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Meredith EG, Filion E, Faria S, Kundapur V, Thuc TVTT, Lok BH, Raman S, Bahig H, Laba JM, Lang P, Louie AV, Hope A, Rodrigues GB, Bezjak A, Campeau MP, Duclos M, Bratman S, Swaminath A, Salunkhe R, Warner A, Palma DA. Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00480-2. [PMID: 38614279 DOI: 10.1016/j.ijrobp.2024.03.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). METHODS Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. RESULTS Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. CONCLUSIONS 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.
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Affiliation(s)
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Sergio Faria
- McGill University Health Centre, Montréal, Canada
| | | | | | | | | | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | | | | | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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Welch ML, Kim S, Hope AJ, Huang SH, Lu Z, Marsilla J, Kazmierski M, Rey-McIntyre K, Patel T, O'Sullivan B, Waldron J, Bratman S, Haibe-Kains B, Tadic T. RADCURE: An open-source head and neck cancer CT dataset for clinical radiation therapy insights. Med Phys 2024; 51:3101-3109. [PMID: 38362943 DOI: 10.1002/mp.16972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE This manuscript presents RADCURE, one of the most extensive head and neck cancer (HNC) imaging datasets accessible to the public. Initially collected for clinical radiation therapy (RT) treatment planning, this dataset has been retrospectively reconstructed for use in imaging research. ACQUISITION AND VALIDATION METHODS RADCURE encompasses data from 3346 patients, featuring computed tomography (CT) RT simulation images with corresponding target and organ-at-risk contours. These CT scans were collected using systems from three different manufacturers. Standard clinical imaging protocols were followed, and contours were manually generated and reviewed at weekly RT quality assurance rounds. RADCURE imaging and structure set data was extracted from our institution's radiation treatment planning and oncology information systems using a custom-built data mining and processing system. Furthermore, images were linked to our clinical anthology of outcomes data for each patient and includes demographic, clinical and treatment information based on the 7th edition TNM staging system (Tumor-Node-Metastasis Classification System of Malignant Tumors). The median patient age is 63, with the final dataset including 80% males. Half of the cohort is diagnosed with oropharyngeal cancer, while laryngeal, nasopharyngeal, and hypopharyngeal cancers account for 25%, 12%, and 5% of cases, respectively. The median duration of follow-up is five years, with 60% of the cohort surviving until the last follow-up point. DATA FORMAT AND USAGE NOTES The dataset provides images and contours in DICOM CT and RT-STRUCT formats, respectively. We have standardized the nomenclature for individual contours-such as the gross primary tumor, gross nodal volumes, and 19 organs-at-risk-to enhance the RT-STRUCT files' utility. Accompanying demographic, clinical, and treatment data are supplied in a comma-separated values (CSV) file format. This comprehensive dataset is publicly accessible via The Cancer Imaging Archive. POTENTIAL APPLICATIONS RADCURE's amalgamation of imaging, clinical, demographic, and treatment data renders it an invaluable resource for a broad spectrum of radiomics image analysis research endeavors. Researchers can utilize this dataset to advance routine clinical procedures using machine learning or artificial intelligence, to identify new non-invasive biomarkers, or to forge prognostic models.
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Affiliation(s)
- Mattea L Welch
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Cancer Digital Intelligence Program, Toronto, ON, Canada
| | - Sejin Kim
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Cancer Digital Intelligence Program, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Andrew J Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Shao Hui Huang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Zhibin Lu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joseph Marsilla
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Michal Kazmierski
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Katrina Rey-McIntyre
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tirth Patel
- Cancer Digital Intelligence Program, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Brian O'Sullivan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - John Waldron
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Scott Bratman
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Cancer Digital Intelligence Program, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Tony Tadic
- Cancer Digital Intelligence Program, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Hope A, Kim JW, Kazmierski M, Welch M, Marsilla J, Huang SH, Hosni A, Tadic T, Patel T, Haibe-Kains B, Waldron J, O'Sullivan B, Bratman S. The Auto-Lindberg Project: Standardized Target Nomenclature in Radiation Oncology Enables Real-World Data Extraction From Radiation Treatment Plans. Int J Radiat Oncol Biol Phys 2024; 118:268-274. [PMID: 37611810 DOI: 10.1016/j.ijrobp.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Michal Kazmierski
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mattea Welch
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Joseph Marsilla
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tony Tadic
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tirth Patel
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Benjamin Haibe-Kains
- Bioinformatics and Computational Genomics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Scott Bratman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Watson E, El Maghrabi A, Lee JH, Pu J, Xu W, Joudah S, D'Souza V, Quiñonez C, Mojdami ZD, Huang SH, O'Sullivan B, Ringash J, Kim J, Cho J, Bratman S, Waldron J, Goldstein D, Abdalaty AH, Glogauer M, Hope A. Implication of dental insurance status on patterns of pre-radiation dental extraction and risk of osteoradionecrosis of the jaw in head-and-neck cancer patients. Oral Oncol 2023; 145:106527. [PMID: 37499325 DOI: 10.1016/j.oraloncology.2023.106527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
Oral toxicities such as osteoradionecrosis can be minimized by dental screening and prophylactic dental care prior to head and neck (HN) radiation therapy (RT). However, limited information is available about how dental insurance interacts with prophylactic dental care and osteoradionecrosis. To address this gap in knowledge, we conducted a cohort study of 2743 consecutive adult patients treated with curative radiation for HN malignancy who underwent pre-radiation dental assessment and where required, prophylactic dental treatment. Charts were reviewed to determine patient demographics, dental findings, dental treatment and development of osteoradionecrosis following radiation. Three insurance cohorts were identified: private-insured (50.4 %), public-insured (7.3 %), being patients with coverage through government-funded disability and welfare programs, and self-pay (42.4 %). More than half the public-insured patients underwent prophylactic pre-radiation dental extractions, followed by self-pay patients (44 %) and private-insured patients (26.6 %). After a median follow-up time of 4.23 years, 6.5 % of patients developed osteoradionecrosis. The actuarial rate of osteoradionecrosis in the public-insured patients was 14.7 % at 5-years post-RT, compared to 7.5 % in private-insured patients and 6.7 % in self-pay patients. On multivariable analysis, dental insurance status, DMFS160, age at diagnosis, sex, tumor site, nodal involvement, years smoked and gross income were all significant risk factors for tooth removal prior to HN radiation. However, only public-insured status, tumor site and years smoked were significant risk factors for development of osteoradionecrosis. Our findings demonstrate that lack of comprehensive dental coverage (patients who self-pay or who have limited coverage under public-insured programs) associates strongly with having teeth removed prior to HN RT. Nearly 1 in 6 patients covered under public-insurance developed osteoradionecrosis within 5 years of completing their treatment. Well-funded dental insurance programs for HN cancer patients might reduce the number of pre-RT extractions performed in these patients, improving quality of life post-RT.
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Affiliation(s)
- Erin Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada; Faculty of Dentistry, University of Toronto, Canada.
| | - Amr El Maghrabi
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Jun Hyung Lee
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Jiajie Pu
- Department of Biostatistics, Princess Margaret Cancer Centre, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Canada
| | - Shahad Joudah
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Violet D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Canada
| | - Carlos Quiñonez
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Zahra Dorna Mojdami
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, Toronto, Canada
| | - Ali Hosni Abdalaty
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
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Johnny C, Huang SH, Su J, Bratman S, Cho J, Hahn E, Hosni A, Hope A, Kim J, O'Sullivan B, Ringash JG, Waldron J, Spreafico A, Eng L, Goldstein D, Tong L, Xu W, McPartlin A. The Prognostic and Predictive Value of Pre-Treatment Total Lymphocyte Count in HPV+ Oropharyngeal Carcinoma Receiving Definitive (Chemo-) Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e591-e592. [PMID: 37785789 DOI: 10.1016/j.ijrobp.2023.06.1942] [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) Evidence of prognostic importance of pre-radiotherapy (RT) total lymphocyte counts (TLC) and interaction with addition of cisplatin (CRT) in HPV-positive oropharyngeal carcinoma (HPV+OPC) is conflicting. Recent data suggest patients with high TLC may not benefit from the addition of chemotherapy (Price et al, JCO 2022). We assess the prognostic and predictive value of TLC in a large single center HPV+OCP cohort. MATERIALS/METHODS All HPV+OPC patients treated at a single academic center with definitive RT/CRT between 2005-2018 were included. Pre-treatment TLC up to 6 weeks prior to RT start were considered. Multivariable analysis (MVA) was applied to assess the prognostic importance of TLC (continuous variable), adjusted for age, gender, performance status, TNM-8 stage, and smoking status in the CRT and RT subgroups. The actuarial rates of locoregional control (LRC), distant control (DC), and overall survival (OS) were calculated using Kaplan-Meier and competing risk methods, stratified by low vs high TLC (determined using Contal and O'Quigley method for optimal cutoff). RESULTS Among 1153 eligible patients, 707 (61%) were treated with CRT. Median age was 59.7 (range 22.7-92.2) years. 526 patients were (46%) TNM-8 stage I, 366 (32%) stage II and 261 (23%) stage III. Median TLC was 1.6 x 109/L (range 0.1-8.5). Median follow-up was 5.5 years. On MVA, TLC was prognostic for patients receiving CRT (OS [adjusted hazard ration (aHR) 0.55 (0.38-0.79), p = 0.002], DC [aHR 0.57 (0.37-0.88), p = 0.011], LRC [aHR 0.57 (0.36-0.89), p = 0.014]) but not RT (OS [aHR 1.04 (0.82-1.31), p = 0.74], LRC [aHR 1.26 (0.86-1.85), p = 0.23], DC [aHR 0.87 (0.64-1.19), p = 0.4)]. The optimal TLC cut-off for OS with CRT was 1.9 x 109/L. Low vs high TLC patients receiving CRT had significantly inferior 5-year DC (87% vs 93%, p = 0.017) and OS (84% vs 90%, p = 0.026). The benefit of higher TLC was most evident in stage II disease (table 1). CRT vs RT improved OS for stage II/III disease at high and low TLC. CONCLUSION Pre-treatment TLC is prognostic in a large cohort of HPV+OPC patients receiving CRT but not RT alone. Further investigation of the interaction of cisplatin and immune response during RT is warranted. The omission of chemotherapy based on TLC is not supported.
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Affiliation(s)
- C Johnny
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S H Huang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Center/University of Toronto, Toronto, ON, Canada
| | - J Cho
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - J G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Spreafico
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Eng
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Tong
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Center/University of Toronto, Toronto, ON, Canada
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Kim JW, Marsilla J, Kazmierski M, Tkachuk D, Huang SH, Xu W, Cho J, Ringash J, Bratman S, Haibe-Kains B, Hope A. Impact of radiotherapy quality assurance on nasopharyngeal carcinoma: Usage of a novel web-based quality assurance application. Pract Radiat Oncol 2023:S1879-8500(23)00057-7. [PMID: 36948414 DOI: 10.1016/j.prro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE We used a new web application for rapid review of radiotherapy (RT) target volumes to evaluate the relationship between target delineation compliance with the international guidelines and outcomes of definitive RT for nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS The dataset consists of CT simulation scans, RT structures, and clinical data of 354 pathology-confirmed NPC patients treated with intensity-modulated RT between 2005 and 2017. Target volumes were peer-reviewed in RT QA rounds, and target contours were revised, if recommended, before treatment. We imported the contours of intermediate-risk clinical target volumes of the primary tumor (IR-CTVp) of 332 patients into the application. Inclusion of anatomic sites within IR-CTVp was determined in accordance with 2018 International guideline for CTV delineation for NPC and correlated with time to local failure (TTLF) using Cox-regression. RESULTS In the peer-review QA analysis, local and distant control and overall survival (OS) rates were similar between peer-reviewed and non-reviewed cases and between cases with and without target contour changes. In the CTV compliance analysis, with a median follow-up of 5.6 years, 5-year TTLF and OS rates were 93.1% and 85.9% respectively. The most frequently non-guideline compliant anatomic sites were sphenoid sinus (n=69, 20.8%), followed by cavernous sinus (n=38, 19.3%), left and right petrous apices (n=37 and 32, 11.1% and 9.6%), and clivus (n=14, 4.2%). Among 23 patients with a local failure (6.9%), the number of non-compliant cases were 8 for sphenoid sinus, 7 cavernous sinus, 4 left and 3 right petrous apices, and 2 clivus. Cavernous sinus-conforming cases showed higher TTLF in comparison with non-conforming cases (93.6% vs 89.1%, p=0.013). Multivariable analysis confirmed that cavernous sinus non-compliance was prognostic for TTLF. CONCLUSIONS Our application allowed rapid quantitative review of CTVp in a large NPC cohort. While compliance with the international guidelines was high, under-coverage of the cavernous sinus was correlated with TTLF.
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Affiliation(s)
- Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Joseph Marsilla
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Michal Kazmierski
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Denis Tkachuk
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center/University of Toronto, Toronto, Ontario, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
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Sanz Garcia E, Laliotis G, Avery L, Spreafico A, Hansen A, Eng L, Singaravalan N, Willingham S, Liu M, Soleimani S, Pugh T, Bratman S, Siu L. 9P Early circulating tumor DNA (ctDNA) kinetics and gene expression analysis to predict treatment outcomes with anti-PD-1 therapy. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Haddad G, Hueniken K, Xu MC, Bratman S, de Almeida J, Goldstein D, Huang SH, Hansen A, Hope A, Spreafico A, Xu W, Liu G. Association of post-treatment longitudinal symptom severity clusters with subsequent survival in oropharyngeal cancer. Head Neck 2022; 44:2181-2196. [PMID: 35801270 DOI: 10.1002/hed.27139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 05/16/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with cancer often experience multiple symptoms concurrently. We identified patient clusters based on longitudinal symptom severity trajectories in oropharyngeal cancer (OPC) and evaluated the potential clinical utility of this approach. METHODS A retrospective OPC patient cluster analysis using 6 months of symptom severity data from radiotherapy initiation. The clinico-demographic characteristics and overall survival of patients were compared between clusters. RESULTS We identified four clusters of patients differing in longitudinal symptom severity. Cluster A (n = 168) included patients with the mildest longitudinal symptoms, cluster B (n = 59) and cluster C (n = 63) were intermediate, and cluster D (n = 30) included patients with the worst symptoms. The clusters differed in their HPV status, ECOG performance status, smoking history, drinking history, treatment modality, and 5-year survival. These clusters separated symptom severity trajectories more distinctly than individual clinico-demographic characteristics. CONCLUSIONS Early symptom severity trajectory clustering revealed distinct patient clusters that were prognostic of overall survival.
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Affiliation(s)
- Ghazal Haddad
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maria Christine Xu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Scott Bratman
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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9
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Dmytriw AA, Ortega C, Anconina R, Metser U, Liu ZA, Liu Z, Li X, Sananmuang T, Yu E, Joshi S, Waldron J, Huang SH, Bratman S, Hope A, Veit-Haibach P. Nasopharyngeal Carcinoma Radiomic Evaluation with Serial PET/CT: Exploring Features Predictive of Survival in Patients with Long-Term Follow-Up. Cancers (Basel) 2022; 14:cancers14133105. [PMID: 35804877 PMCID: PMC9264840 DOI: 10.3390/cancers14133105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nasopharyngeal carcinoma (NPC) is a frequent head and neck cancer, especially in Asian countries. Our studies investigated the value of minable data derived from standard of care PET/CT imaging in patients with NPC. The here presented evaluation found that certain specific imaging features in this patient population can be potentially used to predict overall survival and progression free survival at different time points in those patients. Abstract Purpose: We aim determine the value of PET and CT radiomic parameters on survival with serial follow-up PET/CT in patients with nasopharyngeal carcinoma (NPC) for which curative intent therapy is undertaken. Methods: Patients with NPC and available pre-treatment as well as follow up PET/CT were included from 2005 to 2006 and were followed to 2021. Baseline demographic, radiological and outcome data were collected. Univariable Cox proportional hazard models were used to evaluate features from baseline and follow-up time points, and landmark analyses were performed for each time point. Results: Sixty patients were enrolled, and two-hundred and seventy-eight (278) PET/CT were at baseline and during follow-up. Thirty-eight percent (38%) were female, and sixty-two patients were male. All patients underwent curative radiation or chemoradiation therapy. The median follow-up was 11.72 years (1.26–14.86). Five-year and ten-year overall survivals (OSs) were 80.0% and 66.2%, and progression-free survival (PFS) was 90.0% and 74.4%. Time-dependent modelling suggested that, among others, PET gray-level zone length matrix (GLZLM) gray-level non-uniformity (GLNU) (HR 2.74 95% CI 1.06, 7.05) was significantly associated with OS. Landmark analyses suggested that CT parameters were most predictive at 15 month, whereas PET parameters were most predictive at time points 3, 6, 9 and 15 month. Conclusions: This study with long-term follow up data on NPC suggests that mainly PET-derived radiomic features are predictive for OS but not PFS in a time-dependent evaluation. Furthermore, CT radiomic measures may predict OS and PFS best at initial and long-term follow-up time points and PET measures may be more predictive in the interval. These modalities are commonly used in NPC surveillance, and prospective validation should be considered.
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Affiliation(s)
- Adam A. Dmytriw
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (A.A.D.); (R.A.)
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Claudia Ortega
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Reut Anconina
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (A.A.D.); (R.A.)
| | - Ur Metser
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Zhihui A. Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Zijin Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (Z.A.L.); (Z.L.); (X.L.)
| | - Thiparom Sananmuang
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University,270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Eugene Yu
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - Sayali Joshi
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (J.W.); (S.H.H.); (S.B.); (A.H.)
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada; (C.O.); (U.M.); (T.S.); (E.Y.); (S.J.)
- Correspondence: ; Tel.: +416-340-4800 (ext. 6085); Fax: 416-340-3900
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10
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Cheng N, Soave D, Skead K, Ouellette T, Bratman S, De Carvalho D, Awadalla P. Abstract 3385: Pre-diagnosis plasma cell-free DNA methylation profiling reveals signatures of cancers up to7 years prior to clinical detection. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer survival rates are significantly improved when detected at early stages, particularly when the tumour is still localised to the tissue of origin. However, effective screening tools for early cancer detection is currently limited to a subset of cancer types. Profiling cell-free DNA (cfDNA) patterns has emerged as a prominent non-invasive biomarker for detection and subtyping of cancers. However, owing to difficulties in observing the early development of human malignancies as cancers are often detected once they become symptomatic, most cancer biomarker and evolution studies to date have primarily examined the genomics from solid tumour or liquid biopsies following a diagnosis. Utilizing cfDNA as a screening tool for early cancer detection requires profiling of blood plasma samples collected from asymptomatic individuals prior to the diagnosis of cancers to enable assessment of the earliest detectability and predictive performance of potential biomarkers. Here, we leverage the Canadian Partnership for Tomorrow’s Health Project (CanPaTH), to profile blood plasma collected prior to the clinical detection of underlying cancers. Specifically, we use cell-free methylated DNA immunoprecipitation and high-throughput sequencing (cfMeDIP-seq), a highly sensitive assay for profiling cfDNA methylomes, to profile over 300 blood plasma samples collected up to seven years prior to the detection of a breast, prostate or pancreatic cancer, in addition to matched controls with no history of cancer free through follow-up. We identified differentially methylated signatures in pre-diagnosis cfDNA that discriminated cancer-free controls from pre-diagnosis cancer cases up to seven years before diagnosis, and demonstrated that these markers were reflective of differentially methylated in cancer tissue relative to normal tissue and peripheral blood leukocytes. Further, predictive modelling reveals that cfDNA methylation markers in blood are predictive of pre-diagnosis breast cancer cases, achieving an average test AUROC of 0.75 (95% CI: 0.70 - 0.80). Predictive models trained solely with pre-diagnosis cfDNA methylation samples were also predictive of prostate and pancreatic cancer samples collected following diagnosis, achieving an average test AUROCs of 0.95 (95% CI: 0.93-0.96) and 0.96 (95% CI: 0.94-0.97) respectively. In our current studies, we focus specifically on breast, prostate and pancreatic cancer cases, and are extending this to further pan-cancer applications in subsequent investigations.
Citation Format: Nicholas Cheng, David Soave, Kimberly Skead, Tom Ouellette, Scott Bratman, Daniel De Carvalho, Philip Awadalla. Pre-diagnosis plasma cell-free DNA methylation profiling reveals signatures of cancers up to7 years prior to clinical detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3385.
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Affiliation(s)
- Nicholas Cheng
- 1Ontario Institute Cancer Research, Toronto, Ontario, Canada
| | - David Soave
- 2Wilfrid Laurier University, Toronto, Ontario, Canada
| | - Kimberly Skead
- 1Ontario Institute Cancer Research, Toronto, Ontario, Canada
| | - Tom Ouellette
- 1Ontario Institute Cancer Research, Toronto, Ontario, Canada
| | - Scott Bratman
- 3Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Philip Awadalla
- 1Ontario Institute Cancer Research, Toronto, Ontario, Canada
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11
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Jacinto J, Huang S, Su J, Kim J, O'Sullivan B, Ringash J, Cho J, Hope A, Bratman S, Giuliani M, Hosni A, Hahn E, Spreafico A, Hansen A, Goldstein D, Tong L, Perez-Ordonez B, Weinreb I, Xu W, Waldron J. Clinical Behavior and Outcome of HPV-Positive Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Chin O, Yu E, O'Sullivan B, Su J, Tellier A, Siu L, Waldron J, Kim J, Hansen A, Hope A, Cho J, Giuliani M, Ringash J, Spreafico A, Bratman S, Hosni A, Hahn E, Tong L, Xu W, Huang SH. Prognostic importance of radiologic extranodal extension in nasopharyngeal carcinoma treated in a Canadian cohort. Radiother Oncol 2021; 165:94-102. [PMID: 34718052 DOI: 10.1016/j.radonc.2021.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To confirm the prognostic value of radiologic extranodal extension (rENE) and its role in clinical-N classification in nasopharyngeal carcinoma (NPC) treated in a western institution. METHODS AND MATERIALS NPC treated between 2010 and 2017 were included. Pre-treatment MRI were reviewed for unequivocal rENE and its grade: grade-1: tumour invading through any nodal capsule but confined to perinodal fat; grade-2: ≥2 adjacent nodes forming a coalescent nodal mass; grade-3: tumour extending beyond perinodal fat to invade/encase adjacent structures. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) and rENE-negative (rENE-) patients. Multivariable analysis (MVA) confirmed the prognostic importance of rENE and its grade. Staging schemas including rENE in N-classification were proposed and their performance evaluated. RESULTS A total of 274 patients were eligible (43 cN0; 231 cN-positive). rENE was identified in 83/231 (36%) cN-positive, including grade 1/2/3 rENE in 14/58/11 cases. Compared to rENE-, rENE+ patients had a lower OS (68% vs 89%, p < 0.001) and DFS (58% vs 80%, p < 0.001). MVA confirmed the prognostic importance of grade-2 [HR: OS: 2.85 (p = 0.005); DFS: 2.89 (p < 0.001)] and grade-3 rENE [HR: OS 5.28 (p = 0.004); DFS 3.86 (p = 0.005)], with a trend for grade-1 vs rENE- [HR: OS 2.63 (p = 0.13); DFS 1.49 (p = 0.520)]. We evaluated classifying any rENE as cN3 (Proposal-I) or any grade-2/grade-3 rENE as cN3 (Proposal-II). The stage schema with Proposal-I cN-classification ranked the highest in the performance evaluation. CONCLUSIONS rENE is an important prognostic factor in this western NPC cohort. We propose classifying any unequivocal rENE as cN3.
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Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Canada
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Anais Tellier
- Department of Neuroradiology, University of Toronto, Canada
| | - Lillian Siu
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Aaron Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Anna Spreafico
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada.
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13
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Bratman S. SP-0226 Biomarker-guided precision radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Kim J, Marsilla J, Weiss J, Tkachuk D, Jacinto J, Cho J, Hahn E, Bratman S, Haibe-Kains B, Hope A. OC-0518 Impact of observer knowledge on AI delineation assessments: Bias in clinical acceptability testing. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Chiu K, Hosni A, Huang SH, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. The Potential Impact and Usability of the Eighth Edition TNM Staging Classification in Oral Cavity Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e442-e449. [PMID: 34261594 DOI: 10.1016/j.clon.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
AIMS In the current eighth edition head and neck TNM staging, extranodal extension (ENE) is an adverse feature in oral cavity squamous cell cancer (OSCC). The previous seventh edition N1 with ENE is now staged as N2a. Seventh edition N2+ with ENE is staged as N3b in the eighth edition. We evaluated its potential impact on patients treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS OSCC patients treated with primary surgery and adjuvant (chemo)radiotherapy between January 2005 and December 2014 were reviewed. Cohorts with pathological node-negative (pN-), pathological node-positive without ENE (pN+_pENE-) and pathological node-positive with ENE (pN+_pENE+) diseases were compared for local control, regional control, distant control and overall survival. The pN+ cohorts were further stratified into seventh edition N-staging subgroups for outcomes comparison. RESULTS In total, 478 patients were evaluated: 173 pN-; 159 pN+_pENE-; 146 pN+_pENE+. Outcomes at 5 years were: local control was identical (78%) in all cohorts (P = 0.892), whereas regional control was 91%, 80% and 68%, respectively (P < 0.001). Distant control was 97%, 87%, 68% (P < 0.001) and overall survival was 75%, 53% and 39% (P < 0.001), respectively. Overall survival for N1 and N2a subgroups was not significantly different. In the seventh edition N2b subgroup of pENE- (n = 79) and pENE+ (n = 79) cohorts, overall survival was 67% and 37%, respectively. In the seventh edition N2c subgroups, overall survival for pENE- (n = 17) and pENE+ (n = 38) cohorts was 65% and 35% (P = 0.08), respectively. Overall, an additional 128 patients (42% pN+) were upstaged as N3b. CONCLUSIONS When eighth edition staging was applied, stage migration across the N2-3 categories resulted in expected larger separations of overall survival by stage. Patients treated with primary radiation without surgical staging should have outcomes carefully monitored. Strategies to predict ENE preoperatively and trials to improve the outcomes of pENE+ patients should be explored.
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Affiliation(s)
- K Chiu
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada; Department of Head and Neck Oncology, Mount Vernon Cancer Centre, Northwood, London, UK
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - W Xu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Lu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Bayley
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - M Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre/ University of Toronto, Toronto, Ontario, Canada
| | - J Irish
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - R Gilbert
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - P Gullane
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - D Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
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16
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Cheng N, Skead K, Soave D, Meng J, Gbeha E, Lungu I, Lam B, Bratman S, De Carvalho D, Awadalla P. Abstract 2602: Leveraging cell-free methylome markers for early cancer detection. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer survival rates are significantly improved when detected at early stages, particularly when the tumor is still localized to the tissue of origin. However, effective screening tools for early cancer detection is currently limited to a subset of cancer types. The early development of human malignancies are difficult to observe as cancers are often detected once it becomes symptomatic, as such many cancer biomarker and evolution studies to date have primarily examined the genomics from solid tumor or liquid biopsies following a diagnosis. Investigating early tumor evolution in the pre-diagnosis context could allow us to better understand how to prevent or detect cancers in the earliest stage when survival rates are significantly higher, however this requires application of new technologies to biologics collected prior to a cancer diagnosis. Here, we leverage blood samples collected from participants in the Canadian Partnership for Tomorrow Project (CPTP), a longitudinal population cohort, prior to the onset of a cancer. Specifically, we utilize hybrid capture approaches to enrich for and characterize early mutations and methylation changes in circulating tumor DNA (ctDNA) of pre-cancer plasma samples collected from patients several months to years prior to clinical diagnosis. Here, we identify the earliest detectability of aberrant genetic and epigenetic events in ctDNA and describe the molecular evolution of these events at various stages prior to clinical detection of cancers. Further, we develop molecular biomarkers and implement machine learning tools to classify individuals with early cancers, and to develop risk scores from survival analyses predictive of cancer development up to 5 years prior to diagnosis. In our current study, we focus specifically on breast, prostate, lung and pancreatic cancer cases, and are extending this to pan-cancer applications in subsequent studies.
Citation Format: Nicholas Cheng, Kimberly Skead, David Soave, Jocelyn Meng, Elias Gbeha, Ilinca Lungu, Bernard Lam, Scott Bratman, Daniel De Carvalho, Philip Awadalla. Leveraging cell-free methylome markers for early cancer detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2602.
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Affiliation(s)
- Nicholas Cheng
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kimberly Skead
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - David Soave
- 2Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jocelyn Meng
- 3University of Waterloo, Waterloo, Ontario, Canada
| | - Elias Gbeha
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ilinca Lungu
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Bernard Lam
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Scott Bratman
- 4Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Daniel De Carvalho
- 4Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Philip Awadalla
- 1Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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17
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Arrowsmith C, Reiazi R, Welch ML, Kazmierski M, Patel T, Rezaie A, Tadic T, Bratman S, Haibe-Kains B. Automated detection of dental artifacts for large-scale radiomic analysis in radiation oncology. Phys Imaging Radiat Oncol 2021; 18:41-47. [PMID: 34258406 PMCID: PMC8254196 DOI: 10.1016/j.phro.2021.04.001] [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] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/09/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Background and purpose Computed tomography (CT) is one of the most common medical imaging modalities in radiation oncology and radiomics research, the computational voxel-level analysis of medical images. Radiomics is vulnerable to the effects of dental artifacts (DA) caused by metal implants or fillings and can hamper future reproducibility on new datasets. In this study we seek to better understand the robustness of quantitative radiomic features to DAs. Furthermore, we propose a novel method of detecting DAs in order to safeguard radiomic studies and improve reproducibility. Materials and methods We analyzed the correlations between radiomic features and the location of dental artifacts in a new dataset containing 3D CT scans from 3211 patients. We then combined conventional image processing techniques with a pre-trained convolutional neural network to create a three-class patient-level DA classifier and slice-level DA locator. Finally, we demonstrated its utility in reducing the correlations between the location of DAs and certain radiomic features. Results We found that when strong DAs were present, the proximity of the tumour to the mouth was highly correlated with 36 radiomic features. We predicted the correct DA magnitude yielding a Matthews correlation coefficient of 0.73 and location of DAs achieving the same level of agreement as human labellers. Conclusions Removing radiomic features or CT slices containing DAs could reduce the unwanted correlations between the location of DAs and radiomic features. Automated DA detection can be used to improve the reproducibility of radiomic studies; an important step towards creating effective radiomic models for use in clinical radiation oncology.
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Affiliation(s)
- Colin Arrowsmith
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Reza Reiazi
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Mattea L Welch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michal Kazmierski
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Tirth Patel
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Aria Rezaie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Scott Bratman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Haibe-Kains
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Vector Institute, Toronto, Ontario, Canada
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Smith I, Bell R, Lambie M, Haibe-Kains B, Bratman S. Abstract PO-071: Characterizing transcriptomic indicators of radiosensitivity in cancer and identifying sensitizing therapeutic agents. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.radsci21-po-071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
While radiation therapy is an integral method for cancer treatment, clinical choices are not currently informed by the genetic and molecular profile of a patient’s tumor. Though it has been shown that genetic features implicate variability, the exact relationship between these features and radiosensitivity is poorly understood. Our work focuses on predicting radiosensitivity of squamous cell carcinoma from molecular features. First, we employ RadioGx, a computational platform for integrative analysis of radiogenomic datasets, to identify a gene expression signature predictive of radiosensitivity. To mitigate the high-dimensionality of gene expression data, we employ pathway-level transcriptomic modeling methods to identify cellular programs associated with radiation sensitivity. Our pancancer radiosensitivity model achieves a Pearson’s correlation of 0.47 with measured radiosensitivity from a radiogenomic dataset using only high level transcriptomic features. Second, we use that gene expression signature to query the Connectivity Map via the PharmacoGx resource and identify candidate radiosensitizers - compounds that may induce the radiosensitivity signature. Further validation is necessary to evaluate the efficacy of these compounds at improving radiosensitivity in both model systems and patient contexts. These results implicate cellular processes in radiosensitivity and advance an approach for identifying radiosensitizing agents through integration of large scale datasets.
Citation Format: Ian Smith, Rachel Bell, Meghan Lambie, Benjamin Haibe-Kains, Scott Bratman. Characterizing transcriptomic indicators of radiosensitivity in cancer and identifying sensitizing therapeutic agents [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-071.
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Affiliation(s)
- Ian Smith
- 1University Health Network, University of Toronto, Toronto, ON, Canada,
| | - Rachel Bell
- 2University Health Network, Toronto, ON, Canada
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Kelly D, le L, Law J, Stockley T, Waddell T, Bratman S, Leighl N. 77TiP From liquid biopsy to cure: Using CtDNA detection of minimal residual disease to identify patients for curative therapy after non-small cell lung cancer (NSCLC) resection. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01919-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Lau S, Soleimani S, Wong S, Wang B, Pedersen S, Patel D, Bradbury P, Liu G, Leighl N, Tsao M, Siu L, Bratman S, Ohashi P, Pugh T, Shepherd F, Sacher A. P14.24 Evolution of TCR Clonality during Chemoradiation and Durvalumab as Predictors of Survival in Stage 3 NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.530] [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: 11/30/2022]
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21
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Wong ET, Huang SH, O'Sullivan B, Persaud V, Su J, Waldron J, Goldstein DP, de Almeida J, Ringash J, Kim J, Hope A, Bratman S, Cho J, Giuliani M, Hosni A, Spreafico A, Hansen A, Tong L, Xu W, Yu E. Head and neck imaging surveillance strategy for HPV-positive oropharyngeal carcinoma following definitive (chemo)radiotherapy. Radiother Oncol 2021; 157:255-262. [PMID: 33600871 DOI: 10.1016/j.radonc.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the utilization pattern of head and neck (HN) surveillance imaging and explore the optimal strategy for radiologic "residual" lymph node (LN) surveillance following definitive (chemo)radiotherapy (RT/CRT) in human papillomavirus (HPV)+ oropharyngeal carcinoma (OPC). METHODS All HPV+ OPC patients who completed RT/CRT from 2012 to 2015 were included. Schedule and rationale for post-treatment HN-CT/MRI were recorded. Imaging findings and oncologic outcomes were evaluated. RESULTS A total of 1036 scans in 412 patients were reviewed: 414 scans for first post-treatment response assessment and 622 scans for the following reasons: follow-up of radiologic "residual" LN(s) (293 scans/175 patients); local symptoms (227/146); other (17/16); unknown (85/66). Rate of scans with "unstated" reason varied significantly among clinicians (3-28%, p < 0.001) and none of them yielded any positive imaging findings. First post-treatment scans identified 192 (47%) patients with radiologic "residual" LNs. Neck dissection (ND) was performed in 28 patients: 16 immediately (6/16 positive), 10 after one follow-up scan (2/10 positive), and 2 after 2nd follow-up scan (1/2 positive). Thirty patients had >2 consecutive follow-up scans at 2-3-month intervals, and none showed subsequent imaging progression or regional failure. CONCLUSIONS Pattern of HN imaging utilization for surveillance varied significantly among clinicians. Imaging surveillance reduces the need for ND. However, routine HN-CT/MR surveillance without clinical symptoms/signs does not demonstrate proven value in identifying locoregional failure or toxicity. Radiologic "residual" LNs without adverse features are common. If two subsequent follow-up scans demonstrate stable/regressing radiologic "residual" LNs, clinical surveillance without further imaging appears to be safe in this population.
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Affiliation(s)
- Erin T Wong
- Department of Medical Imaging, University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada.
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - Vincent Persaud
- Department of Medical Imaging, University of Toronto, Canada
| | - Jie Su
- Biostatistics Division, University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Anna Spreafico
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Aaron Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Canada
| | - Wei Xu
- Biostatistics Division, University of Toronto, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Canada; Department of Medical Imaging, Princess Margaret Cancer Centre, University of Toronto, Canada
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Watson E, Xu W, Giuliani M, Huang J, Huang S, O'Sullivan B, Ringash J, Hosni A, Kim J, Waldron J, Bayley A, Cho J, Bratman S, Goldstein D, Maxymiw W, Glogauer M, Hope A. PO-0805: Dental insurance status influences prophylactic dental care prior to head and neck radiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Traverso A, Hosni Abdalaty A, Hasan M, Tadic T, Patel T, Giuliani M, Kim J, Ringash J, Cho J, Bratman S, Bayley A, Waldron J, O'Sullivan B, Irish J, Chepeha D, De Almeida J, Goldstein D, Jaffray D, Wee L, Dekker A, Hope A. PO-1549: Non-invasive prediction of lymph node risk in oral cavity cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sanduleanu S, Tamanupadhaya@gmail.com T, Klaassen R, Woodruff H, Hatt M, Kaanders J, Vrieze O, Laarhoven H, Subramiam R, Huang S, Bratman S, Dubois L, Miclea R, Di Perri D, Geets X, Crispin-Ortuzar M, Aptea A, Hun Oh J, Lee N, Humm J, Schoder H, Ruysscher D, Hoebers F, Lambin P. PO-1583: Non-invasive radiomic imaging prediction of tumour hypoxia: biomarker for FLASH irradiation? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Bogowicz M, Jochems A, Deist TM, Tanadini-Lang S, Huang SH, Chan B, Waldron JN, Bratman S, O'Sullivan B, Riesterer O, Studer G, Unkelbach J, Barakat S, Brakenhoff RH, Nauta I, Gazzani SE, Calareso G, Scheckenbach K, Hoebers F, Wesseling FWR, Keek S, Sanduleanu S, Leijenaar RTH, Vergeer MR, Leemans CR, Terhaard CHJ, van den Brekel MWM, Hamming-Vrieze O, van der Heijden MA, Elhalawani HM, Fuller CD, Guckenberger M, Lambin P. Privacy-preserving distributed learning of radiomics to predict overall survival and HPV status in head and neck cancer. Sci Rep 2020; 10:4542. [PMID: 32161279 PMCID: PMC7066122 DOI: 10.1038/s41598-020-61297-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022] Open
Abstract
A major challenge in radiomics is assembling data from multiple centers. Sharing data between hospitals is restricted by legal and ethical regulations. Distributed learning is a technique, enabling training models on multicenter data without data leaving the hospitals ("privacy-preserving" distributed learning). This study tested feasibility of distributed learning of radiomics data for prediction of two year overall survival and HPV status in head and neck cancer (HNC) patients. Pretreatment CT images were collected from 1174 HNC patients in 6 different cohorts. 981 radiomic features were extracted using Z-Rad software implementation. Hierarchical clustering was performed to preselect features. Classification was done using logistic regression. In the validation dataset, the receiver operating characteristics (ROC) were compared between the models trained in the centralized and distributed manner. No difference in ROC was observed with respect to feature selection. The logistic regression coefficients were identical between the methods (absolute difference <10-7). In comparison of the full workflow (feature selection and classification), no significant difference in ROC was found between centralized and distributed models for both studied endpoints (DeLong p > 0.05). In conclusion, both feature selection and classification are feasible in a distributed manner using radiomics data, which opens new possibility for training more reliable radiomics models.
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Grants
- P30 CA016672 NCI NIH HHS
- P50 CA097007 NCI NIH HHS
- R01 DE025248 NIDCR NIH HHS
- R01 CA214825 NCI NIH HHS
- R25 EB025787 NIBIB NIH HHS
- R56 DE025248 NIDCR NIH HHS
- R01 CA218148 NCI NIH HHS
- Swiss National Science Foundation Sinergia grant (310030_173303) and Scientific Exchange grant (IZSEZ0_180524).
- This work was also supported by the Interreg grant EURADIOMICS and the Dutch technology Foundation STW (grant n° 10696 DuCAT and n° P14-19 Radiomics STRaTegy), which is the applied science division of NWO, the Technology Program of the Ministry of Economic Affairs and the Manchester Cancer Research UK major centre grant. The authors also acknowledge financial support from the EU 7th framework program (ARTFORCE - n° 257144, REQUITE - n° 601826), CTMM-TraIT, EUROSTARS (E-DECIDE, DEEPMAM), Kankeronderzoekfonds Limburg from the Health Foundation Limburg, Alpe d’HuZes-KWF (DESIGN), The Dutch Cancer Society, the European Program H2020-2015-17 (ImmunoSABR - n° 733008 and BD2Decide - PHC30-689715), the ERC advanced grant (ERC-ADG-2015, n° 694812 - Hypoximmuno), SME Phase 2 (EU proposal 673780 – RAIL).
- The clinical study used as one of the cohorts was supported by a research grant from Merck (Schweiz) AG.
- Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receive funding and project-relevant salary support from the National Institutes of Health (NIH), including: National Institute for Dental and Craniofacial Research Award (1R01DE025248-01/R56DE025248-01); National Cancer Institute (NCI) Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program(1R01CA218148-01); National Science Foundation (NSF), Division of Mathematical Sciences; NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program (R25EB025787). Dr. Fuller has received direct industry grant support and travel funding from Elekta AB.and Fuller receive funding and project-relevant salary support from NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007-10).
- This project was supported by the Swiss National Science Foundation Sinergia grant (310030_173303)
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Affiliation(s)
- Marta Bogowicz
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland.
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands.
| | - Arthur Jochems
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Timo M Deist
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Stephanie Tanadini-Lang
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - Shao Hui Huang
- Princess Margaret Cancer Center- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Biu Chan
- Princess Margaret Cancer Center- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - John N Waldron
- Princess Margaret Cancer Center- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Scott Bratman
- Princess Margaret Cancer Center- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Princess Margaret Cancer Center- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Oliver Riesterer
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland
- Kantonsspital Aarau, Center for Radiation Oncology- KSA-KSB-, Aarau, Switzerland
| | - Gabriela Studer
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland
- Cantonal Hospital Lucerne, Radiation Oncology, Lucerne, Switzerland
| | - Jan Unkelbach
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - Samir Barakat
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Amsterdam, The Netherlands
| | - Irene Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Amsterdam, The Netherlands
| | | | - Giuseppina Calareso
- IRCCS Fondazione Istituto Nazionale dei Tumori, Radiology Department, Milan, Italy
| | - Kathrin Scheckenbach
- University Hospital Duesseldorf, Heinrich-Heine-University, Department of Otorhinolaryngology & Head/Neck, Surgery, Duesseldorf, Germany
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre, Department of Radiation Oncology, Maastricht, The Netherlands
| | - Frederik W R Wesseling
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre, Department of Radiation Oncology, Maastricht, The Netherlands
| | - Simon Keek
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Sebastian Sanduleanu
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Ralph T H Leijenaar
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
| | - Marije R Vergeer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology/Head and Neck Surgery, Amsterdam, The Netherlands
| | - Chris H J Terhaard
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands
| | - Michiel W M van den Brekel
- The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Martijn A van der Heijden
- The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Amsterdam, The Netherlands
| | - Hesham M Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthias Guckenberger
- University Hospital Zurich and University of Zurich, Department of Radiation Oncology, Zurich, Switzerland
| | - Philippe Lambin
- GROW-School for Oncology and Developmental Biology-Maastricht University Medical Centre-, Department of Precision Medicine, The D Lab: Decision Support for Precision Medicine-, Maastricht, The Netherlands
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Huang SH, O'Sullivan B, Su J, Bartlett E, Kim J, Waldron JN, Ringash J, de Almeida JR, Bratman S, Hansen A, Bayley A, Cho J, Giuliani M, Hope A, Hosni A, Spreafico A, Siu L, Chepeha D, Tong L, Xu W, Yu E. Prognostic importance of radiologic extranodal extension in HPV-positive oropharyngeal carcinoma and its potential role in refining TNM-8 cN-classification. Radiother Oncol 2020; 144:13-22. [DOI: 10.1016/j.radonc.2019.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
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Stewart E, Martins-Filho S, Cabanero M, Wang A, Huang J, Bao H, Wu X, Patel D, Chen Z, Law J, Bradbury P, Shepherd F, Leighl N, Tsao M, Pugh T, Bratman S, Liu G, Sacher A. P2.14-62 Early, Subclinical SCLC Transformation in Patients with EGFR Mutant Lung Cancer Receiving Osimertinib, Detected Through Cell-Free DNA. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yang C, Iafolla M, Dashner S, Xu W, Hansen A, Bedard P, Lheureux S, Spreafico A, Razak A, Wu HT, Shchegrova S, Liu Z, Ohashi P, Torti D, Louie M, Sethi H, Aleshin A, Siu L, Bratman S, Pugh T. Bespoke circulating tumor DNA (ctDNA) analysis as a predictive biomarker in solid tumor patients (pts) treated with single agent pembrolizumab (P). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.024] [Citation(s) in RCA: 2] [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: 11/12/2022] Open
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Alfaraj F, Craig T, Huang SH, O'Sullivan B, Su J, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Hansen A, de Almeida J, Perez-Ordonez B, Weinreb I, Tong L, Xu W, Hope A. Treatment outcomes in oropharynx cancer patients who did not complete planned curative radiotherapy. Oral Oncol 2019; 97:124-130. [PMID: 31521053 DOI: 10.1016/j.oraloncology.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/01/2018] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate outcomes in oropharyngeal cancer (OPC) patients who did not complete their planned curative radiation therapy (RT). METHODS OPC Patients who received less than planned curative RT dose between 2002 and 2016 were identified for analysis. HPV status was assessed. Radiation dose was normalized for fractionation variations using biological effective doses assuming tumor α/β = 10 Gy [BED10]. Outcomes were compared using BED10. Multivariable and univariable analysis identified OS predictors. RESULTS From a total of 80 patients who did not complete therapy, 64 patients were eligible for analysis. RT incompletion was due to: RT side effects (n = 23), patients' decision (n = 21), disease progression or metastases (n = 3), and other causes (n = 7). Median BED10 (Gy) was 56.2 for the HPV-positive and 58 for the HPV-negative. Three-year OS was 74% vs 13% (p < 0.001) for the HPV-positive (n = 29) and HPV-negative (n = 24), respectively. HPV-positive patients who received BED10 ≥55 had higher OS than those received BED10 <55 (94% vs 47%, p = 0.002) while no difference in OS by BED10 ≥55 vs <55 for the HPV-negative (12 vs 13%, p = NS). HPV-positive status was associated with a higher OS (HR 12.5, 95% CI, 4.54 to 33.3, p < 0.001). A total of 37 patients were available to estimate TD50 for local control assessment. TD50 (BED10) was estimated at 60.5 Gy for HPV-negative patients compared to 27.2 Gy for HPV-positive patients. CONCLUSION Overall, in patients with incomplete treatment, HPV-positive OPC patients demonstrated a better OS compared to HPV-negative patients. HPV-positive patients who received BED10 ≥55 have higher rates of OS.
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Affiliation(s)
- Fatimah Alfaraj
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Tim Craig
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Jie Su
- Joint Department of Biostatistics, Princess Margaret Cancer Centre, Room 10-508, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Scott Bratman
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Cho
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Kim
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Aaron Hansen
- Department of Medicine, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Bras Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Li Tong
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Wei Xu
- Joint Department of Biostatistics, Princess Margaret Cancer Centre, Room 10-508, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada.
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Lassen P, Huang S, Su J, O’Sullivan B, Waldron J, Andersen M, Primdahl H, Johansen J, Kristensen C, Andersen E, Alsner J, Lilja-Fischer J, Bratman S, Spreafico A, de Almeida J, Xu W, Overgaard J. Treatment Outcomes and Survival Following Primary (chemo) Radiotherapy in HPV+ Oropharynx Cancer: A Largescale Comparison of Two Institutions. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1535] [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: 11/15/2022]
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Bernal MO, Chepeha D, Prawira A, Vines D, Spreafico A, Bratman S, Almeida JD, Hansen A, Goldstein D, Gilbert R, Gullane P, Brown DH, Weinreb I, Perez-Ordoñez B, Ohashi PS, McGaha T, Wang BX, Irish J, Chen I, Siu LL. Abstract CT124: Sitravatinib and nivolumab in oral cavity cancer window of opportunity study (SNOW). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Squamous cell carcinoma of the oral cavity (SCCOC) often presents at early stages but its prognosis remains guarded, with a 5-year survival rate of 60% despite curative-intent therapies. Preoperative window-of-opportunity (WOO) studies in resectable SCCOC enable pharmacodynamic evaluation of molecular endpoints without compromising curative-intent treatment. Preoperative nivolumab in SCCOC was safe and showed promising tumor responses in CheckMate-358 WOO study (Ferris et al. ESMO 2017, LBA46). Sitravatinib, a receptor tyrosine kinase inhibitor which potently inhibits Tyro, AXL, Mer, and VEGF family of receptors, has shown encouraging results when combined with nivolumab in non-small cell lung cancer patients who have progressed on anti-PD-1 agents (Leal et al. ESMO 2018, 1129O). We hypothesize that sitravatinib and nivolumab have synergistic antitumor and immunogenic effects by increasing tumor immune infiltration and by blocking oncogenic pathways implicated in disease progression and immune-checkpoint resistance.
Methods: Trial design: SNOW is a single-center, non-randomized WOO study of preoperative sitravatinib and nivolumab in patients with resectable SCCOC. Sitravatinib 120 mg is given orally once daily from day 1 until 48h before surgery or for a maximum period of 28 days. Nivolumab 240mg is given intravenously on day 15 for one dose only. Surgery is planned between days 23-30 following study treatment initiation. Fresh tumor biopsies and serial blood samples for extensive immunophenotyping and evaluation of other pharmacodynamic biomarkers, as well as clinical photographs of the tumor, are collected at baseline, on day 15 prior to nivolumab and at the time of surgery. 18FAZA-PET scans are performed at baseline and before surgery.
Key eligibility criteria: previously untreated and resectable SCCOC; T2-4a, N0-2 or T1 (greater than 1 cm)-N2; no history of tumor bleeding or invasion of major vessels; adequate organ function; no autoimmune disorders; no immunosuppressive therapy.
Study objectives: primary objective is to evaluate the immune and pharmacodynamic effects of sitravatinib plus nivolumab. Secondary objectives are: safety and tolerability including toxicity, rate of surgery completion within the planned window and rate of postoperative complications; antitumor activity including rate of complete pathological response; pharmacokinetics of sitravatinib alone and in combination with nivolumab.
Correlative studies: tumor and blood immunophenotyping, tumor genome and transcriptome analysis, changes in intratumoral hypoxia based on 18FAZA-PET testing. Sample size: SNOW is a proof-of-concept study with no specific statistical assumptions at trial onset. We plan to enroll 12-15 patients evaluable for correlative studies.
Study activation: Aug 30th, 2018. Two patients enrolled as of Jan 10th2019.
Clinical trial identification: NCT03575598.
Citation Format: Marc Oliva Bernal, Douglas Chepeha, Amy Prawira, Douglass Vines, Anna Spreafico, Scott Bratman, John De Almeida, Aaron Hansen, David Goldstein, Ralph Gilbert, Patrick Gullane, Dale H. Brown, Ilan Weinreb, Bayardo Perez-Ordoñez, Pamela S. Ohashi, Tracy McGaha, Ben X. Wang, Jonathan Irish, Isan Chen, Lillian L. Siu. Sitravatinib and nivolumab in oral cavity cancer window of opportunity study (SNOW) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT124.
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Affiliation(s)
- Marc Oliva Bernal
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Chepeha
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amy Prawira
- 3Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent’s Hospital, Sidney, Australia
| | - Douglass Vines
- 4Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Scott Bratman
- 5Department of Radiation Oncology, Princess Margaret Cancer Centre, University of, Toronto, Ontario, Canada
| | - John De Almeida
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Hansen
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - David Goldstein
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale H. Brown
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ilan Weinreb
- 6Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordoñez
- 6Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pamela S. Ohashi
- 7Department of Immunology, Princess Margaret Cancer Center, University of Toronto., Toronto, Ontario, Canada
| | - Tracy McGaha
- 7Department of Immunology, Princess Margaret Cancer Center, University of Toronto., Toronto, Ontario, Canada
| | - Ben X. Wang
- 7Department of Immunology, Princess Margaret Cancer Center, University of Toronto., Toronto, Ontario, Canada
| | - Jonathan Irish
- 2Department of Otolaryngology- Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Lillian L. Siu
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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Billfalk Kelly A, Lin L, Xu W, Huang S, Wu R, Bayley A, Bratman S, Kim J, Giuliani M, Ringash J, Waldron J, O”Sullivan B, Cho J, Goldstein D, Hosni A, Hope A. EP-1201 Outcomes in young patients (<40) treated for oral cavity squamous cell carcinoma in the modern era. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanduleanu S, Jochems A, Upadhaya T, Even A, Leijenaar R, Dankers F, Klaassen R, Woodruff H, Hatt M, Kaanders H, Hamming-Vrieze O, Van Laarhoven H, Subramiam R, Huang S, O’Sullivan B, Bratman S, Dubois L, Miclea R, Di Perri D, Geets X, De Ruysscher D, Hoebers F, Lambin P. PO-0733 Non-invasive imaging for tumor hypoxia: a novel validated CT and FDG-PET-based Radiomic signature. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31153-3] [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: 11/15/2022]
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Huang S, Yu E, Billfalk-Kelly A, Su J, Waldron J, Bartlett E, Bayley A, Bratman S, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Ringash J, Hansen A, De Almeida J, Tong L, Xu W, O’Sullivan B. OC-007 Radiologic extranodal extension portends worse outcome in TNM-8 cT1-T2N1 HPV + oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30173-2] [Citation(s) in RCA: 2] [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: 10/27/2022]
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Jerzak KJ, Cescon DW, Chia SK, Bratman S, Ennis M, Stambolic V, Chang M, Dowling R, Goodwin PJ. Abstract OT1-12-01: Exploration of factors associated with imminent risk of late recurrence in hormone receptor positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-12-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Research objectives: To conduct a prospective observational study of patient and tumor-related factors in women with high risk hormone receptor (HR)+/HER2- breast cancer (BC) following at least 5 years of adjuvant hormonal therapy, in order to identify risk factors for imminent recurrence.
Rationale: Many of the life-threatening BC recurrences in women with HR+HER2- BC take place more than 5 years post-diagnosis, often after completion of adjuvant hormonal therapy. The identification of a biomarker(s) for late BC recurrence could lead to interventional trials to evaluate preventive therapies. We will evaluate whether the presence of blood-based biomarkers [(i) Circulating Tumor Cells (CTCs), (ii) circulating tumor DNA (ctDNA), (iii) tumor markers (CA 15-3, CEA)] and patient factors may predict BC recurrence.
Trial design: A prospective cohort of eligible women with previously treated HR+HER2- BC who have not experienced a distant recurrence will be enrolled; patient and circulating factors will be measured annually until distant recurrence or study completion. Host factors (including BMI, lifestyle, medical illness, surgery, trauma and stress, as well as circulating PlGF, VEGF-1 and inflammatory markers) that may contribute to exit of BC cells from dormancy will also be assessed.
The primary outcome is distant BC recurrence. Any BC event, including loco-regional recurrence, new breast or other primary cancer will be evaluated as a secondary endpoint. Outcomes will be ascertained by regular self-report (via annual telephone calls) and/or physician report and confirmed by medical record review.
Key eligibility criteria: i) Diagnosis of ER and/or PR positive (either or both 10% positive), HER2 negative invasive BC, ii) predicted >1.5-2% annual risk of recurrence (T2, T3 or T4 with any N+;T1 N2+; T2N0 or T1 N1 cancers with high risk genomic scores), iii) receipt of adjuvant endocrine therapy for at least 4 years, with discontinuation planned in the next 12 months or completion of endocrine therapy within the last 5 years, iv) prior adjuvant chemotherapy, targeted therapy and bone targeted therapies are allowed provided they have been completed.
Specific aims: 1) Determine if the presence of (i) CTCs, (ii) ctDNA, (iii) CA15-3 and CEA are associated with imminent risk (within 1-2 years) of distant recurrence in the study population. 2) Identify host factors associated with these blood-based biomarkers, as well as clinical outcomes.
Statistical methods: A matched case control design (matching for time since completion of adjuvant hormone therapy, baseline T, N and grade) will be used to investigate associations of key study variables with imminent risk of distant recurrence within the next 1-2 years. Measurements of patients who do versus do not recur will be compared over the 1-2 years prior to relapse. Each variable will be allocated one third of a study-wide type one error of 0.05 (2-sided). ROC analyses and multivariable modelling will be used to optimize sensitivity, specificity, PPV and NPV. Available questionnaire data will be summarized at all time-points to generate descriptive survivorship data.
Accrual: Starting in August 2018, we plan to recruit 1,000 patients over 2 years at selected Canadian cancer centres.
Citation Format: Jerzak KJ, Cescon DW, Chia SK, Bratman S, Ennis M, Stambolic V, Chang M, Dowling R, Goodwin PJ. Exploration of factors associated with imminent risk of late recurrence in hormone receptor positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-12-01.
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Affiliation(s)
- KJ Jerzak
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - DW Cescon
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - SK Chia
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - S Bratman
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - M Ennis
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - V Stambolic
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - M Chang
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - R Dowling
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | - PJ Goodwin
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, ON, Canada; Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
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Weimar EAM, Huang SH, Lu L, O'Sullivan B, Perez-Ordonez B, Weinreb I, Hope A, Tong L, Goldstein D, Irish J, de Almeida JR, Bratman S, Xu W, Yu E. Radiologic-Pathologic Correlation of Tumor Thickness and Its Prognostic Importance in Squamous Cell Carcinoma of the Oral Cavity: Implications for the Eighth Edition Tumor, Node, Metastasis Classification. AJNR Am J Neuroradiol 2018; 39:1896-1902. [PMID: 30166432 DOI: 10.3174/ajnr.a5782] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Addressing the performance of an imaging-based parameter compared to a "gold standard" pathologic measurement is essential to achieve accurate clinical T-classification. Our aim was to determine the radiologic-pathologic tumor thickness correlation and its prognostic value in oral squamous cell carcinoma. MATERIALS AND METHODS All pathologic T1-T3 (seventh edition of the Cancer Staging Manual of the American Joint Committee on Cancer) oral squamous cell carcinomas diagnosed between 2010 and 2015 were reviewed. Radiologic tumor thickness was measured on preoperative CT or MR imaging blinded to pathology. The radiologic-pathologic tumor thickness correlation was calculated. The impact of the imaging-to-surgery time interval and imaging technique on the correlation was explored. Intra-/interrater reliability on radiologic tumor thickness was calculated. The correlation of radiologic-versus-pathologic tumor thickness and its performance as the seventh edition T-category modifier was evaluated. Multivariable analysis assessed the prognostic value of the radiologic tumor thickness for overall survival adjusted for age, seventh edition T-category, and performance status. RESULTS For 354 consecutive patients, the radiologic-pathologic tumor thickness correlation was similar for the image-to-surgery interval of ≤4.0 weeks (ρ = 0.76) versus 4-8 weeks (ρ = 0.80) but lower in those with more than an 8-week interval (ρ = 0.62). CT and MR imaging had similar correlations (0.76 and 0.80). Intrarater and interrater reliability was excellent (0.88 and 0.84). Excluding 19 cases with an imaging-to-surgery interval of >8 weeks, 335 patients were eligible for further analysis. The radiologic-pathologic tumor thickness correlation was 0.78. The accuracy for upstaging the T-classification based on radiologic tumor thickness was 83% for pathologic T1 and 74% for pathologic T2 tumors. Multivariable analysis confirmed the prognostic value of radiologic tumor thickness (hazard ratio = 1.5, P = .02) for overall survival. CONCLUSIONS This study demonstrates a good radiologic-pathologic tumor thickness correlation. Intrarater and interrater reliability for radiologic tumor thickness was excellent. Radiologically thicker tumor was predictive of inferior survival.
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Affiliation(s)
- E A M Weimar
- From the Departments of Neuroradiology and Head and Neck Imaging (E.A.M.W., E.Y.)
| | - S H Huang
- Radiation Oncology (S.H.H., B.O., A.H., L.T., S.B.)
| | - L Lu
- Biostatistics (L.L., W.X.)
| | - B O'Sullivan
- Radiation Oncology (S.H.H., B.O., A.H., L.T., S.B.)
| | | | | | - A Hope
- Radiation Oncology (S.H.H., B.O., A.H., L.T., S.B.)
| | - L Tong
- Radiation Oncology (S.H.H., B.O., A.H., L.T., S.B.)
| | - D Goldstein
- Otolaryngology-Head and Neck Surgery/Surgical Oncology (D.G., J.I., J.R.d.A.), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Irish
- Otolaryngology-Head and Neck Surgery/Surgical Oncology (D.G., J.I., J.R.d.A.), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J R de Almeida
- Otolaryngology-Head and Neck Surgery/Surgical Oncology (D.G., J.I., J.R.d.A.), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S Bratman
- Radiation Oncology (S.H.H., B.O., A.H., L.T., S.B.)
| | - W Xu
- Biostatistics (L.L., W.X.)
| | - E Yu
- From the Departments of Neuroradiology and Head and Neck Imaging (E.A.M.W., E.Y.)
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Raman S, Bissonnette JP, Warner A, Le L, Bratman S, Leighl N, Bezjak A, Palma D, Schellenberg D, Sun A. Rationale and Protocol for a Canadian Multicenter Phase II Randomized Trial Assessing Selective Metabolically Adaptive Radiation Dose Escalation in Locally Advanced Non-small-cell Lung Cancer (NCT02788461). Clin Lung Cancer 2018; 19:e699-e703. [PMID: 29903551 DOI: 10.1016/j.cllc.2018.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/06/2018] [Accepted: 05/01/2018] [Indexed: 12/25/2022]
Abstract
We explain the rationale for metabolically adaptive radiation dose escalation in stage III non-small-cell lung cancer and describe the design of a Canadian phase II randomized trial investigating this approach. In the trial, patients are randomized to either conventional chemoradiation treatment (60 Gy in 30 fractions) or metabolically adaptive chemoradiation, where fluorodeoxyglucose-avid tumor sub-volumes receive an integrated boost dose to a maximum of 85 Gy in 30 fractions. The trial sample size is 78 patients, and the target population is patients with newly diagnosed, inoperable stage III non-small-cell lung cancer treated with radical intent chemoradiation. The primary objective of the trial is to determine if dose escalation to metabolically active sub-volumes will reduce 2-year local-regional failure rate from 42.3% to 22.3%, when compared with standard treatment. The secondary objectives are to determine the effect of dose escalation on overall survival, progression-free survival, quality of life, and rate of grade 3 to 5 toxicities.
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Affiliation(s)
- Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-Pierre Bissonnette
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Lisa Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Scott Bratman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Natasha Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrea Bezjak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Palma
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, BC Cancer Agency - Fraser Valley Centre, Surrey, BC, Canada
| | - Alexander Sun
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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Hosni A, Huang S, Chiu K, Xu W, Su J, Tong L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Waldron J, De Almeida J, Chepeha D, Goldstein D, Hope A. OC-0277: Development and validation of distant metastases risk group classification in oral cavity cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hosni A, Huang S, Chiu K, Xu W, Su J, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Hansen A, De Almeida J, Monteiro E, Chepeha D, Gilbert R, Irish J, Goldstein D, Waldron J, Hope A. PO-0709: Postoperative salvage therapy for early recurrence in oral cavity squamous cell carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bratman S. SP-0113: Circulating tumour DNA as a therapeutic biomarker for radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bushehri A, Chan B, Wong O, Lee J, Huang S, Bayley A, Cho J, Kim J, Ringash J, O'Sullivan B, Waldron J, Bissonnette J, McNiven A, Zhang B, Hope A, Giuliani M, Bratman S. Automated Assessment of Nasopharynx Cancer GTV Change on Daily Cone Beam CT. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chiu K, Huang S, Hosni A, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. Outcomes of Oral Cavity Cancer Patients Treated with Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chiu K, Huang S, Hosni A, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. Potential Impact of the 8th edition UICC/AJCC Staging in Oral Cavity Cancer Patients Treated With Surgery and Post-Operative Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shi W, Han K, Li M, Williams J, McCusker M, Su J, Xu W, Bratman S, Yip K, Liu FF. Abstract 4752: Inflammatory cytokines and hematopoietic stem cells are associated with fatigue and insomnia in breast cancer patients undergoing adjuvant radiation therapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Breast cancer patients undergoing adjuvant radiation therapy (RT) commonly experience fatigue and insomnia. We previously reported that this fatigue is associated with a reduction in circulating hematopoetic stem cells (HSCs; CD34+); the role of inflammatory cytokines in mediating this process however, has not been clearly elucidated.
Materials and Methods: Breast cancer patients (n=147) undergoing adjuvant RT underwent phlebotomies for analysis of CD34+, CD45+, CBC, as well as 17 inflammatory cytokines using a multiplexed ELISA platform, during 5 time points: prior to RT (D1); after Days 2, 5, during final week of RT (D2, D5, and Df, respectively); as well as one month post RT-completion (M1). At the same time, patients also completed questionnaires for the multidimensional fatigue inventory (MFI-20), hospital anxiety and depression scale (HADS), and insomnia severity index (ISI).
Results: General fatigue worsened over the course of RT from D1 to Df, being most severe at the end of treatment (Df), but returned to baseline at M1. This trend was statistically significant (p<0.001), after adjusting for anxiety, depression, and insomnia. The levels of CD34+, CD45+, white blood cell, as well as lymphocyte counts decreased over time, with the lowest levels observed at Df (p<0.001 for all). General fatigue correlated inversely with CD34+ counts (adjusted for anxiety, depression, and ISI), and was also negatively associated with hemoglobin, RBC, and lymphocyte counts (p<0.001 for all). There was also a significant correlation between increasing insomnia with lower CD34+, CD45+, white blood cell and lymphocyte counts (all p<0.05). Serum concentrations of TGF-β1, MCP-1, MMP-2, IL-1ra and IFN-α2a changed significantly during RT (p<0.01 for all), with either the highest or lowest levels observed at Df. Increasing levels of MCP-1, TNF-RII and TNF-a were associated with worsening general physical fatigue, reduced activity, decreased motivation, as well as increased insomnia (p<0.001 for all). Furthermore, there appeared a trend between increasing MMP-2, as well as decreasing IL-1ra and TGF-β1, with reduced CD34+, CD45+, WBC and lymphocyte counts (p<0.001). The 52 patients who received prior adjuvant chemotherapy demonstrated significantly higher fatigue, anxiety, and insomnia scores.
Conclusions: This study represents one of the most comprehensive longitudinal evaluations of the effects of RT on fatigue and insomnia, demonstrating that this process was associated with increased levels of the pro-inflammatory cytokines MCP-1, TNF-RII and TNF-a, and reductions in circulating HSCs and other hematologic parameters. Further understanding of the roles of these cytokines would provide important insights into both quality of life for patients undergoing cancer therapies, as well as the interactions between RT with immunotherapy.
Citation Format: Wei Shi, Kathy Han, Madeline Li, Justin Williams, Megan McCusker, Jie Su, Wei Xu, Scott Bratman, Kenneth Yip, Fei-Fei Liu. Inflammatory cytokines and hematopoietic stem cells are associated with fatigue and insomnia in breast cancer patients undergoing adjuvant radiation therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4752. doi:10.1158/1538-7445.AM2017-4752
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Affiliation(s)
- Wei Shi
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Kathy Han
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Justin Williams
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Megan McCusker
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jie Su
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Scott Bratman
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Yip
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
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Rock K, Huang S, Tiong A, Lu L, Xu W, Bayley A, Bratman S, Cho J, Giuliani M, Hope A, Kim J, Ringash J, O’Sullivan B, Waldron J. PO-0620: Partial Laryngeal IMRT for T2N0 Glottic Cancer: Impact of Image Guidance and Radiotherapy Regimen. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huang S, Waldron J, Su J, Bratman S, Kim J, Bayley A, Ringash J, Giuliani M, Hope A, Cho J, Hansen A, Jang R, De Almeida J, Perez-Ordonez B, Weinreb I, Tong L, Xu W, O'Sullivan B. PV-0506: Comparison of Clinical Behavior of Viral Related Oropharyngeal and Nasopharyngeal Carcinoma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30946-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Caparrotti F, Huang S, Song Y, Bratman S, Ringash J, Bayley A, Giuliani M, Kim J, Waldron J, Hansen A, Tong L, Xu W, O’Sullivan B, Wood R, Hope A. PO-0606: Mandible osteoradionecrosis in oropharynx carcinoma treated with IMRT: Smoking and tumor size matter. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hope A, Karamboulas C, Xu W, Huang S, Kim J, Bratman S, Cho J, Ringash J, Giuliani M, Bayley A, Waldron J, Perez-Ordonez B, Goldstein D, De Almeida J, Brown D, Irish J, Gullane P, Gilbert R, O'Sullivan B, Ailles L. OC-022: Association of patient derived xenograft formation with oral cavity squamous cell cancer outcomes. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30170-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wong O, McNiven A, Chan B, Lee J, Moseley J, Ren C, Bratman S, Hope A, Bissonnette JP, Waldron J, Zhang B, Giuliani M. Interobserver Variability in Structure Delineation of Organs at Risk on Cone Beam CT using Raystation TPS v4.5.2. J Med Imaging Radiat Sci 2017. [DOI: 10.1016/j.jmir.2017.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee S, Cabanero M, Hyrcza M, Butler M, Liu FF, Hansen A, Huang SH, Tsao M, Song Y, Xu W, Goldstein D, Weinreb I, Bratman S. 29: Computer-Assisted Image Analysis of an Oral Cavity Squamous Cell Carcinoma Tissue Microarray. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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