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Chan AW, Simone Ii CB, van der Velden JM, van der Linden Y, Hoskin P, Detsky J, Choi JI, Lee SF, Wong HCY, Martin EJ, Raman S, Rades D, Willmann J, Rembielak A, Kazmierska J, Keit ER, Marta GN, Vassiliou V, Alcorn S, Bonomo P, Oldenburger E. A phase II trial on radiotherapy for high-risk asymptomatic bone metastases-creating more questions than answers? Ann Palliat Med 2024; 0:apm-23-595. [PMID: 38644554 DOI: 10.21037/apm-23-595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Affiliation(s)
- Adrian Wai Chan
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone Ii
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Emily J Martin
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Jonas Willmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Agata Rembielak
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Electroradiology Department, University of Medical Sciences, Poznan, Poland
| | - Emily R Keit
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus
| | - Sara Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
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Steinberg J, Hughes S, Hui H, Allsop MJ, Egger S, David M, Caruana M, Coxeter P, Carle C, Onyeka T, Rewais I, Monroy Iglesias MJ, Vives N, Wei F, Abila DB, Carreras G, Santero M, O’Dowd EL, Lui G, Tolani MA, Mullooly M, Lee SF, Landy R, Hanley SJB, Binefa G, McShane CM, Gizaw M, Selvamuthu P, Boukheris H, Nakaganda A, Ergin I, Moraes FY, Timilshina N, Kumar A, Vale DB, Molina-Barceló A, Force LM, Campbell DJ, Wang Y, Wan F, Baker AL, Singh R, Salam RA, Yuill S, Shah R, Lansdorp-Vogelaar I, Yusuf A, Aggarwal A, Murillo R, Torode JS, Kliewer EV, Bray F, Chan KKW, Peacock S, Hanna TP, Ginsburg O, Hemelrijck MV, Sullivan R, Roitberg F, Ilbawi AM, Soerjomataram I, Canfell K. Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis. Int J Cancer 2024; 154:1394-1412. [PMID: 38083979 PMCID: PMC10922788 DOI: 10.1002/ijc.34798] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024]
Abstract
While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.
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Affiliation(s)
- Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Peter Coxeter
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chelsea Carle
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Tonia Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- IVAN Research Institute, Enugu, Enugu Stata, Nigeria
| | - Isabel Rewais
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Maria J Monroy Iglesias
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Nuria Vives
- Cancer Screening Unit, Institut Català d’Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau-Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emma L O’Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gigi Lui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | | | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD, United States
| | - Sharon JB Hanley
- Department of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Gemma Binefa
- Cancer Screening Unit,Cancer Prevention and Control Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Charlene M McShane
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University of Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Ethiopia
| | - Poongulali Selvamuthu
- Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India
| | - Houda Boukheris
- University Abderrahmane Mira of Bejaia, School of Medicine, Algeria
- Departement of Epidemiology and Preventive Medicine, University Hospital of Bejaia, Algeria
| | - Annet Nakaganda
- Department of Cancer Epidemiology and Clinical Trials, Uganda Cancer Institute, Uganda
| | - Isil Ergin
- Department of Public Health, Faculty of Medicine, Ege University, Turkey
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Nahari Timilshina
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences-Patna, Patna, India
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Brazil
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO, Valencia, Spain
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Hematology/Oncology, University of Washington, United States
| | - Denise Joan Campbell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Yuqing Wang
- School of Public Health, University of Sydney, Sydney, Australia
| | - Fang Wan
- School of Public Health, University of Sydney, Sydney, Australia
| | - Anna-Lisa Baker
- School of Public Health, University of Sydney, Sydney, Australia
| | - Ramnik Singh
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rehana Abdus Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Susan Yuill
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar, Pakistan
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, King’s College London, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas NHS Trust, London, United Kingdom
| | - Raul Murillo
- Centro Javeriano De Oncologia - Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julie S Torode
- Institute of Cancer Policy, King’s College London, London, United Kingdom
- Research Oncology, Bermondsey Wing, Guy’s Hospital, SE1 9RT, London, United Kingdom
| | - Erich V Kliewer
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kelvin KW Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
- Department of Oncology and Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Maryland, United States
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom
| | - Felipe Roitberg
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
- Hospital Sírio Libanês, São Paulo, Brazil
- Rede Ebserh, Rede Brasileira de Serviços Hospitalares, Brasília, Brazil
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Kennedy SKF, Goodall S, Lee SF, DeAngelis C, Jocko A, Charbonneau F, Wang K, Pasetka M, Ko YJ, Wong HCY, Chan AW, Rajeswaran T, Gojsevic M, Chow E, Gralla RJ, Ng TL, Jerzak KJ. 2020 ASCO, 2023 NCCN, 2023 MASCC/ESMO, and 2019 CCO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer 2024; 32:280. [PMID: 38594320 DOI: 10.1007/s00520-024-08462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common toxicity that may impair the quality of life of patients with various malignancies ranging from early to end stages. In light of frequent changes to the guidelines for optimal management of CINV, we undertook this narrative review to compare the most recent guidelines published by ASCO (2020), NCCN (2023), MASCC/ESMO (2023), and CCO (2019). The processes undertaken by each organization to evaluate existing literature were also described. Although ASCO, NCCN, MASCC/ESMO, and CCO guidelines for the treatment and prevention of CINV share many fundamental similarities, the literature surrounding low and minimal emetic risk regimens is lacking. Current data regarding adherence to these guidelines is poor and warrants further investigation to improve care.
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Affiliation(s)
- Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Shannon Goodall
- Department of Internal Medicine, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Allison Jocko
- Scarborough Health Network, Oncology Pharmacy, Toronto, ON, Canada
| | - Flay Charbonneau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katie Wang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Pasetka
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Yoo-Joung Ko
- Oncology and Endoscopy, St Michael Hospital, Toronto, ON, Canada
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Adrian Wai Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Richard J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Terry L Ng
- Division of Medical Oncology, Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katarzyna J Jerzak
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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4
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Chan AW, Simone CB, van der Linden Y, Hoskin P, Detsky J, Choi JI, Lee SF, Wong HC, Martin EJ, Raman S, Rades D, Rembielak A, Kazmierska J, Vassiliou V, Alcorn S, Bonomo P, Oldenburger E. Prophylactic Radiation Therapy for High-Risk Asymptomatic Bone Metastases: A New Standard of Care or Need for More Data? J Clin Oncol 2024; 42:1326-1327. [PMID: 38320224 DOI: 10.1200/jco.23.02391] [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: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Adrian Wai Chan
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Charles B Simone
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Yvette van der Linden
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Peter Hoskin
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Jay Detsky
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - J Isabelle Choi
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - S F Lee
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Henry Cy Wong
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Emily J Martin
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Dirk Rades
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Agata Rembielak
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Joanna Kazmierska
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Vassilios Vassiliou
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Sara Alcorn
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Pierluigi Bonomo
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Eva Oldenburger
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
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Rades D, Simone CB, Wong HCY, Chow E, Lee SF, Johnstone PAS. Reirradiation of metastases of the central nervous system: part 2-metastatic epidural spinal cord compression. Ann Palliat Med 2024; 0:apm-23-594. [PMID: 38600819 DOI: 10.21037/apm-23-594] [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] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
An increasing number of patients irradiated for metastatic epidural spinal cord compression (MESCC) experience an in-field recurrence and require a second course of radiotherapy. Reirradiation can be performed with conventional radiotherapy or highly-conformal techniques such as intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT). When using conventional radiotherapy, a cumulative biologically effective dose (BED) ≤120 calculated with an α/β value of 2 Gy (Gy2) was not associated with radiation myelopathy in a retrospective study of 124 patients and is considered safe. In that study, conventional reirradiation led to improvements of motor deficits in 36% of patients and stopped further symptomatic progression in another 50% (overall response 86%). In four other studies, overall response rates were 82-89%. In addition to the cumulative BED or equivalent dose in 2 Gy fractions (EQD2), the interval between both radiotherapy courses <6 months and a BED per course ≥102 Gy2 (corresponding to an EQD2 ≥51 Gy2) were identified as risk factors for radiation myelopathy. Without these risk factors, a BED >120 Gy2 may be possible. Scoring tools have been developed that can assist physicians in estimating the risk of radiation myelopathy and selecting the appropriate dose-fractionation regimen of re-treatment. Reirradiation of MESCC may also be performed with highly-conformal radiotherapy. With IMRT or VMAT, rates of pain relief and improvement of neurologic symptoms of 60-93.5% and 42-73%, respectively, were achieved. One-year local control rates ranged between 55% and 88%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0% and 0-9.3%, respectively. With SBRT, rates of pain relief were 65-86%. Two studies reported improvements in neurologic symptoms of 0% and 82%, respectively. One-year local control rates were 74-83%. Rates of myelopathy or radiculopathy and vertebral compression fractures were 0-4.5% and 4.5-13.8%, respectively. For SBRT, a cumulative maximum EQD2 to thecal sac ≤70 Gy2, a maximum EQD2 of SBRT ≤25 Gy2, a ratio ≤0.5 of thecal sac maximum EQD2 of SBRT to maximum cumulative EQD2, and an interval between both courses ≥5 months were associated with a lower risk of myelopathy. Additional prospective trials are required to better define the options of reirradiation of MESCC.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | | | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Rades D, Simone CB, Wong HCY, Chow E, Lee SF, Johnstone PAS. Reirradiation of metastases of the central nervous system: part 1-brain metastasis. Ann Palliat Med 2024; 0:apm-23-593. [PMID: 38509654 DOI: 10.21037/apm-23-593] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Because of improved survival of cancer patients, more patients irradiated for brain metastases develop intracerebral recurrences requiring subsequent courses of radiotherapy. Five studies focused on reirradiation with whole-brain radiation therapy (WBRT) after initial WBRT for brain metastases. Following the second WBRT course, improvement of clinical symptoms was found in 31-68% of patients. Rates of neurotoxicity, such as encephalopathy or cognitive decline, were reported in two studies (1.4% and 32%). In another study, severe or unexpected adverse events were not observed. Survival following the second WBRT course was generally poor, with median survival times of 2.9-4.1 months. The survival prognosis of patients receiving two courses of WBRT can be estimated by a scoring tool considering five prognostic factors. Three studies investigated reirradiation with single-fraction stereotactic radiosurgery (SF-SRS) following primary WBRT. One-year local control rates were 74-91%, and median survival times ranged between 7.8 and 14 months. Rates of radiation necrosis (RN) after reirradiation were 0-6%. Seven studies were considered that investigated re-treatment with SF-SRS or fractionated stereotactic radiation therapy (FSRT) following initial SF-SRS or FSRT. One-year local control rates were 60-88%, and the median survival times ranged between 8.3 and 25 months. During follow-up after reirradiation, rates of overall (asymptomatic or symptomatic) RN ranged between 12.5% and 30.4%. Symptomatic RN occurred in 4.3% to 23.9% of cases (patients or lesions). The risk of RN associated with symptoms and/or requiring surgery or corticosteroids appears lower after reirradiation with FSRT when compared to SF-SRS. Other potential risk factors of RN include the volume of overlap of normal tissue receiving 12 Gy at the first course and 18 Gy at the second course of SF-SRS, maximum doses ≥40 Gy of the first or the second SF-SRS courses, V12 Gy >9 cm3 of the second course, initial treatment with SF-SRS, volume of normal brain receiving 5 Gy during reirradiation with FSRT, and systemic treatment. Cumulative EQD2 ≤100-120 Gy2 to brain, <100 Gy2 to brainstem, and <75 Gy2 to chiasm and optic nerves may be considered safe. Since most studies were retrospective in nature, prospective trials are required to better define safety and efficacy of reirradiation for recurrent or progressive brain metastases.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | | | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Youn HM, Zhang Y, Liu A, Ng CS, Liang J, Lau GKK, Lee SF, Lok J, Lam CLK, Wan EYF, Quan J. Decline in Cancer Diagnoses during the 'Zero COVID' Policy in Hong Kong: Indirect Spillover Impact of the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2024; 36:157-164. [PMID: 38262779 DOI: 10.1016/j.clon.2024.01.008] [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: 06/21/2023] [Revised: 11/26/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
AIMS Despite a largely successful 'zero COVID' policy in 2020, the COVID-19 pandemic disrupted routine cancer services in the city of Hong Kong. The aims of this study were to examine the trends in cancer incidence before and during the COVID-19 pandemic and estimate missed cancer diagnoses. MATERIALS AND METHODS We used population-based data from the Hong Kong Cancer Registry 1983-2020 to examine the trends of age- and sex-standardised cancer incidence before and during the COVID-19 pandemic. We applied: (i) the annual average percentage change (AAPC) calculated using the Joinpoint regression model and (ii) the autoregressive integrated moving average (ARIMA) model to forecast cancer incidence rates in 2020. Missed cancer diagnoses in 2020 were estimated by comparing forecasted incidence rates to reported rates. A subgroup analysis was conducted by sex, age and cancer site. RESULTS The cancer incidence in Hong Kong declined by 4.4% from 2019 to 2020 (male 8.1%; female 1.1%) compared with the long-term AAPC of 0.5% from 2005 to 2019 (95% confidence interval 0.3, 0.7). The gap between the reported and forecasted incidence for 2020 ranged from 5.1 to 5.7% (male 8.5%, 9.8%; female 2.3%, 3.5%). We estimated 1525-1596 missed cancer diagnoses (ARIMA estimate -98, 3148; AAPC 514, 1729) in 2020. Most missed diagnoses were in males (ARIMA 1361 [327, 2394]; AAPC 1401 [1353, 1460]), with an estimated 479-557 missed cases of colorectal cancer (ARIMA 112, 837; AAPC 518, 597) and 256-352 missed cases of prostate cancer (AAPC 231, 280; ARIMA 110, 594). CONCLUSION The incidence of new cancer diagnoses declined in 2020 contrary to the long-term increase over the previous decades. Significantly lower diagnoses than expected were observed in males, particularly for colorectal and prostate cancers. Fewer reported cancer cases indicate missed diagnoses and could lead to delayed treatment that could impact future health outcomes.
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Affiliation(s)
- H M Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Y Zhang
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - A Liu
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - C S Ng
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - J Liang
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - G K K Lau
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - S F Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - J Lok
- Department of Pathology, United Christian Hospital, Hong Kong SAR, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - E Y F Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - J Quan
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; HKU Business School, University of Hong Kong, Hong Kong SAR, China.
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8
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Yip PL, Zheng H, Cheo T, Tan TH, Lee SF, Leong YH, Wong LC, Tey J, Ho F, Soon YY. Stroke Risk in Survivors of Head and Neck Cancer. JAMA Netw Open 2024; 7:e2354947. [PMID: 38349657 PMCID: PMC10865145 DOI: 10.1001/jamanetworkopen.2023.54947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/13/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Survivors of head and neck cancers (HNC) have increased risk of stroke. A comprehensive report using standardized methods is warranted to characterize the risk and to inform on survivorship strategy. Objective To determine the stroke risk in subpopulations of survivors of HNC in Singapore. Design, Setting, and Participants This national, registry-based, cross-sectional study aimed to estimate stroke risk in subgroups of the HNC population between January 2005 and December 2020. Participants were identified from the Singapore Cancer Registry, the Singapore Stroke Registry, and the Registry of Birth and Deaths using relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. HNC subgroups were defined based on patient demographic, disease, and treatment factors. Data were analyzed from September 2022 to September 2023. Exposure Diagnosis of HNC. Main Outcomes and Measures Both ischemic and hemorrhagic stroke were studied. The age-standardized incidence rate ratio (SIRR) and age-standardized incidence rate difference (SIRD) were reported. The Singapore general population (approximately 4 million) served as the reference group for these estimations. Results A total of 9803 survivors of HNC (median [IQR] age at diagnosis, 58 [49-68] years; 7166 [73.1%] male) were identified. The most common HNC subsites were nasopharynx (4680 individuals [47.7%]), larynx (1228 individuals [12.5%]), and tongue (1059 individuals [10.8%]). A total of 337 individuals (3.4%) developed stroke over a median (IQR) follow-up of 42.5 (15.0-94.5) months. The overall SIRR was 2.46 (95% CI, 2.21-2.74), and the overall SIRD was 4.11 (95% CI, 3.37-4.85) strokes per 1000 person-years (PY). The cumulative incidence of stroke was 3% at 5 years and 7% at 10 years after HNC diagnosis. The SIRR was highest among individuals diagnosed at younger than 40 years (SIRR, 30.55 [95% CI, 16.24-52.35]). All population subsets defined by age, sex, race and ethnicity, HNC subsites (except tongue), stage, histology, and treatment modalities had increased risk of stroke compared with the general population. The SIRR and SIRD were significantly higher among individuals who had a primary radiation treatment approach (SIRR, 3.01 [95% CI, 2.64-3.43]; SIRD, 5.12 [95% CI, 4.18-6.29] strokes per 1000 PY) compared with a primary surgery approach (SIRR, 1.64 [95% CI, 1.31-2.05]; SIRD, 1.84 [95% CI, 0.923.67] strokes per 1000 PY). Conclusions and Relevance In this cross-sectional study of survivors of HNC, elevated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention.
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Affiliation(s)
- Pui Lam Yip
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Huili Zheng
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Teng Hwee Tan
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Yiat Horng Leong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Lea Choung Wong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Basu S, Shukron O, Hall D, Parutto P, Ponjavic A, Shah D, Boucher W, Lando D, Zhang W, Reynolds N, Sober LH, Jartseva A, Ragheb R, Ma X, Cramard J, Floyd R, Balmer J, Drury TA, Carr AR, Needham LM, Aubert A, Communie G, Gor K, Steindel M, Morey L, Blanco E, Bartke T, Di Croce L, Berger I, Schaffitzel C, Lee SF, Stevens TJ, Klenerman D, Hendrich BD, Holcman D, Laue ED. Publisher Correction: Live-cell three-dimensional single-molecule tracking reveals modulation of enhancer dynamics by NuRD. Nat Struct Mol Biol 2024; 31:390. [PMID: 38102414 PMCID: PMC10873192 DOI: 10.1038/s41594-023-01179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- S Basu
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - O Shukron
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France
| | - D Hall
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - P Parutto
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France
| | - A Ponjavic
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
- School of Physics and Astronomy, University of Leeds, Leeds, UK
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - D Shah
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - W Boucher
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - D Lando
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - W Zhang
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - N Reynolds
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - L H Sober
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - A Jartseva
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - R Ragheb
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - X Ma
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - J Cramard
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - R Floyd
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Centre for Biodiversity Genomics, University of Guelph, Guelph, Ontario, Canada
| | - J Balmer
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - T A Drury
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - A R Carr
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - L-M Needham
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - A Aubert
- The European Molecular Biology Laboratory EMBL, Grenoble, France
| | - G Communie
- The European Molecular Biology Laboratory EMBL, Grenoble, France
| | - K Gor
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- The European Molecular Biology Laboratory, Heidelberg, Germany
| | - M Steindel
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - L Morey
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Sylvester Comprehensive Cancer Center, Department of Human Genetics, University of Miami Miller School of Medicine, Biomedical Research Building, Miami, FL, USA
| | - E Blanco
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - T Bartke
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Functional Epigenetics, Neuherberg, Germany
| | - L Di Croce
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - I Berger
- School of Biochemistry, University of Bristol, Bristol, UK
| | - C Schaffitzel
- School of Biochemistry, University of Bristol, Bristol, UK
| | - S F Lee
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - T J Stevens
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK
| | - D Klenerman
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK.
| | - B D Hendrich
- Department of Biochemistry, University of Cambridge, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
| | - D Holcman
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France.
| | - E D Laue
- Department of Biochemistry, University of Cambridge, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
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Yip PL, Lee WYV, Leung WK, Nyaw SF, Chan NY, Lee SF. Stereotactic Body Radiation Therapy to the Foot for Bone Metastasis. Adv Radiat Oncol 2024; 9:101363. [PMID: 38261951 PMCID: PMC10797535 DOI: 10.1016/j.adro.2023.101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/19/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Wan Yan Venus Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | | | - Shi Feng Nyaw
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Ngai Yui Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
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Lee SF, Yip PL, Wo B, Wong NSM, Vellayappan BA, Mamon HJ, Lee FAS. Neoadjuvant short-course radiotherapy or chemoradiation plus consolidative chemotherapy followed by radical operation for locally advanced rectal cancer. Front Oncol 2024; 13:1284569. [PMID: 38322287 PMCID: PMC10844885 DOI: 10.3389/fonc.2023.1284569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Limited evidence compares short-course radiotherapy (SCRT) and long-course chemoradiotherapy (LCCRT), both of which are followed by consolidative chemotherapy before radical rectal surgery. We conducted a retrospective cohort study to assess treatment response, survival outcomes, and toxicity in patients with locally advanced rectal cancer. Materials and methods Patients (cT3-4 and/or N+) treated with SCRT or LCCRT, consolidative chemotherapy, or total mesorectal excision between 2013 and 2021 were identified. the cause-specific cumulative incidence of disease-related treatment failure, locoregional recurrence, distant metastases, and overall survival were evaluated using flexible parametric competing risk analysis and Kaplan-Meier methods, adjusted for treatment regimens and clinicopathological factors. A pathological complete response (pCR), tumor downstaging, and toxicity have been reported. Results Among the 144 patients, 115 (80%) underwent curative rectal surgery. The LCCRT and SCRT groups achieved pCR in 10 (18%) and seven (12%) patients, respectively (odds ratio, 1.68; 95% confidence interval [CI], 0.59-4.78). The adjusted cause-specific hazard ratio for disease-related treatment failure with LCCRT versus SCRT was 0.26 (95% CI, 0.08-0.87). Three-year cumulative probability of disease-related treatment failure was 10.0% and 25.6% for LCCRT and SCRT, respectively. No significant differences in T-downstaging, N-downstaging, significant pathologic downstaging (ypT0-2N0), locoregional failure, distant metastasis, or overall survival were found. Late rectal toxicity occurred in 10 (15%) LCCRT and two (3%) SCRT patients, respectively. Conclusion LCCRT with consolidative chemotherapy demonstrated improved disease-related treatment failure compared with SCRT, despite higher late rectal toxicity. Further research is needed to assess the long-term oncologic outcomes and toxicity.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Barry Wo
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Natalie Sean-Man Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Harvey J. Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, United States
| | - Francis Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
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Wong HCY, Lee SF, Chan AW, Caini S, Hoskin P, Simone CB, Johnstone P, van der Linden Y, van der Velden JM, Martin E, Alcorn S, Johnstone C, Isabelle Choi J, Nader Marta G, Oldenburger E, Raman S, Rembielak A, Vassiliou V, Bonomo P, Nguyen QN, Chow E, Ryu S. Stereotactic body radiation therapy versus conventional external beam radiotherapy for spinal metastases: A systematic review and meta-analysis of randomized controlled trials. Radiother Oncol 2023; 189:109914. [PMID: 37739318 DOI: 10.1016/j.radonc.2023.109914] [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: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION This study aimed to compare SBRT and cEBRT for treating spinal metastases through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS PubMed, EMBASE and Cochrane Library were searched up to 6 May 2023 for RCTs comparing SBRT and cEBRT for spinal metastases. Overall and complete pain response, local progression, overall survival, quality of life and adverse events were extracted. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) for dichotomous outcomes, and hazard ratios (HRs) for time-to-event outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic. RESULTS Three RCTs were identified involving 642 patients. No differences were seen in overall pain response comparing SBRT and cEBRT (RR at 3 months: 1.12, 95% CI, 0.74-1.70, p = 0.59; RR at 6 months: 1.29, 95% CI, 0.97-1.72, p = 0.08). Only two of three studies presented complete pain response data. SBRT demonstrated a statistically significant improvement in complete pain response compared to cEBRT (RR at 3 months: 2.52; 95% CI, 1.58-4.01; P < 0.0001; RR at 6 months: 2.48; 95% CI, 1.23-4.99; P = 0.01). There were no significant differences in local progression and overall survival. Adverse events were similar, except for any grade radiation dermatitis, which was significantly lower in SBRT arm (RR 0.17, 95% CI 0.03-0.96, P = 0.04). CONCLUSION SBRT is a safe treatment option for spine metastases. It may provide better complete pain response compared to cEBRT. Additional trials are needed to determine the potential benefits of SBRT in specific patient subsets.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China.
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, United Kingdom
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emily Martin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, LA, USA
| | - Sara Alcorn
- Department of Radiation Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Brazil
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Agata Rembielak
- Division of Cancer Sciences, University of Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Vassilios Vassiliou
- Bank of Cyprus Oncology Centre, Department of Radiation Oncology, Nicosia, Cyprus
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, New York, NY, USA
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Gojsevic M, Akkila S, Kennedy SKF, Herst P, Ogita M, Ye JC, Shariati S, Rajeswaran T, Behroozian T, Lee SF, Chan RJ, Chow E. StrataXRT for the prevention and treatment of radiation dermatitis: a critical review. Support Care Cancer 2023; 31:713. [PMID: 37987843 DOI: 10.1007/s00520-023-08190-8] [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: 03/28/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The primary objective is to systematically review primary studies, such as randomized control trials (RCTs), feasibility, exploratory, and case studies; and the secondary objective is to evaluate all secondary articles, such as reviews, guidelines, and editorials, relevant to the use of StrataXRT for the prevention and/or management of radiation dermatitis (RD) in cancer patients. METHODS A literature search was conducted up to February 26, 2023, for articles investigating the use of StrataXRT for the prevention and treatment of RD, in the following databases: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The keywords "StrataXRT", "dermatitis", "radiotherapy", and "radiation" were used to identify relevant articles. RESULTS Twenty-seven articles from 2018 to 2022 were identified to fulfill the inclusion criteria of this review, of which nine are primary studies and 18 are secondary papers. Significant heterogeneity was observed in the current literature studying the effects of StrataXRT, making it difficult to make cross-trial comparisons. There is a suggestion of the efficacy of StrataXRT in the prevention and treatment of RD. CONCLUSION The findings of this review recommend further adequately powered RCTs with robust methodology including patient and clinician assessments to determine the efficacy of StrataXRT in preventing and treating RD. This is essential to improve the quality of life of patients and identify which groups of patients would benefit most from StrataXRT.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | - Mami Ogita
- Department of Radiology, the University of Tokyo Hospital, Tokyo, Japan
| | - Jason C Ye
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China
| | - Raymond J Chan
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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14
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Basu S, Shukron O, Hall D, Parutto P, Ponjavic A, Shah D, Boucher W, Lando D, Zhang W, Reynolds N, Sober LH, Jartseva A, Ragheb R, Ma X, Cramard J, Floyd R, Balmer J, Drury TA, Carr AR, Needham LM, Aubert A, Communie G, Gor K, Steindel M, Morey L, Blanco E, Bartke T, Di Croce L, Berger I, Schaffitzel C, Lee SF, Stevens TJ, Klenerman D, Hendrich BD, Holcman D, Laue ED. Live-cell three-dimensional single-molecule tracking reveals modulation of enhancer dynamics by NuRD. Nat Struct Mol Biol 2023; 30:1628-1639. [PMID: 37770717 PMCID: PMC10643137 DOI: 10.1038/s41594-023-01095-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/14/2023] [Indexed: 09/30/2023]
Abstract
To understand how the nucleosome remodeling and deacetylase (NuRD) complex regulates enhancers and enhancer-promoter interactions, we have developed an approach to segment and extract key biophysical parameters from live-cell three-dimensional single-molecule trajectories. Unexpectedly, this has revealed that NuRD binds to chromatin for minutes, decompacts chromatin structure and increases enhancer dynamics. We also uncovered a rare fast-diffusing state of enhancers and found that NuRD restricts the time spent in this state. Hi-C and Cut&Run experiments revealed that NuRD modulates enhancer-promoter interactions in active chromatin, allowing them to contact each other over longer distances. Furthermore, NuRD leads to a marked redistribution of CTCF and, in particular, cohesin. We propose that NuRD promotes a decondensed chromatin environment, where enhancers and promoters can contact each other over longer distances, and where the resetting of enhancer-promoter interactions brought about by the fast decondensed chromatin motions is reduced, leading to more stable, long-lived enhancer-promoter relationships.
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Affiliation(s)
- S Basu
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - O Shukron
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France
| | - D Hall
- Department of Biochemistry, University of Cambridge, Cambridge, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - P Parutto
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France
| | - A Ponjavic
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
- School of Physics and Astronomy, University of Leeds, Leeds, UK
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - D Shah
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - W Boucher
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - D Lando
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - W Zhang
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - N Reynolds
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - L H Sober
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - A Jartseva
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - R Ragheb
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - X Ma
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - J Cramard
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - R Floyd
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Centre for Biodiversity Genomics, University of Guelph, Guelph, Ontario, Canada
| | - J Balmer
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - T A Drury
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - A R Carr
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - L-M Needham
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - A Aubert
- The European Molecular Biology Laboratory EMBL, Grenoble, France
| | - G Communie
- The European Molecular Biology Laboratory EMBL, Grenoble, France
| | - K Gor
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- The European Molecular Biology Laboratory, Heidelberg, Germany
| | - M Steindel
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - L Morey
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Sylvester Comprehensive Cancer Center, Department of Human Genetics, University of Miami Miller School of Medicine, Biomedical Research Building, Miami, FL, USA
| | - E Blanco
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - T Bartke
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Functional Epigenetics, Neuherberg, Germany
| | - L Di Croce
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - I Berger
- School of Biochemistry, University of Bristol, Bristol, UK
| | - C Schaffitzel
- School of Biochemistry, University of Bristol, Bristol, UK
| | - S F Lee
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
| | - T J Stevens
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK
| | - D Klenerman
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK.
| | - B D Hendrich
- Department of Biochemistry, University of Cambridge, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
| | - D Holcman
- Department of Applied Mathematics and Computational Biology, Ecole Normale Supérieure, Paris, France.
| | - E D Laue
- Department of Biochemistry, University of Cambridge, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
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15
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Keit E, Lee SF, Woodward M, Rembielak A, Shiue K, Desideri I, Oldenburger E, Bienz M, Rades D, Theodorou M, Agyeman MB, Yarney J, Bryant JM, Yu HHM, Simone CB, Hoskin P, Johnstone PAS. Palliative whole brain radiation therapy: an international state of practice. Ann Palliat Med 2023; 12:1155-1164. [PMID: 37731303 DOI: 10.21037/apm-23-448] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Improvements in radiation delivery and systemic therapies have resulted in few remaining indications for palliative whole brain radiation therapy (WBRT). Most centers preferentially use stereotactic radiotherapy (SRT) and reserve WBRT for those with >15 lesions, leptomeningeal presentation, rapidly progressive disease, or limited estimated survival. Despite regional differences among preferred dose, fractionation, and treatment technique, we predict survival post-WBRT will remain poor-indicating appropriate application of WBRT in this era of SRT and improved systemic therapies. METHODS A multi-center, international retrospective analysis of patients receiving WBRT in 2022 was performed. Primary end point was survival after WBRT. De-identified data were analyzed centrally. Patients receiving WBRT as part of a curative regimen, prophylactically, or as bridging therapy were excluded. The collected data consisted of patient parameters including prescription dose and fractionation, use of neurocognitive sparing techniques and survival after WBRT. Survival was calculated via the Kaplan-Meier method. RESULTS Of 29,943 international RT prescriptions written at ten participating centers in 2022, 462 (1.5%) were for palliative WBRT. Participating centers were in the United States (n=138), the United Kingdom (n=111), Hong Kong (n=72), Italy (n=49), Belgium (n=45), Germany (n=27), Ghana (n=15), and Cyprus (n=5). Twenty-six different dose regimens were used. The most common prescriptions were for 3,000 cGy over 10 fractions (45.0%) and 2,000 cGy over 5 fractions (43.5%) with significant regional preferences (P<0.001). Prior SRT was delivered in 32 patients (6.7%), hippocampal avoidance (HA) was used in 44 patients (9.5%), and memantine was prescribed in 93 patients (20.1%). Survival ranged from 0 days to still surviving at 402 days post-treatment. The global median overall survival (OS) was 84 days after WBRT [95% confidence interval (CI): 68.0-104.0]. Actuarial survival at 7 days, 1 month, 3 months, and 6 months were 95%, 78%, 48%, and 32%, respectively. Twenty-seven patients (5.8%) were unable to complete their prescribed WBRT. CONCLUSIONS This moment-in-time analysis confirms that patients with poor expected survival are being appropriately selected for WBRT-illustrating the dwindling indications for WBRT-and demonstrates the variance in global practice. Since poor survival precludes patients from deriving benefit, memantine and HA are best suited in carefully selected cases.
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Affiliation(s)
- Emily Keit
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Melissa Woodward
- Department of Radiotherapy, The Christie at Oldhman, The Christie NHS Foundation Trust, Manchester, UK
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kevin Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Isacco Desideri
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Maya Bienz
- Mount Vernon Cancer Centre, Northwood, UK
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Mervin B Agyeman
- National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana; University of Cape Coast, Cape Coast, Ghana
| | - John Michael Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter Hoskin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - Peter A S Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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16
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Chan AW, Wong HCY, Taphoorn M, Dirven L, Le Rhun E, Soliman H, Oldenburger E, Raman S, Vassiliou V, Bonomo P, Koller M, Marta GN, Rembielak A, Lee SF, Chow E, Simone CB. Latest clinical research in leptomeningeal disease (LMD)-a narrative review. Ann Palliat Med 2023; 12:1215-1231. [PMID: 37953219 DOI: 10.21037/apm-23-390] [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] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/10/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Leptomeningeal disease (LMD) is associated with poor survival and health-related quality of life (HRQoL). There is an urgent need for clinical research in this area to improve the outcomes. The purpose of this study is to summarize the areas of active clinical research in LMD, identify the knowledge gap, and suggest future research directions. METHODS A narrative review of clinical trials in LMD was conducted based on a search in clinicatrials.gov using the search term "leptomeningeal" under "condition or disease". Clinical trials in patients with LMD arising from solid malignancy that were labelled as "not yet recruiting", "recruiting", "enrolling by invitation" or "active, not recruiting" were included. Studies which were deemed to have significant impact on future research direction in LMD were selected for discussion. KEY CONTENT AND FINDINGS A total of 38 clinical trials were included. Of these 38 trials, 19 are discussed in this review, with focus on their research questions and impact on future research directions. Most of the studies that were not selected for discussion focused on biomarker-driven interventions. Four key areas of research were identified, namely the (I) diagnosis, response assessment or molecular profiling of LMD (n=2); (II) advances in radiotherapy (n=3); (III) intrathecal treatment (n=13); (IV) novel drug carrier for systemic treatment (n=1). The research questions in the 19 discussed clinical trials included the tumour microenvironment of LMD, the role of novel molecular techniques in LMD, combination of radiotherapy with drugs, and cell-based immunotherapy. Among these 19 studies, 11 were phase 1 trials, 3 were phase 2 or phase 1/2 trials, 2 were phase 3 or phase 2/3 trials and the study phase was not reported in the remaining 3 studies. The existing knowledge gaps are discussed, including the lack of primary site-specific prognostic tools, cost-effectiveness studies, dedicated HRQoL assessment tools for LMD and sequencing of treatment. CONCLUSIONS The current clinical trials in LMD offer the promise to improve the diagnosis and treatment outcomes of patients with LMD. More research is needed to overcome the potential hurdles in the current treatment and bridge the knowledge gaps as identified in this review, to improve patients' quantity and quality of survival.
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Affiliation(s)
- Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China; Department of Radiation Oncology, National University Cancer Institute, National Univeresity Hospital, Singapore, Singapore
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
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Wong HCY, Chan AW, Johnstone P, Simone CB, Navarro-Domenech I, Hoskin P, Johnstone C, Recht A, Menten J, van der Linden YM, van der Velden JM, Nguyen QN, Lutz S, Andratschke N, Wilmann J, Kazmierska J, Spalek M, Lim F, Yu HM, Perez B, Marta GN, Vassiliou V, Lee SF, Bonomo P, Rembielak A, Chow E, Oldenburger E, Raman S. A critical appraisal of the four systematic reviews and meta-analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here. Ann Palliat Med 2023; 12:1318-1330. [PMID: 37303218 DOI: 10.21037/apm-23-218] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Radiotherapy is an important treatment modality for pain control in patients with bone metastases. Stereotactic body radiation therapy (SBRT), which allows delivering a much higher dose per fraction while sparing critical structures compared to conventional external beam radiotherapy (cEBRT), has become more widely used, especially in the oligometastatic setting. Randomized controlled trials (RCTs) comparing the pain response rate of SBRT and cEBRT for bone metastases have shown conflicting results, as have four recent systematic reviews with meta-analyses of these trials. Possible reasons for the different outcomes between these reviews include differences in methodology, which trials were included, and the endpoints examined and how they were defined. We suggest ways to improve analysis of these RCTs, particularly performing an individual patient-level meta-analysis since the trials included heterogeneous populations. The results of such studies will help guide future investigations needed to validate patient selection criteria, optimize SBRT dose schedules, include additional endpoints (such as the time to onset of pain response, durability of pain response, quality of life (QOL), and side effects of SBRT), and better assess the cost-effectiveness and trade-offs of SBRT compared to cEBRT. An international Delphi consensus to guide selection of optimal candidates for SBRT is warranted before more prospective data is available.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | | | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, The University of Manchester, UK
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johan Menten
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Yvette M van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Lutz
- Eastern Woods Radiation Oncology, Blanchard Valley Health Organization, Findlay, OH, USA
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Wilmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Department of Electroradiology, Poznań University of Medical Sciences, Poznan, Poland
| | - Mateusz Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Fiona Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - H Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brad Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China; Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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18
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Soon YY, Zheng H, Tan TH, Lee SF, Leong YH, Wong LCC, Tey J, Ho F, Cheo T. Stroke Risk in Survivors of Head and Neck Cancer: A Descriptive Epidemiologic Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e260-e261. [PMID: 37784998 DOI: 10.1016/j.ijrobp.2023.06.1214] [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) Survivors of head and neck cancer (HNC) have an increased risk of stroke. However, the evidence on the risk of stroke in various subpopulations of HNC defined by patient, disease and treatment factors remains unclear. This study aimed to determine whether age-standardized incidence rate ratios (SIRs) and risk differences (SIRDs) of stroke varied across different subpopulations of survivors of HNC. MATERIALS/METHODS We used data from the national stroke and cancer registries to identify all cases of HNC who developed their first stroke after HNC diagnosis from January 2005 to December 2020. We estimated the SIRs and SIRDs of stroke in various subgroups of HNC defined by patient, disease and treatment factors using the Singapore general population as the reference group. RESULTS A total of 8839 cases of HNC were identified and 308 cases (3.4%) developed stroke after HNC diagnosis at median follow up of 42.5 months (interquartile range 15.0 - 94.5 months). The overall SIR and SIRD were 2.46 (95% CI 2.21 - 2.74) and 4.11 cases per 1000 person-years (PY) (95% CI 3.37 - 4.85). The SIR and SIRD were higher among those post five years from HNC diagnosis compared to those with 5 or fewer years from HNC diagnosis (SIR: 3.92 (3.36 - 4.58) vs 1.84 (1.59 - 2.14), SIRD: 6.64 (5.26 - 8.03) vs 2.65 (1.80 - 3.50) cases per 1000 PY). The SIR was highest for those less than 40 years old (< 40 years: 30.55; 40 - 49 years: 5.84; 50 - 59 years: 3.13; 60 - 69 years: 2.38, 70 - 79 years: 1.53, > = 80 years: 1.41) while SIRD was highest for those with age 80 years and above (< 40 years: 2.16; 40 - 49 years: 3.44, 50 - 59 years: 4.25, 60 - 69 years: 5.55, 70 - 79 years: 4.16, > = 80 years: 6.14). Among those who had treatment within 6 months of HNC diagnosis, the SIR and SIRD were significantly higher among those who had primary radiation treatment approach (radiation only, radiation and chemotherapy) (SIR: 3.01 (2.64 - 3.43), SIRD: 5.12 (4.18 - 6.29) cases per 1000 PY) compared to primary surgery treatment approach (surgery only, surgery and radiation, surgery and chemotherapy and radiation) (SIR: 1.64 (1.31 - 2.05), SIRD: 1.84 (0.92 - 3.67)). CONCLUSION The risk of stroke varied across different subpopulations of survivors of HNC with higher risk observed in those surviving five years post HNC diagnosis, less than 40 years old or received primary radiation treatment approach within 6 months from HNC diagnosis. A risk based prophylactic measures for stroke should be considered for different subpopulations of survivors of HNC.
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Affiliation(s)
- Y Y Soon
- National University Cancer Institute, Department of Radiation Oncology, Singapore, Singapore
| | - H Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | - T H Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - S F Lee
- National University Cancer Institute Singapore, Singapore, Singapore
| | - Y H Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - L C C Wong
- National University Cancer Institute Singapore, Singapore, Singapore
| | - J Tey
- National University Cancer Institute Singapore, Singapore, Singapore
| | - F Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Cheo
- National University Cancer Institute Singapore, Singapore, Singapore
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19
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Keit E, Lee SF, Woodward M, Shiue K, Desideri I, Oldenburger E, Beinz M, Agyeman MB, Theodorou M, Froid M, Simone CB, Yu HHM, Yarney J, Rembielak A, Rades D, Hoskin P, Johnstone PAS. Palliative Whole Brain Radiotherapy: International State of Practice 2022. Int J Radiat Oncol Biol Phys 2023; 117:e114-e115. [PMID: 37784656 DOI: 10.1016/j.ijrobp.2023.06.897] [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) Increasing technology of radiation treatment planning and delivery, better systemic therapies, and randomized trials in the population of patients (pts) with brain metastases have provided robust targeted options. This has resulted in palliative whole brain radiation therapy (WBRT) being used far less frequently than previously. Most centers preferentially use stereotactic radiation surgery (SRS) for pts with several lesions and may reserve WBRT for those with poor performance, with rapidly progressive disease, or with leptomeningeal presentation. We hypothesize that different trends in current WBRT regimens exist across different continents with varying rates of use of hippocampal avoidance (HA) and memantine. Despite differences in dose, fractionation, and treatment technique, we predict that survival post-WBRT will remain poor-indicating appropriate application of whole brain treatment in this era of SRS and improved systemic therapies. MATERIALS/METHODS A multi-center international analysis of pts receiving WBRT in 2022 was performed. Primary end point was survival after WBRT. Participating centers were located in Belgium, the United Kingdom, Hong Kong, Cyprus, Italy, Germany, Ghana, and the United States. De-identified data were collected and analyzed centrally. Pts receiving WBRT as part of a curative regimen (e.g., medulloblastoma, primary CNS lymphomas), prophylactically in small cell lung cancer, or as bridging prior to CAR-T were excluded. The collected data consisted of pt parameters including prior stereotactic radiosurgery (SRS), prescription dose and fractionation, use of HA technique with or without memantine, and survival after WBRT. Survival was calculated via the Kaplan-Meier method. RESULTS Of 23,332 RT prescriptions written at these centers in 2022, 399 (1.7%) were for palliative WBRT. Most frequent primary cancers were lung (42%) and breast (28%). Twenty-seven different dose regimens were used. The most common prescriptions were for 3 Gy daily fractions for 10 fractions (45%) and 4 Gy daily for 5 fractions (37%). Prior CNS SRS was delivered in 32 pts (7%). HA technique was used in 44 pts (10%); this technique was almost exclusively used in the United States. Memantine was prescribed in 93 pts (20%). Survival ranged from zero days to still surviving. The global median overall survival was 84 days after completion of treatment (95% CI: 68.0-104.0). Cumulative 3-month and 6-month actuarial survivals were 48% and 32%. CONCLUSION This "moment in time" analysis confirms that pts with poor expected survival are being appropriately selected for WBRT and demonstrates the variance in global practice. Since poor survival precludes these pts from deriving much benefit, memantine and HA may be best suited only for carefully selected cases; use of these is not Standard of Care in the participating European, Asian, and African centers.
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Affiliation(s)
- E Keit
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S F Lee
- National University Cancer Institute Singapore, Singapore, Singapore
| | - M Woodward
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - I Desideri
- Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - M Beinz
- Mount Vernon Hospital, Northwood, United Kingdom
| | | | - M Theodorou
- Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - M Froid
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - H H M Yu
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - A Rembielak
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - D Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P A S Johnstone
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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20
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Lee SF, Wong HCY, Chan AW, Caini S, Shariati S, Rades D, Chan RJ, Kennedy SKF, Wolf JR, van den Hurk C, Behroozian T, Bonomo P, Ho FCH, Chow E, Herst P. Mepitel Film for the prevention of acute radiation dermatitis in head and neck cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:527. [PMID: 37594538 DOI: 10.1007/s00520-023-07988-w] [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: 06/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluates the efficacy of Mepitel Film in preventing acute radiation dermatitis (RD) in patients with head and neck cancer (HNC) across randomized controlled trials (RCTs). METHODS Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched on 5 March 2023 to identify relevant RCTs. RD assessment tools and outcomes were compared across studies. Pooled effect sizes and 95% confidence intervals (CI) were estimated based on random-effects analysis using RevMan 5.4. RESULTS Three RCTs conducted between 2018 and 2020 were included. Mepitel Film decreased RD severity when compared to Sorbolene or Biafine but not when compared to mometasone. A per-protocol analysis of two of the trials revealed that, overall, Mepitel Film significantly reduced the incidence of grade 2-3 RD (odds ratio (OR), 0.24; 95% CI, 0.09-0.65; p = 0.005) and moist desquamation (OR, 0.21; 95% CI, 0.10-0.46; p < 0.0001) and decreased average patient, researcher, and combined components of the Radiation-Induced Skin Reaction Assessment Scale (the standardized mean difference (SMD) for patient ratings, - 2.56; 95% CI, - 3.15 to - 1.96, p < 0.00001; SMD for researcher ratings, - 3.47; 95% CI, - 6.63 to - 0.31, p = 0.03; SMD for combined scores, - 3.68; 95% CI, - 6.43 to - 0.92, p = 0.009). Noted issues with Mepitel Film included itchiness and poor adherence. CONCLUSION While there were discrepancies across studies, Mepitel Film demonstrated a decrease in the incidence of grade 2-3 RD and moist desquamation. These findings emphasize the need for further examining Mepitel Film's efficacy across diverse patient groups and the importance of standardizing RD severity assessment methodologies and control arms.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore.
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong.
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francis C H Ho
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, 119228, Singapore
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patries Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
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21
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Shariati S, Behroozian T, Kennedy S, Caini S, Herst PM, Zhang L, Ding K, Karam I, van den Hurk C, Wolf JR, Lee SF, Wong H, Chan AW, Ogita M, Ye JC, Chan RJ, Gojsevic M, Rajeswaran T, Bonomo P, Chow E. Mepitel film for the prevention and treatment of acute radiation dermatitis in breast cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:524. [PMID: 37584828 DOI: 10.1007/s00520-023-07982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the efficacy of Mepitel film in preventing or treating acute radiation dermatitis (RD) in patients with breast cancer in randomized controlled trials (RCTs). METHODS Embase, APA PsychInfo, Journals@Ovid Full Text, Ovid MEDLINE, PubMed, and Cochrane Trials were searched until December 12, 2022, to identify RCTs on the use of Mepitel film for preventing or treating acute RD from breast cancer radiotherapy. Per-protocol analysis was used to compare outcomes, calculate pooled effect sizes, odds ratio (OR), and 95% confidence intervals (CI), and to create forest plots using random effects analysis in RevMan 5.4. RESULTS Three RCTs were included in this review. Mepitel film significantly reduced the incidence of grade 3 RD (OR 0.15 95% CI 0.06, 0.37, p<0.0001) and grade 2 or 3 RD (OR 0.16 95% CI 0.04, 0.65, p=0.01) as scored on either the CTCAE or the RTOG scale. Additionally, Mepitel film significantly reduced RISRAS mean scores assessed by patients and combined researcher and patient (standardized mean difference (SMD) -7.59, 95% CI -14.42, -0.76, p=0.03; SMD -15.36, 95% CI -30.01, -0.71 p=0.04) but not the researcher component of the assessment tool (SMD -17.55, 95% CI -36.94, 1.84, p=0.08). CONCLUSION Mepitel film reduced the incidence of acute RD and improved patient-reported outcomes with minimal side effects, the main one being itchiness. Future research should assess the feasibility of Mepitel film with respect to specific patient-reported outcomes such as health-related quality of life issues associated with its use.
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Affiliation(s)
- Saba Shariati
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Samantha Kennedy
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Patries M Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
| | | | - Keyue Ding
- Canadian Cancer Trials Division, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, New York, USA
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Henry Wong
- Department of Oncology, Princess Margaret Hospital, Hospital Authority, Lai Chi Kok, Hong Kong
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Mami Ogita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Jason C Ye
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Milena Gojsevic
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thenugaa Rajeswaran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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22
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Lee SF, Shariati S, Caini S, Wong H, Chan AW, Gojsevic M, Ogita M, Ye JC, Chia D, Chao M, Sung K, Kennedy SKF, Rajeswaran T, van den Hurk C, Wolf JR, Chan RJ, Behroozian T, Bonomo P, Chow E. StrataXRT for the prevention of acute radiation dermatitis in breast cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2023; 31:515. [PMID: 37556002 DOI: 10.1007/s00520-023-07983-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To evaluate the overall efficacy of StrataXRT, a topical gel dressing, in preventing acute radiation dermatitis (RD) in breast cancer patients undergoing radiotherapy (RT). METHODS A systematic search was conducted on April 25, 2023 in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) assessing the effectiveness of StrataXRT in preventing acute RD in breast cancer patients undergoing adjuvant RT to the breast or chest wall with or without regional nodes were included. Pooled incidence odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model, with analysis and forest plots generated in RevMan v5.4. RESULTS The analysis included three RCTs with a total of 189 patients assessed using per-protocol analysis. Two RCTs compared StrataXRT to standard of care, while the third compared it with Mepitel film and was reported separately. In the former RCTs, the odds ratio (OR) for developing acute grade 3 RD favored StrataXRT at 0.05 (95% CI, 0.01-0.22; P < 0.0001). The OR for developing acute grades 2-3 RD was 0.32 (95% CI, 0.03-3.18; P = 0.33). The RCT comparing StrataXRT with Mepitel film showed insignificant ORs for grade 3 and grades 2-3 RD. One RCT reported significantly lower erythema index (P = 0.008) and melanin index (P = 0.015) in StrataXRT patients. The use of StrataXRT did not raise additional safety concerns. CONCLUSION StrataXRT may help prevent severe acute RD in breast cancer RT patients. Further high quality, large-scale studies are needed to confirm these findings.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore.
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong.
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Henry Wong
- Department of Oncology, Princess Margaret Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Adrian W Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mami Ogita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Jason C Ye
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - David Chia
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Michael Chao
- Genesis Care Victoria, Ringwood Private Hospital, Ringwood East, Victoria, Australia
| | - KiHoon Sung
- Department of Radiation Oncology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Corina van den Hurk
- Research and Development Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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23
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Lee SF, Simone CB. Survival prediction in advanced cancer patients - a narrative review. Curr Opin Support Palliat Care 2023; 17:105-112. [PMID: 37039589 DOI: 10.1097/spc.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE OF REVIEW The exploration for accurate ways to predict survival for advanced cancer patients continues to be a significant theme despite the advent of objective criteria and their combination with clinical criteria. The purpose of this article was to review some of the latest studies relating to prognostication and the capacity to predict survival during the terminal cancer stage. RECENT FINDINGS Recent studies show notable prognostication approaches using genetic tests and advanced computation methods such as machine learning, which we will summarize. SUMMARY Significant effort has been made to improve the accuracy of survival estimation for advanced cancer patients. The main goals are to optimize individualized patient management and uses of resources. Advanced techniques, including genetic markers and machine learning techniques, may improve the accuracy of prediction.
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Affiliation(s)
- Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
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Yip PL, Fung WHB, Lee FAS, Lee CF, Wong NSM, Lee SF. Effectiveness and safety of capecitabine, irinotecan and panitumumab in advanced colorectal cancer. Front Oncol 2023; 13:1138357. [PMID: 37091154 PMCID: PMC10116611 DOI: 10.3389/fonc.2023.1138357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Capecitabine, irinotecan, and panitumumab (CAPIRI-P) is a controversial regimen for metastatic colorectal cancer, with concerns regarding the efficacy and toxicity. However, its toxicity profile has been improved with dose reduction, and concerns regarding efficacy have been extrapolated from other trials. This retrospective study reports the real-world effectiveness and safety of modified CAPIRI-P (mCAPIRI-P). Material and methods Advanced colorectal cancer patients receiving mCAPIPI-P in the first-line setting between July 2019 and December 2021 were analyzed. The progression-free survival on treatment (PFSOT) and overall survival (OS) were estimated using the Kaplan-Meier method, and the association with clinical and disease factors was analyzed using the Cox regression model. Serial changes in carcinoembryonic antigen (CEA) level and treatment toxicity were also evaluated. Results A total of 106 patients were included, of whom 97 (92%) and 31 (29%) had left-sided primary and unresectable liver-only disease, respectively. The median PFSOT and OS were 15.4 (95% CI 12.5-18.3) and 25.5 (95% CI 17.6-33.4) months, respectively. Sixteen (51.6%) and 10 (32.3%) liver-only disease patients underwent secondary liver treatment and R0 resection, respectively. In multivariable Cox regression, CEA responders (PFSOT: HR 0.53) and CEA normalization (PFSOT: HR 0.27; OS: HR 0.28) were independent favorable prognostic factors for PFSOT and OS. Grade ≥3 toxicity rate was 43%, mainly related to uncomplicated hematological toxicities. Conclusion The real-world data show that mCAPIRI-P is safe and effective as the first-line treatment regimen for RAS wild-type advanced colorectal cancer and warrants further study.
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Affiliation(s)
- Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Wai Him Brian Fung
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Francis Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Chak Fei Lee
- Department of Pharmacy, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Natalie Sean Man Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, Patel P, Kanee L, Lee SF, Chan AW, Wong HCY, Caini S, Mahal S, Kennedy S, Chow E, Bonomo P. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine 2023; 58:101886. [PMID: 37181415 PMCID: PMC10166790 DOI: 10.1016/j.eclinm.2023.101886] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 05/16/2023] Open
Abstract
Acute radiation dermatitis (ARD) commonly develops in cancer patients undergoing radiotherapy and is often characterized by erythema, desquamation, and pain. A systematic review was conducted to summarize the current evidence on interventions for the prevention and management of ARD. Databases were searched from 1946 to September 2020 to identify all original studies that evaluated an intervention for the prevention or management of ARD, with an updated search conducted in January 2023. A total of 235 original studies were included in this review, including 149 randomized controlled trials (RCTs). Most interventions could not be recommended due to a low quality of evidence, lack of supporting evidence, or conflicting findings across multiple trials. Photobiomodulation therapy, Mepitel® film, mometasone furoate, betamethasone, olive oil, and oral enzyme mixtures showed promising results across multiple RCTs. Recommendations could not be made solely based on the published evidence due to limited high-quality evidence. As such, Delphi consensus recommendations will be reported in a separate publication.
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Affiliation(s)
- Tara Behroozian
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA
| | | | | | - Henry Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Partha Patel
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Lauren Kanee
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Henry Chun Yip Wong
- Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong, China
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy
| | - Simran Mahal
- Faculty of Health, University of Waterloo, Ontario, Canada
| | | | - Edward Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Behroozian T, Bonomo P, Patel P, Kanee L, Finkelstein S, van den Hurk C, Chow E, Wolf JR, Behroozian T, Bonomo P, Patel P, Kanee L, Finkelstein S, van den Hurk C, Chow E, Ryan Wolf J, Banerjee S, Becherini C, Boers-Doets C, Carlesimo M, Caro G, Caterina Fortuna M, Chan AW, Drapek L, Freites-Martinez A, Hirakawa S, Hoffman Smith E, Iacovelli NA, Kwong B, Lee SF, Markova A, Miller R, Marta GN, Pugliese S, Reyes Habito CM, Robijns J, Salvestrini V, Schmeel LC, Spalek M, Trombetta M, Wong HCY. Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: international Delphi consensus-based recommendations. Lancet Oncol 2023; 24:e172-e185. [PMID: 36990615 DOI: 10.1016/s1470-2045(23)00067-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
Acute radiation dermatitis is a frequent adverse effect of radiotherapy, but standardisation of care for acute radiation dermatitis is lacking. Due to the conflicting evidence and variability in current guidelines, a four-round Delphi consensus process was used to compile opinions of 42 international experts on care for people with acute radiation dermatitis on the basis of the evidence in existing medical literature. Interventions for acute radiation dermatitis prevention or management that reached at least 75% consensus were recommended for clinical use. Six interventions could be recommended for the prevention of acute radiation dermatitis: photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil. Mepilex Lite dressings were recommended for the management of acute radiation dermatitis. Most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use, suggesting a need for further research. Clinicians can consider implementing recommended interventions in their practice to prevent and manage acute radiation dermatitis until additional evidence becomes available.
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Kwok KHF, Ip EC, Lee SF. The conundrums of the reasonable patient standard in English medical law. BMC Med Ethics 2023; 24:15. [PMID: 36823572 PMCID: PMC9948388 DOI: 10.1186/s12910-023-00892-2] [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: 02/12/2021] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In its 2015 decision in Montgomery v. Lanarkshire Health Board, the Supreme Court of the United Kingdom overruled the long-standing, paternalistic prudent doctor standard of care in favour of a new reasonable patient standard which obligates doctors to make their patients aware of all material risks of the recommended treatment and of any reasonable alternative treatment. This landmark judgment has been of interest to the rest of the common law world. A judicial trend of invoking Montgomery to impose more stringent requirements on doctors is discernible in subsequent decisions since then. MAIN BODY In this narrative review, without questioning the idea that properly informed patients should play a more active role in procedures affecting their own health in furtherance of their autonomy, safety, and consumer rights, we identify and analyse, with the aid of realistic clinical thought experiments, three practical conundrums that the Montgomery standard may inflict on the daily work of doctors, unfairly exposing them to arbitrary legal risks. CONCLUSIONS These conundrums pertain to the ascertainment of the risks that must be disclosed to the patient under the test of 'materiality'; the legal uncertainty as to the scope of the exceptions; and the actual ability of doctors to cope with the pressures of time. These conundrums offer ripe opportunities to rethink the proper role of judicially developed medical law in modern health care practice.
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Affiliation(s)
- Kelvin Hiu Fai Kwok
- Faculty of Law, The University of Hong Kong, Pokfulam, Hong Kong SAR.,Asian Institute of International Financial Law, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Eric C Ip
- Faculty of Law, The University of Hong Kong, Pokfulam, Hong Kong SAR.,Centre for Medical Ethics and Law, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore. .,Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong SAR.
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Lee SF, Yip PL, Vellayappan BA, Chee CE, Wong LC, Wan EYF, Chan EWY, Lee CF, Lee FAS, Luque-Fernandez MA. Incident Cardiovascular Diseases Among Survivors of High-Risk Stage II–III Colorectal Cancer: A Cluster-Wide Cohort Study. J Natl Compr Canc Netw 2022; 20:1125-1133.e10. [DOI: 10.6004/jnccn.2022.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
Background: The incidence and survival of colorectal cancer (CRC) are increasing. There is an increasing number of long-term survivors, many of whom are elderly and have comorbidities. We conducted a population-based study in Hong Kong to assess the long-term cardiovascular disease (CVD) incidence associated with adjuvant fluoropyrimidine-based chemotherapy among CRC survivors. Patients and Methods: Using the population-based electronic medical database of Hong Kong, we identified adults who were diagnosed with high-risk stage II–III CRC and treated with radical surgery followed by adjuvant fluoropyrimidine-based chemotherapy between 2010 and 2019. We evaluated the cause-specific cumulative incidence of CVD (including ischemic heart disease, heart failure, cardiomyopathy, and stroke) using the flexible parametric competing risk modeling framework. The control group without a history of CVD was selected from among a noncancer random sample from primary care clinics in the same geographic area. Results: We analyzed 1,037 treated patients with CRC and 5,078 noncancer controls. The adjusted cause-specific hazard ratio (HR) for CVD in the cancer cohort compared with the control group was 2.11 (95% CI, 1.39–3.20). The 1-, 5-, and 10-year cause-specific cumulative incidences were 2.0%, 4.5%, and 5.4% in the cancer cohort versus 1.2%, 3.0%, and 3.8% in the control group, respectively. Age at cancer diagnosis (HR per 5-year increase, 1.16; 95% CI, 1.08–1.24), male sex (HR, 1.40; 95% CI, 1.06–1.86), comorbidity (HR, 1.88; 95% CI, 1.36–2.61 for 1 comorbidity vs none, and HR, 6.61; 95% CI, 4.55–9.60 for ≥2 comorbidities vs none), diabetes (HR, 1.38; 95% CI, 1.04–1.84), hypertension (HR, 3.27; 95% CI, 2.39–4.50), and dyslipidemia/hyperlipidemia (HR, 2.53; 95% CI, 1.68–3.81) were associated with incident CVD. Conclusions: Exposure to adjuvant fluoropyrimidine-based chemotherapy was associated with an increased risk of CVD among survivors of high-risk stage II–III CRC. Cardiovascular risk monitoring of this group throughout cancer survivorship is advisable.
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Affiliation(s)
- Shing Fung Lee
- 1Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
- 2Department of Clinical Oncology, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong, China
- 3Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Pui Lam Yip
- 1Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | | | - Cheng Ean Chee
- 4Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Lea Choung Wong
- 3Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Eric Yuk-Fai Wan
- 5Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- 6Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Sha Tin, Hong Kong, China
- 7Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Esther Wai-Yin Chan
- 5Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- 6Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Sha Tin, Hong Kong, China
- 8The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
- 9Department of Pharmacy, University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Chak-Fei Lee
- 10Department of Pharmacy, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
- 11School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Francis Ann-Shing Lee
- 1Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Miguel Angel Luque-Fernandez
- 12Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 13Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 14Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada, Granada, Spain
- 15Cancer Registry of Granada, Andalusian School of Public Health, Granada, Spain; and
- 16Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), Madrid, Spain
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Lee SF, Yip PL, Wong A, Ng F, Koh V, Wong LC, Luk H, Ng CK, Lee FAS, Mamon HJ. Splenic irradiation contributes to grade ≥ 3 lymphopenia after adjuvant chemoradiation for stomach cancer. Clin Transl Radiat Oncol 2022; 36:83-90. [PMID: 35909437 PMCID: PMC9334913 DOI: 10.1016/j.ctro.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/04/2022] Open
Abstract
Severe lymphopenia occurs commonly after adjuvant chemoradiation for gastric cancer. High splenic radiation doses increase the chances of severe lymphopenia. Severe lymphopenia predicts a poorer overall survival and higher risk of infections. The spleen is not routinely considered an organ-at-risk with dosimetric constraint. Applying dose constraints to the spleen might lower the risk of severe lymphopenia.
Introduction Adjuvant chemoradiation therapy (CRT) in gastric cancer inevitably results in an unintentional spleen radiation dose. We aimed to determine the association between the spleen radiation dose and the observed severity of lymphopenia which may affect the clinical outcomes (survival time and infection risk). Methods Patients who received adjuvant CRT for gastric cancer between January 2015 and December 2020 were analyzed. The splenic dose-volume histogram (DVH) parameters were reported as mean splenic dose (MSD) and percentage of splenic volume receiving at least × Gray (Gy). Peripheral blood counts were recorded pre- and post-CRT. The development of severe (Common Terminology Criteria for Adverse Events, version 5.0, grade ≥ 3) post-CRT lymphopenia (absolute lymphocyte count [ALC] < 0.5 K/μL) was assessed by multivariable logistic regression using patient and dosimetric factors. Overall survival (OS), recurrence-free survival (RFS), and cumulative incidence of infectious events were estimated and analyzed using the Cox model or competing risk analysis. Results Eighty-four patients with a median follow-up duration of 42 months were analyzed. Pre- and post-CRT median ALC values were 1.8 K/μL (0.9–3.1 K/μL) and 0.9 K/μL (0.0–4.9 K/μL), respectively (P < 0.001). MSD > 40 Gy (odds ratio [OR], 1.13; 95 % confidence interval [CI], 1.01–1.26; P = 0.041), sex (OR for male to female, 0.25; 95 % CI, 0.09–0.70; P = 0.008), and baseline absolute neutrophil count (OR per 1 unit increase, 1.61; 95 % CI, 1.02–2.58; P = 0.040) were associated with the development of severe post-CRT lymphopenia, which was a risk factor for poorer OS (hazard ratio [HR] = 2.47; 95 % CI, 1.24–4.92; P = 0.010) and RFS (HR = 2.27; 95 % CI, 1.16–4.46; P = 0.017). The cumulative incidence of infections was higher among severe post-CRT lymphopenia patients (2.53, 95 % CI, 1.03–6.23, P = 0.043). Conclusion High splenic radiation doses increase the odds of severe post-CRT lymphopenia, an independent predictor of lower OS and higher risks of recurrence and infections in gastric cancer patients receiving adjuvant CRT. Therefore, optimizing the splenic DVH parameters may decrease the risk of severe post-CRT lymphopenia.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong.,Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong.,Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong
| | - Aray Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong
| | - Francesca Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong
| | - Vicky Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Lea Choung Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Hollis Luk
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong
| | - Chuk Kwan Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong
| | | | - Harvey J Mamon
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA 02115, USA
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Mak IL, Wan EYF, Wong TKT, Lee WWJ, Chan EWY, Choi EPH, Chui CSL, Ip MSM, Lau WCS, Lau KK, Lee SF, Wong ICK, Yu EYT, Lam CLK. The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review. Public Health Rev 2022; 43:1604121. [PMID: 35574567 PMCID: PMC9091177 DOI: 10.3389/phrs.2022.1604121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.
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Affiliation(s)
- Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- *Correspondence: Eric Yuk Fai Wan,
| | - Teenie Kwan Tung Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wendy Woo Jung Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wallace Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Lee SF, Vellayappan BA, Wong LC, Chiang CL, Chan SK, Wan EYF, Wong ICK, Lambert PC, Rachet B, Ng AK, Luque-Fernandez MA. Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study. ESMO Open 2022; 7:100363. [PMID: 35026723 PMCID: PMC8760397 DOI: 10.1016/j.esmoop.2021.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework. PATIENTS AND METHODS Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death). RESULTS A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years. CONCLUSIONS In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.
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Affiliation(s)
- S F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - B A Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - L C Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - C L Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S K Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - E Y-F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong
| | - I C-K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong; Research Department of Policy and Practice, School of Pharmacy, University College London, London, UK
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Rachet
- Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine, London, UK
| | - A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M A Luque-Fernandez
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), Andalusian School of Public Health, Granada, Spain.
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Yip PL, Mok KCJ, Ho HS, Lee WYV, Wong ACL, Lau CT, Wong FCS, Yeung KW, Lee SF. Sensorineural Hearing Loss in Nasopharyngeal Carcinoma Survivors in the Modern Treatment Era - The Early and Late Effects of Radiation and Cisplatin. Clin Oncol (R Coll Radiol) 2021; 34:e160-e167. [PMID: 34772581 DOI: 10.1016/j.clon.2021.10.013] [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: 03/08/2021] [Revised: 09/25/2021] [Accepted: 10/21/2021] [Indexed: 12/08/2022]
Abstract
AIMS Hearing loss is a common debilitating complication in nasopharyngeal carcinoma (NPC) survivors. The aim of the present study was to investigate the impact of inner ear/cochlear radiation dose and cisplatin use on early and late sensorineural hearing loss (SNHL) in NPC patients treated with radiotherapy alone, concurrent chemoradiation (cCRT) and induction chemotherapy followed by cCRT (iCRT) in the intensity-modulated radiotherapy era. MATERIALS AND METHODS The study included 81 NPC patients treated with intensity-modulated radiotherapy between 2014 and 2016. Pure tone audiometry was carried out at baseline and follow-up. The effects of cochlear/inner ear radiation and cisplatin doses on early (<12 months) and late (≥24 months) SNHL were analysed using multivariable regression after adjusting for important predictors. RESULTS In total, 156 ears were examined. In early SNHL (n = 136), cisplatin use predicted the incidence of early high-frequency SHNL (HF-SNHL) (odds ratio 6.4, 95% confidence interval 1.7-23.9, P = 0.005). Ninety ears were analysed for late SNHL (median follow-up 38 months). Inner ear/cochlear radiation and cisplatin doses and better pre-treatment hearing were independent predictors of threshold change at 4 kHz. Every 10 Gy increase in inner ear/cochlear Dmean resulted in 5-dB and 6-dB threshold changes, respectively (cochlear Dmean: B = 0.005, 95% confidence interval 0.0004-0.009, P = 0.031; inner ear Dmean: B = 0.006, 95% confidence interval 0.001-0.010, P = 0.014). Cisplatin use was associated with late HF-SNHL (odds ratio 3.74, 95% confidence interval 1.1-12.3, P = 0.031). In the cCRT and iCRT subgroups, no cisplatin dose-dependent ototoxicity was observed. Severe (≥30 dB) late HF-SNHL occurred in 14% and 25% of the patients when the cochlear dose constraints were 40 Gy and 44 Gy, respectively. The radiotherapy-alone group did not develop severe late HF-SNHL. CONCLUSION Cochlear/inner ear radiation dose and cisplatin use showed differential and independent ototoxicity in early and late SNHL. As cochlear/inner ear dose-dependent ototoxicity was demonstrated, the cochlear dose constraint should be as low as reasonably achievable, especially when cisplatin is also administered.
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Affiliation(s)
- P L Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - K C J Mok
- Department of Otorhinolaryngology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - H S Ho
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - W Y V Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - A C L Wong
- Department of Otorhinolaryngology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - C T Lau
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - F C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - K W Yeung
- Department of Otorhinolaryngology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong; Department of Clinical Oncology, University of Hong Kong, Hong Kong.
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Lee SF, Redondo Sánchez D, Sánchez MJ, Gelaye B, Chiang CL, Wong IOL, Cheung DST, Luque Fernandez MA. Trends in gender of authors of original research in oncology among major medical journals: a retrospective bibliometric study. BMJ Open 2021; 11:e046618. [PMID: 34663651 PMCID: PMC8524267 DOI: 10.1136/bmjopen-2020-046618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We evaluated the temporal trend in gender ratios of first and last authors in the field of oncological research published in major general medical and oncology journals and examined the gender pattern in coauthorship. DESIGN We conducted a retrospective study in PubMed using the R package RISmed. We retrieved original research articles published in four general medical journals and six oncology specialty journals. These journals were selected based on their impact factors and popularity among oncologists. We identified the names of first and last authors from 1 January 2002 to 31 December 2019. The gender of the authors was identified and validated using the Gender API database (https://gender-api.com/). PRIMARY AND SECONDARY OUTCOME MEASURES The percentages of first and last authors by gender and the gender ratios (male to female) and temporal trends in gender ratios of first and last authors were determined. RESULTS We identified 34 624 research articles, in which 32 452 had the gender of both first and last authors identified. Among these 11 650 (33.6%) had women as the first author and 7908 (22.8%) as the last author, respectively. The proportion of female first and last authors increased from 26.6% and 16.2% in 2002, to 32.9% and 27.5% in 2019, respectively. However, the gender ratio (male to female) of first and last authors decreased by 1.5% and 2.6% per year, respectively, which were statistically significant (first author: incidence rate ratio (IRR) 0.98, 95% CI 0.97 to 1.00; last author: IRR 0.97, 95% CI 0.96 to 0.99). Male first and last authorship was the most common combination. Male-female and female-female pairs increased by 2.0% and 5.0%, respectively (IRR 1.02, 95% CI 1.01 to 1.03 and IRR 1.05, 95% CI 1.04 to 1.06, respectively). CONCLUSIONS The continued under-representation of women means that more efforts to address parity for advancement of women in academic oncology are needed.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | - Daniel Redondo Sánchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Bizu Gelaye
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Chi Leung Chiang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
| | | | | | - Miguel Angel Luque Fernandez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain
- Andalusian School of Public Health, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Cheung DST, Takemura N, Smith R, Yeung WF, Xu X, Ng AYM, Lee SF, Lin CC. Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis. Sleep Med 2021; 85:108-122. [PMID: 34303913 DOI: 10.1016/j.sleep.2021.06.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effects of qigong interventions on sleep disturbance-related symptom clusters for cancer patients and to explore the possible mediating role of fatigue and depression in affecting sleep. METHODS In this systematic review and meta-analysis, a systematic search was conducted through October 2020 by searching multiple English and Chinese databases. Inclusion was limited to randomized controlled trials that measured the effect of qigong on sleep and fatigue/depressive symptoms in cancer patients. Eleven studies involving 907 cancer patients were included in the systematic review, whereas the meta-analysis included ten studies with 851 cancer patients. RESULTS The most commonly investigated form of qigong was Taichi, and the intervention length ranged from 10 days to 6 months. All studies employed self-reported measurements. Overall, qigong significantly improved sleep (SMD = -1.28, 95% CI: -2.01, -0.55) and fatigue (SMD = -0.89, 95% CI: -1.59, -0.19) in cancer patients post-intervention, but not depressive symptoms (SMD = -0.69, 95% CI: -1.81, 0.42). Notably, the benefits on sleep and fatigue became non-significant after 3 months. Qigong's effect on sleep was significantly mediated by its effect on fatigue (β = 1.27, SE = 0.24, p = 0.002), but not depressive symptoms (β = 0.53, SE = 0.26, p = 0.106). CONCLUSIONS Qigong can be recommended for improving sleep disturbance-fatigue symptom clusters in the cancer population, while qigong's benefit on sleep is likely based on its effect on reducing fatigue. Future qigong studies should adopt more rigorous design and employ strategies to maintain longevity of intervention benefits.
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Affiliation(s)
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alina Yee Man Ng
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; School of Nursing, College of Nursing, Taipei Medical University, Taiwan; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Shadmany J, Lee SF, Taylor PW. Real-time PCR-based Y-specific sperm quantification assay in Queensland fruit fly: Insights to patterns of sperm storage. Insect Mol Biol 2021; 30:315-324. [PMID: 33527600 DOI: 10.1111/imb.12697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Studies of reproductive biology in insects often require quantification of sperm production, transfer or storage. Here, we develop a quantitative real-time PCR-based assay using a Y-specific marker for quantification of sperm from spermathecae of female Queensland fruit fly ('Q-fly'), overcoming constraints typical of traditional sperm quantification methods. The assay enables accurate and reliable quantification of as few as 50 sperms and provides a means to analyse large numbers of samples with flexible timing. The real-time PCR method enables revised understanding of how many sperms are stored by female Q-flies, the distribution of storage between the two spermathecae and the relationship between copula duration and sperm storage. Real-time PCR assays based on Y-specific markers provide an effective solution for sperm quantification in tephritid flies, as well as in other insects and potentially other animals with sperm storage organs.
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Affiliation(s)
- J Shadmany
- Applied BioSciences, Macquarie University, North Ryde, New South Wales, Australia
| | - S F Lee
- Applied BioSciences, Macquarie University, North Ryde, New South Wales, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, ACT, Australia
| | - P W Taylor
- Applied BioSciences, Macquarie University, North Ryde, New South Wales, Australia
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Affiliation(s)
- Eric C Ip
- Centre for Medical Ethics and Law, Li Ka Shing Faculty of Medicine and Faculty of Law, The University of Hong Kong, Hong Kong
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong; The University of Hong Kong, Hong Kong.
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Lee SF, Choi HCW, Chan SK, Lam KO, Lee VHF, Wong IOL, Chiang CL. Cost-Effectiveness of Anti-Epidermal Growth Factor Receptor Therapy Versus Bevacizumab in KRAS Wild-Type (WT), Pan-RAS WT, and Pan-RAS WT Left-Sided Metastatic Colorectal Cancer. Front Oncol 2021; 11:651299. [PMID: 34012917 PMCID: PMC8127841 DOI: 10.3389/fonc.2021.651299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives We aimed to compare the economic value of chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) against chemotherapy with bevacizumab (Bev, an anti-vascular endothelial growth factor mAb) as first-line treatment in KRAS wild-type (WT), pan-RAS WT and pan-RAS WT left-sided metastatic colorectal cancer (mCRC) patients from the Hong Kong societal perspective. Materials and Methods We developed Markov models and 10-year horizon to estimate costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of chemotherapy plus anti-EGFR therapy against chemotherapy plus Bev in KRAS WT, pan-RAS WT, and pan-RAS WT left-sided mCRC. We considered two times of the local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (2× GDPpc; US$97,832). Results Adding anti-EGFR mAb to chemotherapy provides additional 0.24 (95% confidence interval [CI] 0.19-0.29), 0.32 (95% CI 0.27-0.37), and 0.57 (95% CI 0.49-0.63) QALY compared to adding Bev in KRAS WT, pan-RAS WT, and left-sided pan-RAS WT mCRC populations respectively. The corresponding ICER is US$106,847 (95% CI 87,806-134,523), US$88,565 (95% CI 75,678-105,871), US$76,537 (95% CI 67,794-87,917) per QALY gained, respectively. Conclusions Anti-EGFR therapy is more cost-effective than Bev as a first-line targeted therapy in left-sided pan-RAS WT and pan-RAS WT, with ICER <US$100,000/QALY, compared to KRAS WT mCRC population.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, Hong Kong
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Sik Kwan Chan
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Ka On Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Victor H F Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Irene O L Wong
- School of Public Health, University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, Hong Kong.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Lee SF, Nikšić M, Rachet B, Sanchez MJ, Luque-Fernandez MA. Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort. Cancers (Basel) 2021; 13:1514. [PMID: 33806016 PMCID: PMC8037247 DOI: 10.3390/cancers13071514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
We explored the role of socioeconomic inequalities in COVID-19 incidence among cancer patients during the first wave of the pandemic. We conducted a case-control study within the UK Biobank cohort linked to the COVID-19 tests results available from 16 March 2020 until 23 August 2020. The main exposure variable was socioeconomic status, assessed using the Townsend Deprivation Index. Among 18,917 participants with an incident malignancy in the UK Biobank cohort, 89 tested positive for COVID-19. The overall COVID-19 incidence was 4.7 cases per 1000 incident cancer patients (95%CI 3.8-5.8). Compared with the least deprived cancer patients, those living in the most deprived areas had an almost three times higher risk of testing positive (RR 2.6, 95%CI 1.1-5.8). Other independent risk factors were ethnic minority background, obesity, unemployment, smoking, and being diagnosed with a haematological cancer for less than five years. A consistent pattern of socioeconomic inequalities in COVID-19 among incident cancer patients in the UK highlights the need to prioritise the cancer patients living in the most deprived areas in vaccination planning. This socio-demographic profiling of vulnerable cancer patients at increased risk of infection can inform prevention strategies and policy improvements for the coming pandemic waves.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong;
| | - Maja Nikšić
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
| | - Bernard Rachet
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Maria-Jose Sanchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, 18071 Granada, Spain;
- Cancer Registry of Granada, Andalusian School of Public Health, 18011 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), 28029 Madrid, Spain
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, 18071 Granada, Spain;
- Cancer Registry of Granada, Andalusian School of Public Health, 18011 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), 28029 Madrid, Spain
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Abstract
The continuing outbreak of the coronavirus disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2 has inflicted considerable burdens onto the health system of China, the world's most populous country. Remarkably, among spectrum of potential mitigation strategies, the Chinese government has implemented all-out lockdowns on large geographical areas, unprecedented in the modern era. This inevitably undermined the right to healthcare of many who now faced great difficulty in getting treatment, especially those with cancer or other life-threatening issues. We elaborate and discuss the medico-legal and human rights consideration triggered by the lockdowns, the unprecedented mass quarantine of Hubei province in China, and the suspension of normal healthcare services. We argue that the same challenge will now be faced by other countries, particularly the USA, Italy, Spain, and France, as the epicentres of COVID-19 has shifted to Europe and the Americas.
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Affiliation(s)
- Eric C Ip
- Centre for Medical Ethics and Law, The University of Hong Kong, Pokfulam Road, Hong Kong Island, Hong Kong SAR
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong SAR.
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Chiang CL, Lee SF, Lee VW, Yeung CS, Cheung SK, Poon MC, Foo DC, Lo SH, Lam KO, Lee FA, Wong FC, Chan MK. Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients. Strahlenther Onkol 2020; 196:993-997. [PMID: 32313964 DOI: 10.1007/s00066-020-01612-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
AIM This communication reviews results and toxicity of image-guided high-dose-rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (ERT) in medically inoperable patients with rectal cancer. MATERIALS AND METHODS A total of 18 patients with rectal cancer and clinical stage T2-4N0‑2 treated with HDREBT boost after ERT were retrospectively reviewed. RESULTS Following treatment with a median total dose (EQD2, α/β = 10) of 66 Gy (range 48-92 Gy), the incidence of early and late rectal grade 3 toxicity was 11% and 19%, respectively. There was no correlation between the occurrence of acute and late toxicity. CONCLUSION With proper technique, a combined approach using EBRT and HDREBT was associated with acceptable toxicity in medically inoperable rectal cancer patients.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China.
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus Wy Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Cynthia Sy Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Steven Kt Cheung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | | | - Dominic Cc Foo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - S H Lo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Francis As Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank Cs Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Mark Kh Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
- Clinic for Radiation Oncology, University Hospital Essen, Essen, Germany
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Lee SF, Luk H, Wong A, Ng CK, Wong FCS, Luque-Fernandez MA. Prediction model for short-term mortality after palliative radiotherapy for patients having advanced cancer: a cohort study from routine electronic medical data. Sci Rep 2020; 10:5779. [PMID: 32238885 PMCID: PMC7113237 DOI: 10.1038/s41598-020-62826-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/11/2020] [Indexed: 12/18/2022] Open
Abstract
We developed a predictive score system for 30-day mortality after palliative radiotherapy by using predictors from routine electronic medical record. Patients with metastatic cancer receiving first course palliative radiotherapy from 1 July, 2007 to 31 December, 2017 were identified. 30-day mortality odds ratios and probabilities of the death predictive score were obtained using multivariable logistic regression model. Overall, 5,795 patients participated. Median follow-up was 39.6 months (range, 24.5-69.3) for all surviving patients. 5,290 patients died over a median 110 days, of whom 995 (17.2%) died within 30 days of radiotherapy commencement. The most important mortality predictors were primary lung cancer (odds ratio: 1.73, 95% confidence interval: 1.47-2.04) and log peripheral blood neutrophil lymphocyte ratio (odds ratio: 1.71, 95% confidence interval: 1.52-1.92). The developed predictive scoring system had 10 predictor variables and 20 points. The cross-validated area under curve was 0.81 (95% confidence interval: 0.79-0.82). The calibration suggested a reasonably good fit for the model (likelihood-ratio statistic: 2.81, P = 0.094), providing an accurate prediction for almost all 30-day mortality probabilities. The predictive scoring system accurately predicted 30-day mortality among patients with stage IV cancer. Oncologists may use this to tailor palliative therapy for patients.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Hollis Luk
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Aray Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Chuk Kwan Ng
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Frank Chi Sing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease and Cancer Epidemiology, Institute de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, Granada, Spain. .,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Luque-Fernandez MA, Redondo-Sanchez D, Lee SF, Rodríguez-Barranco M, Carmona-García MC, Marcos-Gragera R, Sánchez MJ. Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study. Clin Epidemiol 2020; 12:31-40. [PMID: 32021469 PMCID: PMC6969691 DOI: 10.2147/clep.s229935] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cancer treatment and outcomes can be influenced by tumor characteristics, patient overall health status, and comorbidities. While previous studies have analyzed the influence of comorbidity on cancer outcomes, limited information is available regarding factors associated with the increased prevalence of comorbidities and multimorbidity among patients with colorectal cancer in Spain. Patients and Methods This cross-sectional study obtained data from all colorectal cancer cases diagnosed in two Spanish provinces in 2011 from two population-based cancer registries and electronic health records. We calculated the prevalence of comorbidities according to patient and tumor factors, identified factors associated with an increased prevalence of comorbidity and multimorbidity, analyzed the association between comorbidities and time-to-surgery, and developed an interactive web application (https://comcor.netlify.com/). Results The most common comorbidities were diabetes (23.6%), chronic obstructive pulmonary disease (17.2%), and congestive heart failure (14.5%). Among all comorbidities, 52% of patients were diagnosed at more advanced stages (stage III/IV). Patients with advanced age, restricted performance status or who were disabled, obese, and smokers had a higher prevalence of multimorbidity. Patients with multimorbidity had a longer time-to-surgery than those without comorbidity (17 days, 95% confidence interval: 3–29 days). Conclusion We identified a consistent pattern of factors associated with a higher prevalence of comorbidities and multimorbidity at diagnosis and an increased time-to-surgery among patients with colorectal cancer with multimorbidity in Spain. This pattern may provide insights for further etiological and preventive research and help to identify patients at a higher risk for poorer cancer outcomes and suboptimal treatment.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Daniel Redondo-Sanchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Miguel Rodríguez-Barranco
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
| | - Ma Carmen Carmona-García
- Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Rafael Marcos-Gragera
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - María-José Sánchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada ibs. GRANADA, University of Granada, Granada, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada, Spain
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Lee CF, Zhou K, Young WM, Wong CS, Ng TY, Lee SF, Leung K, Wong LKM, So KH, Tang W, Chong G, Chan SK, Yip YTE, Ma VYM, Yeung A, Chin CHY, Kwan MW, Tsang HT. Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration. Support Care Cancer 2019; 28:3801-3812. [PMID: 31832822 DOI: 10.1007/s00520-019-05111-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/30/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colony-stimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7-day PP. METHODS We identified 3916 breast cancer patients using docetaxel-cyclophosphamide (TC), doxorubicin-cyclophosphamide then docetaxel (AC-T), fluorouracil-epirubicin-cyclophosphamide then docetaxel (FEC-T), docetaxel-carboplatin-trastuzumab (TJH), or docetaxel-doxorubicin-cyclophosphamide (TAC) from a hospital pharmacy dispensing database in Hong Kong between 2014 and 2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration. RESULTS In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p < 0.001), and 5.33% (OR 0.20, p < 0.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p < 0.001), and 8.57% (OR 0.15, p < 0.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84%, respectively (OR 0.28, p = 0.005); with FEC-T regimen, the incidence was 9.91% and 4.77%, respectively (OR 0.46, p = 0.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21 ± 2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66 ± 2.60, 4.37 ± 2.85, and 5.12 ± 2.97 days, respectively. CONCLUSION GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.
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Affiliation(s)
- C F Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Department of Pharmacy, Tuen Mun Hospital, Tuen Mun, Hong Kong.
| | - K Zhou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W M Young
- Department of Pharmacy, Tuen Mun Hospital, Tuen Mun, Hong Kong.,COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong
| | - C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - T Y Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - K Leung
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - L K M Wong
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - K H So
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - W Tang
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, United Christian Hospital, Kwun Tong, Hong Kong
| | - G Chong
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, United Christian Hospital, Kwun Tong, Hong Kong
| | - S K Chan
- Department of Pharmacy, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Y T E Yip
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - V Y M Ma
- COC Pharmaceutical Service - Oncology Working Group, Hospital Authority, Kowloon, Hong Kong.,Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - A Yeung
- Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C H Y Chin
- Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - M W Kwan
- Department of Pharmacy, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - H T Tsang
- Department of Pharmacy, Queen Elizabeth Hospital, Kowloon, Hong Kong
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster Hospital Authority, Hong Kong
| | - Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster Hospital Authority, Hong Kong
| | - Frank Chi Sing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster Hospital Authority, Hong Kong
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Van Spall HGC, Lee SF, Averbuch T, Erbas Oz U, Perez R, Ko DT, Connolly SJ. P6351A point-of-care risk score predicts 30-day readmission in patients hospitalized with heart failure (HF): derivation and validation of the LENT index. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Risk prediction models in heart failure (HF) are typically complex, derived retrospectively from administrative databases, and modest in their ability to discriminate between high, medium, and low risk categories. The complexity of these models makes them difficult to use at the point of care.
Purpose
To determine if a simple risk index using Length of hospital stay (L), number of Emergency department visits in the preceding 6 months (E), and either admission or discharge N-Terminal (NT) prohormone of Brain Natriuretic Peptide (pro-BNP) at the point of care can predict 30-day readmissions in patients hospitalized for HF.
Methods
This is a sub-study of the Patient-Centered Care Transitions in HF (PACT-HF) stepped-wedge cluster randomized trial. We included 772 patients hospitalized for HF at 10 Canadian hospitals. We used log-binomial regression models with Length of stay, Emergency department visits in the preceding 6 months, and either admission or discharge N-Terminal prohormone of Brain Natriuretic Peptide (NT-pro-BNP) as the predictor variables and 30-day all-cause readmission as the outcome. We derived the LENT risk score from the β-coefficients of the regression model (Fig. 1). All the models were adjusted for post-discharge services. We assessed model discrimination with C-statistics and model calibration with the net reclassification index (NRI). We used the bootstrapping approach with 100 runs for internal validation.
Results
The LENT index had a possible score ranging from 1 to 13 (Fig 1). Increments in the LENT risk score were associated with an increased risk of 30-day readmission; a 1-point increase in the LENT index using the admission and discharge NT-pro-BNP predicted a 23% and 19% increase in 30-day readmission risk, respectively. The internal validation produced similar results. Compared to a null model, the LE index had an NRI of 0.35 [95% CI 0.18, 0.53], and admission and discharge NT-pro-BNP further improved calibration of the LE index (NRI 0.15 [95% CI 0, 0.32] and 0.20 [95% CI 0.03, 0.37], respectively). The LENT index offered modest discrimination for 30-day readmission (C-statistic 0.64 [95% CI 0.59, 0.69]), similar to more complex risk models.
Figure 1. The LENT index scoring system
Conclusion
A simple risk index based on Length of stay, Emergent visits, and NT-pro-BNP at the point of care can reliably predict 30-day readmissions. The LENT index offers ease of use over traditional risk prediction models.
Acknowledgement/Funding
Canadian Institutes of Health Research, Ontario MOHLTC, Roche Diagnostics
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Affiliation(s)
- H G C Van Spall
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - S F Lee
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | | | - U Erbas Oz
- Institute for Clinical Evaluative Sciences, Hamilton, Canada
| | - R Perez
- Institute for Clinical Evaluative Sciences, Hamilton, Canada
| | - D T Ko
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - S J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Canada
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, P. R. China.
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease and Cancer Epidemiology, Biomedical Research Institute of Granada, University of Granada, 18002, Granada, Spain.,Department of Non-Communicable Disease and Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 6HW, UK.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA
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Lee SF, Ng TY, Spika D. Prognostic value of lymphocyte-monocyte ratio at diagnosis in Hodgkin lymphoma: a meta-analysis. BMC Cancer 2019; 19:338. [PMID: 30971203 PMCID: PMC6458704 DOI: 10.1186/s12885-019-5552-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. However, many are under-treated or over-treated by standard modern therapies. An accurate determination of prognosis may allow clinicians to design personalised treatment according to individual risk of disease progression and survival. Lymphocyte monocyte ratio (LMR) at diagnosis has been investigated as a prognostic biomarker in patients with HL. Our objective with this meta-analysis was to explore the prognostic value of the LMR at diagnosis in adult HL, by investigating the association between LMR and survival outcomes. Methods PUBMED and EMBASE were searched for relevant articles. Survival outcomes that we investigated included overall survival (OS), progression-free survival (PFS), event-free survival (EFS), lymphoma-specific survival (LSS), and time to progression (TTP). No restriction to the language, date, study country, or sample size was applied. Final search of databases was performed on 2 April 2018. We performed random-effects meta-analysis to aggregate and summarise the results from included studies, where four or more studies on a particular outcome were available. Results A total of eight studies (all retrospective cohort studies) involving 3319 HL patients were selected for analysis. All studies except one reported the effect of LMR on OS; five reported on PFS, three reported on TTP and LSS, respectively, and one reported on EFS. The pooled estimates showed low LMR was associated with poor OS (hazard ratio [HR] 2.67, 95% CI 1.67, 4.26) and PFS (HR 2.19, 95% CI 1.46, 3.29). Subgroup analyses of OS stratified by LMR cut-off values and sample sizes both indicated that low baseline LMR was associated with poorer prognosis. Conclusions Low LMR at diagnosis was associated with poor OS and PFS in HL. LMR is easy and cheap to determine and has a potential role in daily clinical management. More studies are needed to validate this biomarker and explore its interaction with known prognostic factors. Electronic supplementary material The online version of this article (10.1186/s12885-019-5552-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Devon Spika
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden.,Department of Economics, School of Economics and Management, Lund University, Lund, Sweden.,London School of Hygiene and Tropical Medicine, London, UK
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Chiang CL, Choi HC, Lam KO, Chan BY, Lee SF, Yeung SY, Lau KS, Chan SY, Choy TS, Yuen KK. Real-world treatment patterns and outcomes in refractory metastatic colorectal cancer. Asia Pac J Clin Oncol 2019; 15 Suppl 2:5-13. [PMID: 30887726 DOI: 10.1111/ajco.13114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS-102 became available in Hong Kong. METHODS The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. RESULTS Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow-up time of 6.6 [range, 0.4-37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third-line (3L) treatment: regorafenib (n = 22), TAS-102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28-0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post-3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. CONCLUSION Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected "trial ineligible" patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - B Y Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - T S Choy
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - K K Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
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49
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
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50
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Lee SF. Medicine's Achilles' Heel – Errors and Variations. Clin Oncol (R Coll Radiol) 2018; 30:595-596. [DOI: 10.1016/j.clon.2018.04.010] [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] [Received: 04/05/2018] [Revised: 04/13/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022]
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