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Doyle E, Killean AJ, Harrow S, Phillips ID. Systematic review of the efficacy of stereotactic ablative radiotherapy for oligoprogressive disease in metastatic cancer. Radiother Oncol 2024:110288. [PMID: 38648995 DOI: 10.1016/j.radonc.2024.110288] [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: 12/07/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Stereotactic Ablative Radiotherapy (SABR) for the treatment of oligometastatic disease can improve survival and delay the requirement for systemic therapy. The benefits of SABR in oligoprogressive disease are less well-defined. Here, we evaluate the available evidence investigating the efficacy of SABR in the treatment of oligoprogressive disease. METHODS A systematic review was carried out following PRISMA guidelines. Medline and Embase databases were searched using the terms "stereotactic radiotherapy" OR "SABR" OR "Stereotactic Ablative Body Radiotherapy" OR "SBRT" OR "SRT" AND "oligoprogression" in May 2022, June 2023, and February 2024. Studies were excluded where: SABR was used as a radical treatment, a specific oligoprogressive cohort could not be identified, publication was as a conference abstract or where fewer than 10 patients were recruited. Studies treating only brain metastases were also excluded. The site of primary tumour, oligoprogressive sites, rates of overall survival (OS), progression free survival (PFS), local control (LC) and time to next systemic therapy were collected. RESULTS Thirty-three full text studies were included. These consisted of single centre and multi-institutional observational studies, case series and phase II trials. Twenty-two studies were related to a specific tumour type: 12 urological cancer (9 prostate, 3 renal cancer), 6 non-small cell lung cancer, 2 colorectal cancer, 2 breast cancer and 11 were studies covering multiple tumour sites (5 studies involving SABR to a single organ and 6 studies involving SABR to multi-organ). Median PFS was >6months in patients with oligoprogressive prostate, non-small cell lung cancer and renal cancer patients. CONCLUSIONS SABR appears to have clinical benefit in oligoprogresssive prostate, lung, and renal patients. However, the optimal management of patients with oligoprogressive disease is still somewhat uncertain due to lack of prospective data. This will hopefully become clearer in the near future with the publication of further randomised trials.
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Affiliation(s)
- Emma Doyle
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom.
| | - Angus J Killean
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Stephen Harrow
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Iain D Phillips
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
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2
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Palma DA, Bahig H, Hope A, Harrow S, Debenham BJ, Louie AV, Vu TTT(T, Filion E, Bezjak A, Campeau MP, Duimering A, Giuliani ME, Laba JM, Lang P, Lok BH, Qu XM, Raman S, Rodrigues GB, Goodman CD, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson CJ. Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial. JAMA Oncol 2024:2815670. [PMID: 38451491 PMCID: PMC10921346 DOI: 10.1001/jamaoncol.2023.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 03/08/2024]
Abstract
Importance Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects of SABR in this patient population. Design, Setting, and Participants This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Intervention Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. Main Outcomes and Measures The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Results Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). Conclusions and Relevance In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Trial Registration ClinicalTrials.gov Identifier: NCT03485378.
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Affiliation(s)
- David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Brock J. Debenham
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thi Trinh Thuc (Toni) Vu
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Adele Duimering
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Meredith E. Giuliani
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joanna M. Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin H. Lok
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - X. Melody Qu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - George B. Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher D. Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Physics, Western University, London, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Inderdeep Dhaliwal
- Department of Respirology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher J. Ryerson
- Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Scobie H, Robb KA, Macdonald S, Harrow S, Sullivan F. Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment. J Med Screen 2024; 31:46-52. [PMID: 37525582 PMCID: PMC10878003 DOI: 10.1177/09691413231190785] [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: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. DESIGN Secondary data analysis of ECLS trial baseline data. METHODS Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. RESULTS The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. CONCLUSIONS Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.
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Affiliation(s)
- Hannah Scobie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Olson R, Abraham H, Leclerc C, Benny A, Baker S, Matthews Q, Chng N, Bergman A, Mou B, Dunne EM, Schellenberg D, Jiang W, Chan E, Atrchian S, Lefresne S, Carolan H, Valev B, Tyldesley S, Bang A, Berrang T, Clark H, Hsu F, Louie AV, Warner A, Palma DA, Howell D, Barry A, Dawson L, Grendarova P, Walker D, Sinha R, Tsai J, Bahig H, Thibault I, Koul R, Senthi S, Phillips I, Grose D, Kelly P, Armstrong J, McDermott R, Johnstone C, Vasan S, Aherne N, Harrow S, Liu M. Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET. BMC Cancer 2024; 24:171. [PMID: 38310262 PMCID: PMC10838428 DOI: 10.1186/s12885-024-11905-7] [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: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada.
- University of Northern British Columbia, Prince George, Canada.
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada.
- Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada.
| | - Hadassah Abraham
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Curtis Leclerc
- University of British Columbia, Vancouver, Canada
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | | | - Sarah Baker
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Nick Chng
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Alanah Bergman
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Emma M Dunne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Will Jiang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Elisa Chan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Shilo Lefresne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Hannah Carolan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Boris Valev
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | | | - Andrew Bang
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Tanya Berrang
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | - Haley Clark
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Fred Hsu
- BC Cancer- Abbotsford, Abbotsford, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Laura Dawson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Debra Walker
- Patient partner, BC Cancer-Prince George, Prince George, BC, Canada
| | - Rishi Sinha
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jillian Tsai
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Rashmi Koul
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Iain Phillips
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Paul Kelly
- Bon Secours Radiotherapy Cork (In Partnership with UPMC Hillman Cancer Centre), Cork, Ireland
| | | | | | - Candice Johnstone
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Srini Vasan
- Precision Cancer Center, Ashland, Kentucky, United States of America
| | - Noel Aherne
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
| | - Stephen Harrow
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Mitchell Liu
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
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5
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Palma DA, Bahig H, Hope AJ, Harrow S, Debenham BJ, Louie A, Vu T, Filion EJ, Bezjak A, Campeau MP, Duimering A, Giuliani M, Laba JM, Lang P, Lok BH, Qu MX, Raman S, Rodrigues G, Goodman C, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson C. Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD): Primary Analysis of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S28-S29. [PMID: 37784467 DOI: 10.1016/j.ijrobp.2023.06.289] [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) The use of stereotactic ablative radiotherapy (SABR) in patients with fibrotic interstitial lung disease (ILD) has been associated with an increased risk of toxicity, but patients with ILD and lung cancer may have no other options for curative-intent treatment. The goal of the ASPIRE-ILD trial was to assess the benefits and toxicities of SABR in patients with fibrotic ILD. MATERIALS/METHODS We enrolled patients with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgery. All patients were centrally reviewed prior to enrollment to confirm the presence and subtype of ILD. After stratification by the ILD-GAP score (a measure of ILD severity and prognosis), patients were treated with SABR to a dose of 50 Gy in 5 fractions EOD (BED = 100 Gy10), with a built-in de-escalation protocol in case of unacceptable toxicity. The primary endpoint was overall survival (OS), powered to distinguish 1-year OS >70% vs. an unacceptable rate of ≤50%. Secondary endpoints included toxicity (CTC-AE version 4.0), progression-free survival (PFS), local control (LC), patient-reported outcomes (FACT-L quality of life and cough severity), and changes in pulmonary function tests (PFTs). The study pre-specified that SABR would be considered worthwhile if median OS was >1 year, with a grade 3-4 toxicity risk <35% and a grade 5 toxicity risk <15%. Target accrual was 39 treated patients. RESULTS Thirty-nine patients were enrolled and treated with SABR between March 2019 and January 2022, all to a dose of 50 Gy in 5 fractions, at 5 institutions in Canada and 1 in Scotland. Median age was 78 years (interquartile range: 67-83), 59% were male, and 92% had a history of smoking (median 43 pack-years). At baseline, 70% reported dyspnea, median FEV1 was 80% predicted and median DLCO was 49% predicted. ILD-GAP scores were as follows: ≤2 (i.e., best ILD status): n = 14; 3-5: n = 23; ≥6 (i.e., worst ILD status): n = 2. Median follow-up was 19 months. OS at 1-year was 78.9% (p<0.001 by binomial test vs. the unacceptable rate). Median OS was 25 months, median PFS was 19 months, and 2-year LC was 92%. AE rates (possibly, probably or definitely related) were as follows (highest grade per patient): grade 1-2: n = 12 (31%); grade 3: n = 4 (10%); grade 4; n = 0; grade 5 n = 3 (7.7%, all due to respiratory deterioration). AE rates did not differ by ILD-GAP category or ILD subtype. FACT-L scores trended downward over time (p = 0.07), and cough severity scale scores worsened over time (p = 0.02). Comparing last-available PFTs with baseline, DLCO declined (median: -4%; p = 0.046), FVC trended downward (median: -2.5%; p = 0.11), and FEV1 remained stable (median change: 0%). CONCLUSION The use of SABR in patients with ILD met the pre-specified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Further studies exploring pharmacologic options to reduce toxicity may be beneficial in this population. ().
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Affiliation(s)
- D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - H Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - A Louie
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - T Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M P Campeau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J M Laba
- London Health Sciences Centre, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M X Qu
- London Regional Cancer Centre, London, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - C Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - J Morisset
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - I Dhaliwal
- London Health Sciences Centre, London, ON, Canada
| | - C Ryerson
- University of British Columbia, Vancouver, BC, Canada
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Stares M, Lewis G, Vallet M, Killean A, Tramonti G, Patrizio A, Mackean M, Harrow S, Barrie C, MacLennan K, Campbell S, Evans T, Tufail A, Hall P, Phillips I. Real-World Impact of SABR on Stage I Non-Small-Cell Lung Cancer Outcomes at a Scottish Cancer Centre. Cancers (Basel) 2023; 15:cancers15051431. [PMID: 36900224 PMCID: PMC10000454 DOI: 10.3390/cancers15051431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Stereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied. METHODS The Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outcomes were compared across treatment groups (no radical therapy (NRT), conventional radical radiotherapy (CRRT), SABR and surgery) and across three time periods reflecting the availability of SABR (A, January 2012/2013 (pre-SABR); B, 2014/2016 (introduction of SABR); C, 2017/2019, (SABR established)). RESULTS 1143 patients with stage I NSCLC were identified. Treatment was NRT in 361 (32%), CRRT in 182 (16%), SABR in 132 (12%) and surgery in 468 (41%) patients. Age, performance status, and comorbidities correlated with treatment choice. The median survival increased from 32.5 months in time period A to 38.8 months in period B to 48.8 months in time period C. The greatest improvement in survival was seen in patients treated with surgery between time periods A and C (HR 0.69 (95% CI 0.56-0.86), p < 0.001). The proportion of patients receiving a radical therapy rose between time periods A and C in younger (age ≤ 65, 65-74 and 75-84 years), fitter (PS 0 and 1), and less comorbid patients (CCI 0 and 1-2), but fell in other patient groups. CONCLUSIONS The introduction and establishment of SABR for stage I NSCLC has improved survival outcomes in Southeast Scotland. Increasing SABR utilisation appears to have enhanced the selection of surgical patients and increased the proportion of patients receiving a radical therapy.
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Affiliation(s)
- Mark Stares
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
- Correspondence: ; Tel.: +44-1315371000
| | - Georgina Lewis
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Maheva Vallet
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Angus Killean
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Giovanni Tramonti
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Ailsa Patrizio
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Kirsty MacLennan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Sorcha Campbell
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Tamasin Evans
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Aisha Tufail
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Edinburgh Cancer Informatics Programme
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Peter Hall
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Iain Phillips
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
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Van Oirschot M, Bergman A, Verbakel WFAR, Ward L, Gagne I, Huang V, Chng N, Houston P, Symes K, Thomas CG, Basran P, Bowes D, Harrow S, Olson R, Senan S, Warner A, Palma DA, Gaede S. Determining Planning Priorities for SABR for Oligometastatic Disease: A Secondary Analysis of the SABR-COMET Phase II Randomized Trial. Int J Radiat Oncol Biol Phys 2022; 114:1016-1021. [PMID: 35031340 DOI: 10.1016/j.ijrobp.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE SABR may improve survival in patients with oligometastases, but for some lesions, safe delivery of SABR may require a reduction in delivered dose or target coverage. This study assessed the association between target coverage compromise and oncologic and survival outcomes. METHODS AND MATERIALS Patients with a controlled primary malignancy and 1 to 5 oligometastases were randomized (1:2) between standard of care (SOC) treatment and SOC plus SABR. In patients receiving SABR, the target dose coverage was reduced to meet organ at risk (OAR) constraints, if necessary. The D99 value (minimum dose received by the hottest 99% of the planning target volume [PTV]) was used as a measure of PTV coverage for each treatment plan, and the relationship between the coverage compromise index (CCI, defined as D99/prescription dose) and patient outcomes was assessed. RESULTS Sixty-two patients in the SABR arm had dosimetric information available and a total of 109 lesions were evaluated. The mean CCI per lesion was 0.96 (95% CI, 0.56-1.61). Of the 109 lesions evaluated, 29.4% (n = 32) required coverage compromise (CCI <0.9). Adrenal metastases required coverage compromise in 100% of analyzed lesions (n = 7). CCI was not significantly associated with lesional control, adverse events, overall survival (OS), or progression-free survival (PFS). CONCLUSIONS Target compromise was required in a substantial minority of cases, but PTV coverage was not associated with OS, progression-free survival, or lesional control. This suggests that OAR constraints used for SABR treatments in the oligometastatic setting should continue to be prioritized during planning.
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Affiliation(s)
| | - Alanah Bergman
- British Columbia Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Wilko F A R Verbakel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lucy Ward
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Isabelle Gagne
- British Columbia Cancer, Victoria Centre, Victoria, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey Centre, Surrey, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Peter Houston
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Kerry Symes
- British Columbia Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | | | | | - David Bowes
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Stephen Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Robert Olson
- British Columbia Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Suresh Senan
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrew Warner
- London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- London Health Sciences Centre, London, Ontario, Canada.
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Voruganti I, Cunningham C, McLeod L, Chaudhuri N, Chua K, Evison M, Faivre-Finn C, Franks K, Harden S, Kruser J, Kruser T, Lee P, Peedell C, Phillips I, Robinson C, Senan S, Videtic G, Wright A, Harrow S, Louie A. Final Results of an International Delphi Consensus Study Regarding the Optimal Management of Radiation Pneumonitis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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9
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Van Oirschot M, Bergman A, Verbakel W, Ward L, Gagne I, Huang V, Chng N, Houston P, Symes K, Thomas C, Basran P, Bowes D, Harrow S, Olson R, Senan S, Warner A, Palma D, Gaede S. Does Compromising Target Coverage Impact Overall Survival when Treating Oligometastatic Disease with Stereotactic Ablative Radiotherapy (SABR)? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Voruganti I, Cunningham C, McLeod L, Harrow S, Louie A. 173: Final Results of an International Delphi Consensus Study Regarding the Optimal Management of Radiation Pneumonitis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Salem A, Franks K, Greystoke A, Hanna GG, Harrow S, Hatton M, Hiley C, McDonald F, Faivre-Finn C. Unaccounted Confounders Limit the Ability to Draw Conclusions From Big Data Analysis Comparing Radiotherapy Fractionation Regimens in NSCLC. J Thorac Oncol 2022; 17:e55-e56. [PMID: 35623677 DOI: 10.1016/j.jtho.2022.02.010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Ahmed Salem
- Department of Basic Medical Sciences, Hashemite University, Zarqa, Jordan; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
| | - Kevin Franks
- Leeds Cancer Centre, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alastair Greystoke
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom
| | - Crispin Hiley
- Research Department of Oncology, University College London, London, United Kingdom
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Harrow S, Palma DA, Olson R, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S. Stereotactic Radiation for the Comprehensive Treatment of Oligometastases (SABR-COMET) – Extended Long-Term Outcomes. Int J Radiat Oncol Biol Phys 2022; 114:611-616. [DOI: 10.1016/j.ijrobp.2022.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
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13
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Diez P, Hanna GG, Aitken KL, van As N, Carver A, Colaco RJ, Conibear J, Dunne EM, Eaton DJ, Franks KN, Good JS, Harrow S, Hatfield P, Hawkins MA, Jain S, McDonald F, Patel R, Rackley T, Sanghera P, Tree A, Murray L. UK 2022 Consensus on Normal Tissue Dose-Volume Constraints for Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:288-300. [PMID: 35272913 DOI: 10.1016/j.clon.2022.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 12/17/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) in the UK has expanded over the past decade, in part as the result of several UK clinical trials and a recent NHS England Commissioning through Evaluation programme. A UK SABR Consortium consensus for normal tissue constraints for SABR was published in 2017, based on the existing literature at the time. The published literature regarding SABR has increased in volume over the past 5 years and multiple UK centres are currently working to develop new SABR services. A review and update of the previous consensus is therefore appropriate and timely. It is hoped that this document will provide a useful resource to facilitate safe and consistent SABR practice.
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Affiliation(s)
- P Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - G G Hanna
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - N van As
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - A Carver
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - R J Colaco
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Conibear
- Radiotherapy Department, Barts Cancer Centre, London, UK
| | - E M Dunne
- Department of Clinical Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - D J Eaton
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK; Department of Medical Physics, Guys and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K N Franks
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - J S Good
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Harrow
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - P Hatfield
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - M A Hawkins
- Department of Medical Physics and Biomechanical Engineering, University College London, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Jain
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - F McDonald
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - R Patel
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - T Rackley
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - P Sanghera
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - L Murray
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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Palma D, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Schlijper R, Bauman G, Laba J, Qu X, Warner A, Senan S. OC-0104 Stereotactic radiation for treatment of oligometastases (SABR-COMET) – Extended long-term outcomes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Stares M, Ding T, Stratton C, Thomson F, Baxter M, Cagney H, Cumming K, Swan A, Ross F, Barrie C, Maclennan K, Campbell S, Evans T, Tufail A, Harrow S, Lord H, Laird B, MacKean M, Phillips I. Biomarkers of systemic inflammation predict survival with first-line immune checkpoint inhibitors in non-small-cell lung cancer. ESMO Open 2022; 7:100445. [PMID: 35398717 PMCID: PMC9058907 DOI: 10.1016/j.esmoop.2022.100445] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/08/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pembrolizumab is an established first-line option for patients with advanced non-small-cell lung cancer (NSCLC) expressing programmed death-ligand 1 ≥50%. Durable responses are seen in a subset of patients; however, many derive little clinical benefit. Biomarkers of the systemic inflammatory response predict survival in NSCLC. We evaluated their prognostic significance in patients receiving first-line pembrolizumab for advanced NSCLC. METHODS Patients treated with first-line pembrolizumab for advanced NSCLC with programmed death-ligand 1 expression ≥50% at two regional Scottish cancer centres were identified. Pretreatment inflammatory biomarkers (white cell count, neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albumin, prognostic nutritional index) were recorded. The relationship between these and progression-free survival (PFS) and overall survival (OS) were examined. RESULTS Data were available for 219 patients. On multivariate analysis, albumin and neutrophil count were independently associated with PFS (P < 0.001, P = 0.002, respectively) and OS (both P < 0.001). A simple score combining these biomarkers was explored. The Scottish Inflammatory Prognostic Score (SIPS) assigned 1 point each for albumin <35 g/l and neutrophil count >7.5 × 109/l to give a three-tier categorical score. SIPS predicted PFS [hazard ratio 2.06, 95% confidence interval (CI) 1.68-2.52 (P < 0.001)] and OS [hazard ratio 2.33, 95% CI 1.86-2.92 (P < 0.001)]. It stratified PFS from 2.5 (SIPS2), to 8.7 (SIPS1) to 17.9 months (SIPS0) (P < 0.001) and OS from 5.1 (SIPS2), to 12.4 (SIPS1) to 28.7 months (SIPS0) (P < 0.001). The relative risk of death before 6 months was 2.96 (95% CI 1.98-4.42) in patients with SIPS2 compared with those with SIPS0-1 (P < 0.001). CONCLUSIONS SIPS, a simple score combining albumin and neutrophil count, predicts survival in patients with NSCLC receiving first-line pembrolizumab. Unlike many proposed prognostic scores, SIPS uses only routinely collected pretreatment test results and provides a categorical score. It stratifies survival across clinically meaningful time periods that may assist clinicians and patients with treatment decisions. We advocate validation of the prognostic utility of SIPS in this and other immune checkpoint inhibitor treatment settings.
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Affiliation(s)
- M. Stares
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh,University of Edinburgh, Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh
| | - T.E. Ding
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - C. Stratton
- University of Edinburgh, Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh
| | - F. Thomson
- University of Edinburgh, Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh
| | - M. Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee,Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee
| | - H. Cagney
- School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - K. Cumming
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - A. Swan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - F. Ross
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - C. Barrie
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - K. Maclennan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - S. Campbell
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - T. Evans
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - A. Tufail
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - S. Harrow
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - H. Lord
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee
| | - B. Laird
- University of Edinburgh, Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh
| | - M. MacKean
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh
| | - I. Phillips
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Edinburgh,University of Edinburgh, Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh,Correspondence to: Dr Iain Phillips, Consultant in Clinical Oncology, Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. Tel: +441315371000 @caleycachexia
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Cunningham C, Voruganti I, McLeod L, Louie A, Harrow S. Final results of an International Delphi Consensus study regarding the optimal management of radiation pneumonitis. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Leach J, Stares M, Langley B, Fenner F, Killean A, Barrie C, Maclennan K, Campbell S, Evans T, Tufail A, Harrow S, McMenemy M, Mackean M, Phillips I. Real-world outcomes for patients with inoperable stage III non-small cell lung cancer: a prognostic role for albumin? Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Langley B, Leach J, Fenner F, Killean A, Barrie C, Maclennan K, Campbell S, Evans T, Tufail A, Harrow S, McMenemy M, MacKean M, Phillips I, Stares M. Biomarkers of systemic inflammation predict survival in stage III non-small cell lung cancer treated with chemoradiotherapy. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Horne A, Ali A, Brown S, Butterworth K, Chalmers A, Clipson A, Collinson F, Dive C, Faivre-Finn C, Forster M, Franks K, Gilbert A, Hanna G, Hannaway N, Harrow S, Hartley J, Hiley C, Jones R, Kendall J, Krebs M, Mallison G, O’Connor J, Oughton J, Phillip R, Rothwell D, Salem A, Sebag-Montefiore D, Shaw P, Walls G, Young R, Greystoke A. CONCORDE: a phase Ib platform study of novel agents in combination with conventional radiotherapy in non-small cell lung cancer (NSCLC). Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Phillips I, Olson R, Palma D, Harrow S. In Response to: 'Should We be Offering our Patients with Oligometastases Stereotactic Ablative Body Radiotherapy?' by Ostler et al. and 'Should We be Offering our Patients with Oligometastases Stereotactic Ablative Body Radiotherapy - No' by Macbeth and Hughes-Davies. Clin Oncol (R Coll Radiol) 2022; 34:e169-e170. [PMID: 35148914 DOI: 10.1016/j.clon.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- I Phillips
- Edinburgh Cancer Centre, Edinburgh, UK; Edinburgh Cancer Research UK Centre, Edinburgh, UK.
| | - R Olson
- Department of Radiation Oncology, BC Cancer - Centre for the North, Prince George, British Columbia, Canada
| | - D Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, UK; Edinburgh Cancer Research UK Centre, Edinburgh, UK
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Qu M, Chen Y, Zaric G, Senan S, Olson R, Harrow S, John-Baptiste A, Gaede S, Mulroy L, Schellenberg D, Senthi S, Swaminath A, Kopek N, Liu M, Warner A, Rodrigues G, Palma D, Louie A. Cost-Effectiveness of SABR in Oligometastatic Cancer: An Economic Analysis Based on Long-Term Results of the SABR-COMET Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Voruganti I, Cunningham C, McLeod L, Harrow S, Louie A. Optimal Management of Radiation Pneumonitis: Preliminary Findings of an International Delphi Consensus Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Stares M, Swan A, Cumming K, Ding TE, Leach J, Stratton C, Thomson F, Barrie C, MacLennan K, Campbell S, Evans T, Tufail A, Harrow S, MacKean M, Phillips I. Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer. Front Nutr 2021; 8:734735. [PMID: 34660664 PMCID: PMC8517082 DOI: 10.3389/fnut.2021.734735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albumin in patients receiving first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC. Methods: All patients treated with first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC at a regional Scottish cancer centre were identified. Serum albumin at pre-treatment, after 12-weeks of treatment, and at the time of progressive disease were recorded. The relationship between albumin (≥ 35g/L v <35g/L) and overall survival (OS) was examined. Results: Data were available for 389 patients of both targeted therapy cohort (n = 159) and immunotherapy-based therapy cohort (n = 230). Pre-treatment albumin was predictive of OS in each cohort at HR1.82 (95%CI 1.23–2.7) (p =0.003) and HR2.55 (95%CI 1.78–3.65) (p < 0.001), respectively. Pre-treatment albumin <35 g/L was associated with a significantly higher relative risk of death within 12 weeks in each cohort at RR9.58 (95%CI 2.20–41.72, p = 0.003) and RR3.60 (95%CI 1.74–6.57, p < 0.001), respectively. The 12-week albumin was predictive of OS in each cohort at HR1.88 (95%CI 1.86–4.46) (p < 0.001) and HR2.67 (95%CI 1.74–4.08) (p < 0.001), respectively. 46 out of 133 (35%) evaluable patients treated with targeted therapy and 43 out of 169 (25%) treated with immunotherapy-based therapy crossed over albumin prognostic groups between pre-treatment and 12-week. The prognostic value of 12-week albumin was independent of pre-treatment albumin status. A majority of patients had albumin <35g/L at the time of progressive disease when it was also predictive of survival following progressive disease at HR2.48 (95%CI 1.61–3.82) (p < 0.001) and HR2.87 (95%CI 1.91–4.31) (p < 0.001) respectively). Conclusions: Albumin is a reliable prognostic factor in patients with metastatic NSCLC, predicting survival independent of the class of drug treatment at various time points during the patient journey. Tracking albumin concentrations during systemic therapy may indicate disease activity or treatment response over time.
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Affiliation(s)
- Mark Stares
- Edinburgh Cancer Centre, Edinburgh, United Kingdom.,Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Amanda Swan
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - Tze-En Ding
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | - James Leach
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | - Cory Stratton
- Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Findlay Thomson
- Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Colin Barrie
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | | | | | - Aisha Tufail
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | | | - Iain Phillips
- Edinburgh Cancer Centre, Edinburgh, United Kingdom.,Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
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Voruganti I, Cunningham C, McLeod L, Harrow S, Louie A. 62: Optimal Management of Radiation Pneumonitis: Preliminary Findings of an International Delphi Consensus Study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rulach R, Fenwick J, Harrow S. P05.09 Thoracic Re-Irradiation Dose Constraints for Late Lung Fibrosis: Preliminary Modelling Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Walls GM, Oughton JB, Chalmers AJ, Brown S, Collinson F, Forster MD, Franks KN, Gilbert A, Hanna GG, Hannaway N, Harrow S, Haswell T, Hiley CT, Hinsley S, Krebs M, Murden G, Phillip R, Ryan AJ, Salem A, Sebag-Montefoire D, Shaw P, Twelves CJ, Walker K, Young RJ, Faivre-Finn C, Greystoke A. CONCORDE: A phase I platform study of novel agents in combination with conventional radiotherapy in non-small-cell lung cancer. Clin Transl Radiat Oncol 2020; 25:61-66. [PMID: 33072895 PMCID: PMC7548952 DOI: 10.1016/j.ctro.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the leading cause of cancer mortality worldwide and most patients are unsuitable for 'gold standard' treatment, which is concurrent chemoradiotherapy. CONCORDE is a platform study seeking to establish the toxicity profiles of multiple novel radiosensitisers targeting DNA repair proteins in patients treated with sequential chemoradiotherapy. Time-to-event continual reassessment will facilitate efficient dose-finding.
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Key Words
- ATM, Ataxia telangiectasia mutated
- ATR, Ataxia telangiectasia and Rad3 related
- CRT, Chemoradiotherapy
- CT, Computed tomography
- CTCAE, Common terminology criteria for adverse events
- CTRad, Clinical and Translational Radiotherapy Research Working Group
- Continual reassessment method
- DDRi, DNA damage response inhibitor
- DLT, Dose limiting toxicity
- DNA damage repair inhibitor
- DNA, Deoxyribonucleic acid
- DNA-PK, DNA-dependent protein kinase
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organisation for Research and Treatment of Cancer
- ICRU, International Commission on Radiation Units and Measurements
- IMPs, Investigational medicinal products
- LA, Locally advanced
- MRC, Medical Research Council
- NCRI, National Cancer Research Institute
- NSCLC, Non-small cell lung cancer
- Non-small cell lung cancer
- PARP, Poly (ADP-ribose) polymerase
- PET, Positron emission tomography
- PFS, Progression free survival
- PROMs, Patient-reported outcome measures
- Platform trial
- RECIST, Response evaluation criteria in solid tumours
- RP2D, Recommended phase II dose
- RT, Radiotherapy
- SACT, Systemic anti-cancer therapy
- SRC, Safety review committee
- Sequential chemoradiotherapy
- TNM, Tumour node metastasis
- TiTE-CRM, Time to event continual reassessment method
- cfDNA, Cell-free DNA
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Affiliation(s)
- Gerard M. Walls
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Northern Ireland, UK
| | - Jamie B. Oughton
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | | | - Sarah Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Fiona Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | | | - Kevin N. Franks
- St James’ Institute of Oncology, University of Leeds, England, UK
| | | | - Gerard G. Hanna
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | | | - Stephen Harrow
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | | | | | - Samantha Hinsley
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
- Institute of Cancer Sciences, University of Glasgow, Scotland, UK
| | - Matthew Krebs
- Faculty of Biology, Medicine and Health, University of Manchester, England, UK
| | - Geraldine Murden
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Rachel Phillip
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Anderson J. Ryan
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England, UK
| | - Ahmed Salem
- The Christie NHS Foundation Trust/University of Manchester, Manchester, England, UK
| | | | - Paul Shaw
- Velindre University NHS Trust, Cardiff, Wales, UK
| | - Chris J. Twelves
- St James’ Institute of Oncology, University of Leeds, England, UK
| | - Katrina Walker
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Robin J. Young
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, England, UK
| | - Corinne Faivre-Finn
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England, UK
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Cunningham C, Voruganti I, McLeod L, Louie A, Harrow S. Optimal Management of Radiation Pneumonitis: Preliminary Findings of an International Delphi Consensus Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patibandla A, Featherstone C, Maclaren V, Lumsden G, Harrow S, Jones R, Chalmers AJ, McLoone P, Hicks J. Hypofractionated Accelerated Concurrent Chemoradiotherapy in Inoperable Stage III Non-small Cell Lung Cancer: SOCCAR. A Large Single-Centre Experience. Clin Oncol (R Coll Radiol) 2020; 32:e211. [PMID: 32665103 PMCID: PMC7353906 DOI: 10.1016/j.clon.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- A Patibandla
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - V Maclaren
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - G Lumsden
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Jones
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - P McLoone
- Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
| | - J Hicks
- Beatson West of Scotland Cancer Centre, Glasgow, UK
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Palma D, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Ahmad B, Schlijper R, Laba J, Qu M, Schellenberg D, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman G, Warner A, Senan S. 8: Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-Comet Randomized Trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Voruganti I, Cunningham C, McLeod L, Harrow S, Louie AV. 134: Optimal Management of Radiation Pneumonitis: Preliminary Findings of An International Delphi Consensus Study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Faivre-Finn C, Fenwick JD, Franks KN, Harrow S, Hatton MQF, Hiley C, McAleese JJ, McDonald F, O'Hare J, Peedell C, Pope T, Powell C, Rulach R, Toy E. Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:481-489. [PMID: 32405158 PMCID: PMC7218369 DOI: 10.1016/j.clon.2020.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic. Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.
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Affiliation(s)
- C Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
| | - J D Fenwick
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Physics, Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - K N Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK; University of Leeds, Leeds, UK
| | - S Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | | | - C Hiley
- CRUK Lung Cancer Centre of Excellence, University College London, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J J McAleese
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - F McDonald
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J O'Hare
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - C Peedell
- James Cook University Hospital, Middlesbrough, UK
| | - T Pope
- Clatterbridge Cancer Centre, Bebington, Wirral, UK
| | - C Powell
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK; Velindre Cancer Centre, Cardiff, UK
| | - R Rulach
- Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter Hospital, Exeter, UK
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Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol 2020; 38:2830-2838. [PMID: 32484754 PMCID: PMC7460150 DOI: 10.1200/jco.20.00818] [Citation(s) in RCA: 611] [Impact Index Per Article: 152.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long-term disease control, or even cure, if all sites of disease can be ablated. However, long-term randomized data that test this paradigm are lacking. METHODS < .20 indicates a positive trial). Secondary end points included progression-free survival (PFS), toxicity, and quality of life (QOL). Herein, we present long-term outcomes from the trial. RESULTS = .001). There were no new grade 2-5 adverse events and no differences in QOL between arms. CONCLUSION With extended follow-up, the impact of SABR on OS was larger in magnitude than in the initial analysis and durable over time. There were no new safety signals, and SABR had no detrimental impact on QOL.
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Affiliation(s)
- David A Palma
- London Health Sciences Centre, London, Ontario, Canada
| | - Robert Olson
- BC Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Stephen Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Stewart Gaede
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Cornelis Haasbeek
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, Nova Scotia, Canada
| | - Michael Lock
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Belal Ahmad
- London Health Sciences Centre, London, Ontario, Canada
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | | | - Neil Kopek
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Mitchell Liu
- BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Karen Moore
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Suzanne Currie
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Roel Schlijper
- BC Cancer, Centre for the North, Prince George, British Columbia, Canada
| | | | - Joanna Laba
- London Health Sciences Centre, London, Ontario, Canada
| | - X Melody Qu
- London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- London Health Sciences Centre, London, Ontario, Canada
| | - Suresh Senan
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Rulach R, Fenwick J, Harrow S. Thoracic re-irradiation dose constraints: early results from a literature review. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Docherty K, McKechnie S, Glass E, McIntyre H, Harrow S. Implementing a virtual systemic anti-cancer treatment pre-assessment clinic for lung cancer patients living on the Isle of Bute and Cowal peninsula. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Palma DA, Chen H, Bahig H, Gaede S, Harrow S, Laba JM, Qu XM, Rodrigues GB, Yaremko BP, Yu E, Louie AV, Dhaliwal I, Ryerson CJ. Assessment of precision irradiation in early non-small cell lung cancer and interstitial lung disease (ASPIRE-ILD): study protocol for a phase II trial. BMC Cancer 2019; 19:1206. [PMID: 31829203 PMCID: PMC6905060 DOI: 10.1186/s12885-019-6392-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/12/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) has become an established treatment option for medically-inoperable early-stage (Stage I-IIA) non-small cell lung cancer (ES-NSCLC). SABR is able to obtain high rates of local control with low rates of symptomatic toxicity in this patient population. However, in a subset of patients with fibrotic interstitial lung disease (ILD), elevated rates of SABR-related toxicity and mortality have been described. The Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD) study will conduct a thorough prospective evaluation of the clinical outcomes, toxicity, changes in diagnostic test parameters and patient-related outcomes following SABR for ES-NSCLC for patients with fibrotic ILD. METHODS ASPIRE-ILD is a single-arm Phase II prospective study. The accrual target is 39 adult patients with T1-2N0M0 non-small cell lung cancer with co-existing ILD who are not candidates for surgical excision. Pathological confirmation of diagnosis is strongly recommended but not strictly required. Enrolled patients will be stratified by ILD-related mortality risk. The starting SABR dose will be 50 Gy in 5 fractions every other day (biologically effective dose: 100 Gy10 or 217 Gy3), but the radiation dose can be de-escalated up to two times to 50 Gy in 10 fractions daily (75 Gy10 or 133 Gy3) and 45 Gy in 15 fractions daily (58 Gy10 or 90 Gy3). Dose de-escalation will occur if 2 or more of the first 7 patients in a cohort experiences grade 5 toxicity within 6 months of treatment. Similarly, dose de-escalation can also occur if 2 or more of the first 7 patients with a specific subtype of ILD experiences grade 5 toxicity within 6 months of treatment. The primary endpoint is overall survival. Secondary endpoints include toxicity (CTC-AE 4.0), progression-free survival, local control, patient-reported outcomes (cough severity and quality of life), rates of ILD exacerbation and changes in pulmonary function tests/high-resolution computed tomography findings post-SABR. DISCUSSION ASPIRE-ILD will be the first prospective study specifically designed to comprehensively evaluate the effectiveness and safety of SABR for ES-NSCLC in patients with co-existing ILD. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03485378. Date of registration: April 2, 2018.
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Affiliation(s)
- David A. Palma
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Hanbo Chen
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet Street, Montreal, Quebec H2X 3E4 Canada
| | - Stewart Gaede
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Stephen Harrow
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Joanna M. Laba
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - X. Melody Qu
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - George B. Rodrigues
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Brian P. Yaremko
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Edward Yu
- Department of Oncology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Inderdeep Dhaliwal
- Department of Respirology, Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9 Canada
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Rulach R, McLoone P, Lumsden G, McKay S, MacLaren V, Macphee J, Moore K, Omand M, Sproule M, Currie S, Aitken A, Ferguson R, Valentine R, Houston P, Harrow S, Hicks J. Toxicity and Efficacy of Stereotactic Ablative Body Radiotherapy for Moderately Central Non-small Cell Lung Cancers Using 50 Gy in Five Fractions. Clin Oncol (R Coll Radiol) 2019; 32:250-258. [PMID: 31607611 DOI: 10.1016/j.clon.2019.09.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022]
Abstract
AIMS Stereotactic ablative body radiotherapy doses for peripheral lung lesions caused high toxicity when used for central non-small cell lung cancer (NSCLC). To determine a safe stereotactic ablative body radiotherapy dose for central tumours, the phase I/II Radiation Therapy Oncology Group RTOG 0813 trial used 50 Gy/five fractions as a baseline. From 2013, 50 Gy/five fractions was adopted at the Beatson West of Scotland Cancer Centre for inoperable early stage central NSCLC. We report our prospectively collected toxicity and efficacy data. MATERIALS AND METHODS Patient and treatment characteristics were obtained from electronic medical records. Tumours were classed as moderately central or ultra-central tumours using published definitions. Toxicity was assessed in a centralised follow-up clinic at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years after treatment. RESULTS Fifty patients (31 women, 19 men, median age 75.1 years) were identified with T1-2N0M0 moderately central NSCLC; one patient had both an ultra-central and a moderately central tumour. Eighty-four per cent were medically unfit for surgery. Forty per cent had biopsy-proven NSCLC and 60% were diagnosed radiologically using 18-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Fifty-six per cent of patients were Eastern Cooperative Oncology Group (ECOG) performance status 2 or worse. All patients received 50 Gy/five fractions on alternate days on schedule. Two patients died within 90 days of treatment, one from a chest infection, the other cause of death was unknown. There was one episode of early grade 3 oesophagitis and one grade 3 late dyspnoea. There was no grade 4 toxicity. Over a median follow-up of 25.2 months (range 1-70 months), there were 34 deaths: 18 unrelated to cancer and 16 due to cancer recurrence. The median overall survival was 27.0 months (95% confidence interval 20.6-35.9) and cancer-specific survival was 39.8 months (95% confidence interval 28.6, not reached). CONCLUSION This study has shown that 50 Gy/five fractions is a safe dose and fractionation for early stage inoperable moderately central NSCLC, with outcomes comparable with other series, even with patients with a poor performance status.
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Affiliation(s)
- R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - P McLoone
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - G Lumsden
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S McKay
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - V MacLaren
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Macphee
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - K Moore
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Omand
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Sproule
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Currie
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Aitken
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Ferguson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Valentine
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - P Houston
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Harrow
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Hicks
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
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March GR, Ju X, Marshall S, Dick C, Harrow S. P1.09-08 Registration of Pre-Operative Lung Cancer PET/CT Scans with Post-Operative Histopathology Maps. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Olson R, Senan S, Harrow S, Gaede S, Louie A, Haasbeek N, Mulroy L, Lock M, Rodriques G, Yaremko B, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman G, Warner A, Palma D. 91 Quality of Life Outcomes After Stereotactic Ablative Radiotherapy (SABR) Versus Standard of Care Palliative Treatments: A Secondary Analysis of the SABR-COMET Randomized Trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hudson A, Brown S, Chalmers A, Dive C, Franks K, Hanna G, Hannaway N, Harrow S, Haswell T, Hiley C, Hinsley S, Krebs M, Murden G, Reed S, Ryan A, Sebag-Montefiore D, Shaw P, Smith A, Walls G, Young R, Faivre-Finn C, Greystoke A. P2.01-08 Clinical Trial in Progress: CONCORDE - A Phase 1B Study of Novel Agents in Combination with Conventional Radiotherapy in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Olson R, Senan S, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman G, Warner A, Palma D. Quality of Life Outcomes after Stereotactic Ablative Radiotherapy (SABR) vs. Standard of Care Palliative Treatments: A Secondary Analysis of the SABR-COMET Randomized Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Qu M, Chen Y, Zaric G, Senan S, Olson R, Harrow S, John-Baptiste A, Gaede S, Mulroy L, Schellenberg D, Senthi S, Swaminath A, Kopek N, Liu M, Warner A, Rodrigues G, Palma D, Louie A. Is SABR Cost-Effective in Oligometastatic Cancer? An Economic Analysis of SABR-Comet. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olson R, Senan S, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman G, Warner A, Palma D. Quality of Life Outcomes After Stereotactic Ablative Radiation Therapy (SABR) Versus Standard of Care Treatments in the Oligometastatic Setting: A Secondary Analysis of the SABR-COMET Randomized Trial. Int J Radiat Oncol Biol Phys 2019; 105:943-947. [PMID: 31470091 DOI: 10.1016/j.ijrobp.2019.08.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Randomized data assessing the longitudinal quality of life (QoL) impact of stereotactic ablative radiation therapy (SABR) in the oligometastatic setting are lacking. METHODS AND MATERIALS We enrolled patients who had a controlled primary malignancy with 1 to 5 metastatic lesions, with good performance status and life expectancy >6 months. We randomized in a 1:2 ratio between standard of care (SOC) treatment (SOC arm) and SOC plus SABR to all metastatic lesions (SABR arm). QoL was measured using the Functional Assessment of Cancer Therapy-General. QoL changes over time and between groups were assessed with linear mixed modeling. RESULTS Ninety-nine patients were randomized. Median age was 68 years (range, 43-89), and 60% were male. The most common primary tumor types were breast (n = 18), lung (n = 18), colorectal (n = 18), and prostate (n = 16). Most patients (n = 92) had 1 to 3 metastases. Median follow-up was 26 months. Because of the previously reported inferior survival of the SOC arm, the time for attrition in QoL respondents to <10% of subjects was shorter in the SOC versus SABR arm (30 vs 42 months). In the whole cohort, QoL declined over time after randomization: There were significant declines in total Functional Assessment of Cancer Therapy-General score over time compared with baseline (P < .001) owing to declines in physical and functional subscales (both P < .001), with no declines in social and emotional subscales. However, the magnitudes of decline were small, and clinically meaningful changes were not seen at most time points. Comparison between arms showed no differences in QoL between the SABR and SOC arms in total score (P = .42) or in the physical (P = .98), functional (P = .59), emotional (P = .82), or social (P = .17) subscales. CONCLUSIONS For patients with oligometastases, average QoL declines slowly over time regardless of treatment approach, although the changes are small in magnitude. The use of SABR, compared with SOC, was not associated with a QoL detriment.
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Affiliation(s)
- Robert Olson
- BC Cancer-Centre for the North, Prince George, British Columbia, Canada.
| | - Suresh Senan
- VU University Medical Center, Amsterdam, Netherlands
| | - Stephen Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Stewart Gaede
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, Nova Scotia, Canada
| | - Michael Lock
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Brian Yaremko
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Belal Ahmad
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Neil Kopek
- McGill University Health Centre, Montreal, QC, Canada
| | - Mitchell Liu
- BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Karen Moore
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Suzanne Currie
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Glenn Bauman
- London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- London Health Sciences Centre, London, Ontario, Canada
| | - David Palma
- London Health Sciences Centre, London, Ontario, Canada
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Palma DA, Olson R, Harrow S, Correa RJM, Schneiders F, Haasbeek CJA, Rodrigues GB, Lock M, Yaremko BP, Bauman GS, Ahmad B, Schellenberg D, Liu M, Gaede S, Laba J, Mulroy L, Senthi S, Louie AV, Swaminath A, Chalmers A, Warner A, Slotman BJ, de Gruijl TD, Allan A, Senan S. Stereotactic ablative radiotherapy for the comprehensive treatment of 4-10 oligometastatic tumors (SABR-COMET-10): study protocol for a randomized phase III trial. BMC Cancer 2019; 19:816. [PMID: 31426760 PMCID: PMC6699121 DOI: 10.1186/s12885-019-5977-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [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: 02/02/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control for primary tumors or metastases. A recent randomized phase II trial evaluated SABR in a group of patients with a small burden of oligometastatic disease (mostly with 1–3 metastatic lesions), and found that SABR was associated with benefits in progression-free survival and overall survival. The goal of this phase III trial is to assess the impact of SABR in patients with 4–10 metastatic cancer lesions. Methods One hundred and fifty-nine patients will be randomized in a 1:2 ratio between the control arm (consisting of standard of care palliative-intent treatments), and the SABR arm (consisting of standard of care treatment + SABR to all sites of known disease). Randomization will be stratified by two factors: histology (Group 1: prostate, breast, or renal; Group 2: all others), and type of pre-specified systemic therapy (Group 1: immunotherapy/targeted; Group 2: cytotoxic; Group 3: observation). SABR is to be completed within 2 weeks, allowing for rapid initiation of systemic therapy. Recommended SABR doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions, or 35 Gy in 5 fractions, chosen to minimize risks of toxicity. The primary endpoint is overall survival, and secondary endpoints include progression-free survival, time to development of new metastatic lesions, quality of life, and toxicity. Translational endpoints include assessment of circulating tumor cells, cell-free DNA, and tumor tissue as prognostic and predictive markers, including assessment of immunological predictors of response and long-term survival. Discussion This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with 4–10 oligometastatic lesions. Trial registration Clinicaltrials.gov identifier: NCT03721341. Date of registration: October 26, 2018. Electronic supplementary material The online version of this article (10.1186/s12885-019-5977-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David A Palma
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada.
| | - Robert Olson
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | | | - Rohann J M Correa
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Famke Schneiders
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - George B Rodrigues
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Michael Lock
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Brian P Yaremko
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Glenn S Bauman
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Belal Ahmad
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Stewart Gaede
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Joanna Laba
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, NS, Canada
| | | | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Cancer Centre, Toronto, Canada
| | | | - Anthony Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Warner
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alison Allan
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman GS, Warner A, Senan S. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 2019; 393:2051-2058. [PMID: 30982687 DOI: 10.1016/s0140-6736(18)32487-5] [Citation(s) in RCA: 1132] [Impact Index Per Article: 226.4] [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: 06/21/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The oligometastatic paradigm suggests that some patients with a limited number of metastases might be cured if all lesions are eradicated. Evidence from randomised controlled trials to support this paradigm is scarce. We aimed to assess the effect of stereotactic ablative radiotherapy (SABR) on survival, oncological outcomes, toxicity, and quality of life in patients with a controlled primary tumour and one to five oligometastatic lesions. METHODS This randomised, open-label phase 2 study was done at 10 hospitals in Canada, the Netherlands, Scotland, and Australia. Patients aged 18 or older with a controlled primary tumour and one to five metastatic lesions, Eastern Cooperative Oncology Group score of 0-1, and a life expectancy of at least 6 months were eligible. After stratifying by the number of metastases (1-3 vs 4-5), we randomly assigned patients (1:2) to receive either palliative standard of care treatments alone (control group), or standard of care plus SABR to all metastatic lesions (SABR group), using a computer-generated randomisation list with permuted blocks of nine. Neither patients nor physicians were masked to treatment allocation. The primary endpoint was overall survival. We used a randomised phase 2 screening design with a two-sided α of 0·20 (wherein p<0·20 designates a positive trial). All analyses were intention to treat. This study is registered with ClinicalTrials.gov, number NCT01446744. FINDINGS 99 patients were randomised between Feb 10, 2012, and Aug 30, 2016. Of 99 patients, 33 (33%) were assigned to the control group and 66 (67%) to the SABR group. Two (3%) patients in the SABR group did not receive allocated treatment and withdrew from the trial; two (6%) patients in the control group also withdrew from the trial. Median follow-up was 25 months (IQR 19-54) in the control group versus 26 months (23-37) in the SABR group. Median overall survival was 28 months (95% CI 19-33) in the control group versus 41 months (26-not reached) in the SABR group (hazard ratio 0·57, 95% CI 0·30-1·10; p=0·090). Adverse events of grade 2 or worse occurred in three (9%) of 33 controls and 19 (29%) of 66 patients in the SABR group (p=0·026), an absolute increase of 20% (95% CI 5-34). Treatment-related deaths occurred in three (4·5%) of 66 patients after SABR, compared with none in the control group. INTERPRETATION SABR was associated with an improvement in overall survival, meeting the primary endpoint of this trial, but three (4·5%) of 66 patients in the SABR group had treatment-related death. Phase 3 trials are needed to conclusively show an overall survival benefit, and to determine the maximum number of metastatic lesions wherein SABR provides a benefit. FUNDING Ontario Institute for Cancer Research and London Regional Cancer Program Catalyst Grant.
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Affiliation(s)
| | - Robert Olson
- British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | | | | | | | | | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, NS, Canada
| | - Michael Lock
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Belal Ahmad
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Neil Kopek
- McGill University Health Centre, Montreal, QC, Canada
| | - Mitchell Liu
- British Columbia Cancer, Vancouver Centre, Vancouver, BC, Canada
| | - Karen Moore
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | | | - Suresh Senan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Cunningham Y, Wyke S, Blyth KG, Rigg D, Macdonald S, Macleod U, Harrow S, Robb KA, Whitaker KL. Lung cancer symptom appraisal among people with chronic obstructive pulmonary disease: A qualitative interview study. Psychooncology 2019; 28:718-725. [PMID: 30693608 PMCID: PMC6492269 DOI: 10.1002/pon.5005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The incidence of lung cancer is four times higher in people with chronic obstructive pulmonary disease (COPD) compared with the general population. Promotion of a shorter time from symptom onset to presentation is one potential strategy for earlier lung cancer diagnosis, but distinguishing respiratory symptoms can be difficult. We investigated how the experience of COPD influences symptom appraisal and help seeking for potential lung cancer symptoms. METHODS We conducted qualitative interviews with men (n = 17) and women (n = 23) aged 40 to 83 years with COPD. Topic guides drew on the integrated symptom-response framework and covered symptom experience, interpretation, action, recognition, help seeking, evaluation, and reevaluation. We used the framework method to analyse the data. RESULTS Participants said that they attributed chest symptoms to their COPD; no other cause was considered. Participants said that family/friends noticed changes in their symptoms and encouraged help seeking. Others felt isolated by their COPD because they could not get out, were fatigued, or were embarrassed. Participants visited health professionals frequently, but increased risk of lung cancer was not discussed. CONCLUSIONS Our study provides insight into different levels of influence on symptom appraisal and targets for intervention. Greater awareness of increased lung cancer risk and support to act on symptom changes is essential and could be achieved through a concerted information campaign. Health professionals working with people with COPD could also optimise appointments to support symptom appraisal of potential lung cancer symptoms.
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Affiliation(s)
| | - Sally Wyke
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Kevin G. Blyth
- Pleural Disease UnitQueen Elizabeth University HospitalGlasgowUK
- Institute of Infection, Immunity & InflammationUniversity of GlasgowGlasgowUK
| | - Douglas Rigg
- Keppoch Medical PracticePossilpark Health & Care CentreGlasgowUK
| | - Sara Macdonald
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Una Macleod
- Faculty of Health SciencesHull York Medical SchoolHullUK
| | - Stephen Harrow
- PET/CT CentreBeatson West of Scotland Cancer CentreGlasgowUK
| | - Kathryn A. Robb
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
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Palma D, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Liu M, Moore K, Currie S, Bauman G, Warner A, Senan S. Stereotactic Ablative Radiation Therapy for the Comprehensive Treatment of Oligometastatic Tumors (SABR-COMET): Results of a Randomized Trial. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.105] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Senan S, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C, Mulroy L, Lock M, Rodrigues G, Yaremko B, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Liu M, Moore K, Currie S, Bauman G, Warner A, Palma D. Stereotactic ablative radiotherapy for oligometastatic cancers: Efficacy and toxicity results from the randomized SABR-COMET Trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moore K, Clark B, Featherstone C, Harrow S, Hicks J, Lumsden G, McKay S, Mohammed N, McLoone P. Does a Central Stereotactic Ablative Radiotherapy (SABR) Multidisciplinary Team (MDT) for Early Stage Lung Cancer Influence Patient Outcome? Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ashton M, O'Rourke N, Harrow S, Currie S, Kearns D, Valentine R. OC-0620: Dose constraints for hypofractionated, dose escalated radiotherapy in malignant pleural mesothelioma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Haslett K, Ashcroft L, Bayman N, Franks K, Groom N, Hanna G, Harden S, Harris C, Harrow S, Hatton M, McCloskey P, McDonald F, Ryder D, Faivre-Finn C. PO-0752: Isotoxic Intensity Modulated Radiotherapy in stage III NSCLC – A feasibility study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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