy were compared among the following three groups: patients with over 60% of haemoglobin levels less than 12 g/dl; patients with over 60% of haemoglobin levels at 12-14 g/dl; and patients with over 60% of haemoglobin levels greater than 14 g/dl. RESULTS On univariate analysis, haemoglobin levels of 12-14 g/dl and greater than 14 g/dl during concurrent radio-chemotherapy provided better outcomes than haemoglobin levels less than 12 g/dl. The 2-year overall survival rates were 34%, 35% and 16%, respectively (P = 0.002). The 2-year MFS survival rates were 23%, 46% and 21%, respectively (P = 0.06). The 2-year locoregional control rates were 44%, 58% and 19%, respectively (P < 0.001). ECOG performance status (1 better than 2-3) was significantly associated with overall survival (P = 0.013), tumour length (<7 cm better than > or = 7 cm) with overall survival (P = 0.002) and MFS (P = 0.002), N-stage (N0 better than N1) with overall survival (P = 0.004) and MFS (P < 0.001), and UICC-stage (stage II better than III) with overall survival (P = 0.025) and MFS (P = 0.010). On multivariate analysis, haemoglobin levels during radio-chemotherapy maintained significance for overall survival (P = 0.002) and locoregional control (P < 0.001), tumour length for overall survival (P = 0.002) and MFS (P = 0.008), and N-stage for MFS (P = 0.003). CONCLUSIONS Haemoglobin during radiotherapy and concurrent radio-chemotherapy is an independent prognostic factor in oesophageal cancer treatment. To improve outcome, it seems important to maintain the haemoglobin at 12-14 g/dl.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Germany.
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Dy GK, Miller AA, Mandrekar SJ, Aubry MC, Langdon RM, Morton RF, Schild SE, Jett JR, Adjei AA. A phase II trial of imatinib (ST1571) in patients with c-kit expressing relapsed small-cell lung cancer: a CALGB and NCCTG study. Ann Oncol 2005; 16:1811-6. [PMID: 16087693 DOI: 10.1093/annonc/mdi365] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the clinical activity of imatinib mesylate in patients with recurrent and refractory c-kit-expressing small-cell lung cancer. PATIENTS AND METHODS Patients with c-kit-expressing SCLC (> or =1+ by immunohistochemistry) were enrolled in two groups. Arm A included patients with disease progression <3 months and arm B included patients with disease progression > or =3 months after previous treatment. Imatinib was administered at a dose of 400 mg b.i.d. continuously, with a cycle length of 28 days. A single stage Simon design with a planned interim analysis was used to evaluate the 16-week progression free rate in each arm. RESULTS A total of 29 evaluable patients were entered into the study (seven in arm A, median age 68; 22 in arm B, median age 64.5). Median number of treatment cycles was one in both arms. Grade 3+ non-hematologic adverse events were seen in 15 (52%) patients, with nausea, vomiting, dyspnea, fatigue, anorexia and dehydration each occurring in at least 10% of patients. Median survival was 3.9 and 5.3 months and median time to progression was 1 and 1.1 months for arms A and B, respectively. Enrollment to arm A was temporarily suspended prior to reaching interim analysis due to striking early disease progression (29%), early deaths (29%) and patient refusal (42%). No objective responses and no confirmed stable disease > or =6 weeks were seen in either arm. Accrual was permanently terminated to both arms as only one patient was progression-free at 16 weeks. CONCLUSION Imatinib failed to demonstrate any clinical activity in spite of patient selection for c-kit-expressing SCLC. Our results strengthen the collective evidence that prediction of efficacy of novel therapeutic agents based on target expression, rather than pathway activation (for example, through activating mutations), may not be a valid paradigm for drug development.
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Affiliation(s)
- G K Dy
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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