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Amaral A, Ferreira da Silva D, Sampaio MB, Salvado C. Colchicine Poisoning: A Rare Case. Cureus 2023; 15:e48933. [PMID: 38106754 PMCID: PMC10725528 DOI: 10.7759/cureus.48933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Intoxication by colchicine is rare, and its rapid recognition is crucial, as severe toxicity or death is reported in 10% of cases. Here, we present the case of a 50-year-old female admitted to the emergency department 24 hours after ingesting 10 mg of colchicine. Upon examination, she was conscious and hemodynamically stable. Analytically, she exhibited leukocytosis with neutrophilia and an elevation of lactate dehydrogenase (LDH). She was initiated on fluid therapy and transferred to the intermediate care unit of medicine. On the third day of hospitalization, she developed anterior chest pain, reduced breath sounds in the right hemithorax, and dullness on percussion. Arterial blood gas analysis showed partial respiratory failure, and chest X-rays and a computed tomography (CT) scan revealed a right-sided pleural effusion. The likely diagnosis was pleural effusion secondary to cardiac dysfunction due to colchicine intoxication. This case aims to describe the potential toxic effects of colchicine in cases of overdose and to reflect on ways to reduce its morbidity and mortality.
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Affiliation(s)
- Andreia Amaral
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
| | | | | | - Catarina Salvado
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
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Huo L, Chu C, Jiang X, Zheng S, Zhang P, Zhou R, Chen N, Guo J, Qiu B, Liu H. A pilot trial of consolidation bevacizumab after hypo-fractionated concurrent chemoradiotherapy in patients with unresectable locally advanced non-squamous non-small-cell lung cancer. Cancer Med 2023; 12:17638-17647. [PMID: 37537968 PMCID: PMC10523965 DOI: 10.1002/cam4.6381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE To determine the feasibility of incorporating bevacizumab consolidation into hypo-fractionated concurrent chemoradiotherapy (hypo-CCRT) for patients with unresectable locally advanced non-squamous non-small-cell lung cancer (LA-NS-NSCLC). PATIENTS AND METHODS Eligible patients were treated with hypo-RT (40Gy in 10 fractions) followed by hypo-boost (24-28Gy in 6-7 fractions), along with concurrent weekly chemotherapy. Patients who completed the hypo-CCRT without experiencing ≥G2 toxicities received consolidation bevacizumab every 3 weeks for up to 1 year, until disease progression or unacceptable treatment-related toxicities. The primary endpoint was the risk of G4 or higher hemorrhage. Secondary endpoints included progression-free survival (PFS), overall survival (OS), locoregional failure-free survival (LRFS), distant metastasis-free survival (DMFS), and objective response rate (ORR). All time-to-event endpoints (OS, PFS, LRFS, and DMFS) were measured from the start of radiotherapy. RESULTS Between December 2017 and July 2020, a total of 27 patients were included in the analysis, with a median follow-up duration of 28.0 months. One patient (3.7%) developed G5 hemorrhage during bevacizumab consolidation. Additionally, seven patients (25.9%) had G3 cough and three patients (11.1%) experienced G3 pneumonitis. The ORR for the entire cohort was 92.6%. The median OS was 37.0 months (95% confidence interval, 8.9-65.1 months), the median PFS was 16.0 months (95% confidence interval, 14.0-18.0 months), the median LRFS was not reached, and the median DMFS was 18.0 months. CONCLUSIONS This pilot study met its goal of demonstrating the tolerability of consolidation bevacizumab after hypo-CCRT. Further investigation of antiangiogenic and immunotherapy combinations in LA-NSCLC is warranted, while the potential for grade 3 respiratory toxicities should be taken into consideration.
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Affiliation(s)
- LanQing Huo
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Chu Chu
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - XiaoBo Jiang
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - ShiYang Zheng
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - PengXin Zhang
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Rui Zhou
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - NaiBin Chen
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - JinYu Guo
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Bo Qiu
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
- Lung Cancer Institute of Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Association Study of Thoracic OncologyGuangzhouChina
| | - Hui Liu
- Department of Radiation OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
- Lung Cancer Institute of Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Association Study of Thoracic OncologyGuangzhouChina
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Arumugam S, Wong K, Do V, Sidhom M. Reducing the margin in prostate radiotherapy: optimizing radiotherapy with a general-purpose linear accelerator using an in-house position monitoring system. Front Oncol 2023; 13:1116999. [PMID: 37519807 PMCID: PMC10373585 DOI: 10.3389/fonc.2023.1116999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To study the feasibility of optimizing the Clinical Target Volume to Planning Target Volume (CTV-PTV) margin in prostate radiotherapy(RT) with a general-purpose linear accelerator using an in-house developed position monitoring system, SeedTracker. Methods A cohort of 30 patients having definitive prostate radiotherapy treated within an ethics-approved prospective trial was considered for this study. The intrafraction prostate motion and the position deviations were measured using SeedTracker system during each treatment fraction. Using this data the CTV-PTV margin required to cover 90% of the patients with a minimum of 95% of the prescription dose to CTV was calculated using van Herk's formula. The margin calculations were performed for treatment scenarios both with and without applying the position corrections for observed position deviations. The feasibility of margin reduction with real-time monitoring was studied by assessing the delivered dose that incorporates the actual target position during treatment delivery and comparing it with the planned dose. This assessment was performed for plans generated with reduced CTV-PTV margin in the range of 7mm-3mm. Results With real-time monitoring and position corrections applied the margin of 2.0mm, 2.1mm and 2.1mm in LR, AP and SI directions were required to meet the criteria of 90% population to receive 95% of the dose prescription to CTV. Without position corrections applied for observed position deviations a margin of 3.1mm, 4.0mm and 3.0mm was required in LR, AP and SI directions to meet the same criteria. A mean ± SD reduction of 0.5 ± 1.8% and 3 ± 7% of V60 for the rectum and bladder can be achieved for every 1mm reduction of PTV margin. With position corrections applied, the CTV D99 can be delivered within -0.2 ± 0.3 Gy of the planned dose for plans with a 3mm margin. Without applying corrections for position deviations the CTV D99 was reduced by a maximum of 1.1 ± 1.1 Gy for the 3mm margin plan and there was a statistically significant difference between planned and delivered dose for 3mm and 4mm margin plans. Conclusion This study demonstrates the feasibility of reducing the margin in prostate radiotherapy with SeedTracker system without compromising the dose delivery accuracy to CTV while reducing dose to critical structures.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Erul E, Guven DC, Ozbay Y, Altunbulak AY, Kahvecioglu A, Ercan F, Yesil MF, Ucdal MT, Cengiz M, Yazici G, Kuscu O, Suslu N, Gullu I, Onur MR, Aksoy S. Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma. Biomark Med 2023; 17:87-99. [PMID: 37042459 DOI: 10.2217/bmm-2022-0748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.
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Affiliation(s)
- Enes Erul
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
| | - Yakup Ozbay
- Department of Radiology, Hacettepe University, Ankara, 06230, Turkey
| | | | - Alper Kahvecioglu
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Fatih Ercan
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Muhammed F Yesil
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Mete T Ucdal
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Oguz Kuscu
- Department of Otorhinolaryngology & Head & Neck Surgery, Hacettepe University, Ankara, 06230, Turkey
| | - Nilda Suslu
- Department of Otorhinolaryngology & Head & Neck Surgery, Hacettepe University, Ankara, 06230, Turkey
| | - Ibrahim Gullu
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
| | - Mehmet R Onur
- Department of Radiology, Hacettepe University, Ankara, 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
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Mall A, Negi P, Philip AO, Kingsley PA. Induction chemotherapy in head and neck cancer - Boon or bane? J Cancer Res Ther 2023; 19:420-425. [PMID: 37006076 DOI: 10.4103/jcrt.jcrt_839_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Introduction Although concurrent chemoradiotherapy is the standard of care for inoperable locally advanced head and neck cancer, induction chemotherapy is considered an alternative approach by head and neck oncologists worldwide. Aims To evaluate the response to induction chemotherapy in terms of loco-regional control and treatment-related toxicity in inoperable locally advanced head and neck cancer patients. Materials and Methods This prospective study was conducted on patients who received two to three cycles of induction chemotherapy. Following this, response assessment was performed clinically. Grading of radiation-induced oral mucositis and any interruptions in treatment were noted. At 8 weeks following treatment, magnetic resonance imaging-based radiological response assessment was performed using RECIST criteria version 1.1. Results Our data revealed 57.7% complete response rate with induction chemotherapy, followed by chemoradiation therapy. We observed that post induction, 67.5% and 47.5% patients had reduction in T-stage (<0.001) and N-stage of disease (<0.001), respectively, with complete response more achieved in younger patients (≤50 years). Chemotherapy-induced bone marrow suppression and febrile neutropenia occurred in 7.5% patients. We demonstrated that a higher grade of radiation-induced mucositis was noticed among those receiving three cycles of induction chemotherapy (ICT) and aged >50 years. Conclusion We conclude that induction chemotherapy could still be a viable option for down-staging unresectable locally advanced disease, especially for younger patients in terms of better treatment response and tolerability. The number of cycles of ICT seems to influence radiation-induced mucositis. This study underscores the need for further studies to determine the exact role of ICT in locally advanced head and neck cancer.
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Affiliation(s)
- Aprajita Mall
- Department of Radiation Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Preety Negi
- Department of Radiation Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashwin Oommen Philip
- Department of Medical Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Pamela A Kingsley
- Department of Radiation Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Tonetto F, Magli A, Moretti E, Guerini AE, Tullio A, Reverberi C, Ceschia T, Spiazzi L, Titone F, Prisco A, Signor MA, Buglione M, De Giorgi G, Trovò M, Triggiani L. Prostate Cancer Treatment-Related Toxicity: Comparison between 3D-Conformal Radiation Therapy (3D-CRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques. J Clin Med 2022; 11:jcm11236913. [PMID: 36498488 PMCID: PMC9737605 DOI: 10.3390/jcm11236913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: This paper illustrates the results of a mono-institutional registry trial, aimed to test whether gastrointestinal (GI) and genitourinary (GU) toxicity rates were lower in localized prostate cancer patients treated with image-guided volumetric modulated arc therapy (IG-VMAT) compared to those treated with IG-3D conformal radiation therapy (IG-3DCRT). Materials and Methods: Histologically proven prostate cancer patients with organ-confined disease, treated between October 2008 and September 2014 with moderately hypofractionated radiotherapy, were reviewed. Fiducial markers were placed in the prostate gland by transrectal ultrasound guide. The prescribed total dose was 70 Gy in 28 fractions. The mean and median dose volume constraints for bladder and rectum as well as total volume of treatment were analyzed as potentially prognostic factors influencing toxicity. The Kaplan−Meier method was applied to calculate survival. Results: Overall, 83 consecutive patients were included. Forty-two (50.6%) patients were treated with 3D-CRT and 41 (49.4%) with the VMAT technique. The median follow-up for toxicity was 77.26 months for the whole cohort. The VMAT allowed for a dose reduction to the rectum and bladder for the large majority of the considered parameters; nonetheless, the only parameter correlated with a clinical outcome was a rectal dose limit V66 > 8.5% for late GI toxicity G ≥ 2 (p = 0.045). Rates of G ≥ 2 toxicities were low among the whole cohort of these patients treated with IGRT. The analysis for rectum dose volume histograms (DVHs) showed that a severe (grade ≥ 2) late GI toxicity was related with the rectal dose limit V66 > 8.5% (p = 0.045). Conclusions: This study shows that moderate hypofractionation is feasible and safe in patients with intermediate and high-risk prostate cancer. Daily IGRT may decrease acute and late toxicity to organs at risk and improve clinical benefit and disease control rate, cutting down the risk of PTV geographical missing. The adoption of VMAT allows for promising results in terms of OAR sparing and a reduction in toxicity that, also given the small sample, did not reach statistical significance.
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Affiliation(s)
- Fabrizio Tonetto
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Eugenia Moretti
- Department of Medical Physics, University General Hospital, 33100 Udine, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, ASST Spedali Civili and Brescia University, 25100 Brescia, Italy
- Correspondence: ; Tel.: +39-03-0399-5272
| | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, University General Hospital, 33100 Udine, Italy
| | - Chiara Reverberi
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Tino Ceschia
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Luigi Spiazzi
- Department of Radiation Oncology, ASST Spedali Civili and Brescia University, 25100 Brescia, Italy
| | - Francesca Titone
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Agnese Prisco
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Marco Andrea Signor
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Michela Buglione
- Department of Radiation Oncology, ASST Spedali Civili and Brescia University, 25100 Brescia, Italy
| | | | - Marco Trovò
- Department of Radiation Oncology, University General Hospital, 33100 Udine, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, ASST Spedali Civili and Brescia University, 25100 Brescia, Italy
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Karalexi MA, Markozannes G, Tagkas CF, Katsimpris A, Tseretopoulou X, Tsilidis KK, Spector LG, Schüz J, Siahanidou T, Petridou ET, Ntzani EE. Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature. Diagnostics (Basel) 2022; 12:2357. [PMID: 36292046 PMCID: PMC9600212 DOI: 10.3390/diagnostics12102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies so far have examined the impact of nutritional status on the survival of children with cancer, with the majority of them focusing on hematological malignancies. We summarized published evidence reporting the association of nutritional status at diagnosis with overall survival (OS), event-free survival (EFS), relapse, and treatment-related toxicity (TRT) in children with cancer. Published studies on children with leukemia, lymphoma, and other solid tumors have shown that both under-nourished and over-nourished children at cancer diagnosis had worse OS and EFS. Particularly, the risk of death and relapse increased by 30-50% among children with leukemia with increased body mass index at diagnosis. Likewise, the risk of TRT was higher among malnourished children with osteosarcoma and Ewing sarcoma. Nutritional status seems to play a crucial role in clinical outcomes of children with cancer, thus providing a significant modifiable prognostic tool in childhood cancer management. Future studies with adequate power and longitudinal design are needed to further evaluate the association of nutritional status with childhood cancer outcomes using a more standardized definition to measure nutritional status in this population. The use of new technologies is expected to shed further light on this understudied area and give room to person-targeted intervention strategies.
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Affiliation(s)
- Maria A. Karalexi
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Christos F. Tagkas
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Andreas Katsimpris
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Xanthippi Tseretopoulou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Pediatric Endocrinology, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Konstantinos K. Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Logan G. Spector
- Department of Pediatrics, Division of Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Th. Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelia E. Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI 02903, USA
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Chang BS, Peng TC, Wu YF, Hsieh TC, Huang CH. Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors. J Pers Med 2022; 12. [PMID: 35330404 DOI: 10.3390/jpm12030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to access the predictive value of inflammatory indices and clinical factors in toxicity and survival in patients with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma receiving first-line tyrosine kinase inhibitor (TKI)-treatment. A total of 259 patients with stage IIIB−IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI treatment between 2008 and 2020 were retrospectively enrolled and analyzed. The prognostic factors of TKI-related toxicity, overall survival (OS), and progression-free survival (PFS) were identified by using logistic regression analysis and Cox proportional hazards models. Pre-TKI high platelet-to-lymphocyte ratio (PLR) was associated with post-TKI anemia. Hypoalbuminemia was associated with acneiform rash. Elderly age (≥70 years) and lower body mass index (<18.5 kg/m2) were also associated with hypoalbuminemia. Elderly age, stage IV, EGFR-mutated with L858R and uncommon mutations, and neutrophil-to-lymphocyte ratio were found to be independent prognostic factors for PFS, while elderly age, uncommon EGFR-related mutations, and lymphocyte-to-monocyte ratio were found to be independent prognostic factors for OS. A useful prognostic scoring tool for improving the survival risk stratification of patients was established by incorporating the above essential factors. Baseline hypoalbuminemia and PLR could be crucial clinical assessment factors when initiating TKI therapy. In addition, the optimization of individualized treatment strategies for these patients may be assisted by using the risk-scoring model.
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Guo S, Liu F, Liu H, Wu Y, Zhang X, Ye W, Luo G, Li Q, Chen N, Hu N, Wang B, Zhang J, Lin M, Feng H, Qiu B. A Prospective Phase II Study of Simultaneous Modulated Accelerated Radiotherapy Concurrently With CDDP/S1 for Esophageal Squamous Cell Carcinoma in the Elderly. Front Oncol 2021; 11:760631. [PMID: 34900709 PMCID: PMC8654786 DOI: 10.3389/fonc.2021.760631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background To explore the efficacy and toxicity of simultaneous modulated accelerated radiotherapy (SMART) concurrently with cisplatin (CDDP) and S1 (tegafur/gimeracil/oteracil) in elderly patients with esophageal squamous cell carcinoma (ESCC). Methods This single-arm, phase II study enrolled pathologically confirmed, stage II-IVa ESCC of 70-80 years old and Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2. Patients received SMART (64 Gy to gross tumor volume and 48 Gy to clinical target volume in 30 fractions) with concurrent CDDP (day 1 of each week) and S1 (days 1-14, 22-35). The primary endpoint was objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicities. Results Thirty-seven eligible patients were analyzed with median follow-up of 25.7 months for all and 46.1 months for survivors. The ORR was 88.9%. Patients with baseline weight loss <5% (p=0.050) and nutritional risk index (NRI) ≥105.2 (p=0.023) had better tumor response. Median PFS was 13.8 months with 2-year PFS of 37.5%. Median OS was 27.7 months with 2-year OS of 57.5%. OS was significantly associated with ECOG PS (p=0.005), stage (p=0.014), gross tumor volume (p=0.004), baseline NRI (p=0.036), baseline C-reactive protein (CRP) level (p=0.003) and tumor response (p=0.000). CRP level (p=0.016) and tumor response (p=0.021) were independently prognostic of OS. ≥grade 3 anemia, neutropenia and thrombocytopenia occurred in 2.7%, 10.8% and 13.5% of patients; ≥grade 3 esophagitis and pneumonitis occurred in 18.9% and 2.7% of patient, respectively. Conclusion SMART concurrently with CDDP/S1 yielded satisfactory response rate, survival outcome and tolerable treatment-related toxicities in elderly patients with ESCC. Further studies are warranted to validate the results.
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Affiliation(s)
- SuPing Guo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - FangJie Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - YingJia Wu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - XuHui Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - WenFeng Ye
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Nutrition, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - GuangYu Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Endoscopy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - QiWen Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - NaiBin Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Nan Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Bin Wang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - MaoSheng Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - HuiXia Feng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
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10
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Kautiainen RJ, Keeler C, Dwivedi B, MacDonald TJ, King TZ. MTHFR single nucleotide polymorphism associated with working memory in pediatric medulloblastoma survivors. Child Neuropsychol 2021; 28:287-301. [PMID: 34448443 DOI: 10.1080/09297049.2021.1970736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Associations have been found between single nucleotide polymorphisms (SNPs) in the MTHFR gene and cognitive outcomes in cancer survivors. Prior research has demonstrated that the presence of MTHFR SNPs (rs1801131 and rs1801133) in survivors of acute lymphoblastic leukemia (ALL) corresponds to impairments in attention and executive functioning. The current study examines the associations between rs1801131 and/or rs1801133 SNPs and cognitive performance in long-term survivors of medulloblastoma. Procedure: Eighteen pediatric medulloblastoma survivors, on average 12.42 years post-diagnosis, completed the Digit Span Forward, Digit Span Backward, California Verbal Learning Test Trial 1, and Auditory Consonant Trigrams tests. MTHFR SNPs were detected using whole genome sequencing data and custom scripts within R software. Results: Survivors with a rs1801131 SNP performed significantly worse on Digit Span Backward than survivors without this SNP exhibiting a large effect (p = 0.049; d = 0.95). Survivors with a rs1801131 SNP performed worse on Digit Span Forward (d = 0.478) and the CVLT Trial 1 (d = 0.417) with medium effect sizes. In contrast to rs1801131, relationships were not identified between a rs1801133 SNP and these performance measures. Conclusions Our findings demonstrate the potential links between MTHFR SNPs and cognitive outcomes following treatment in brain tumor survivors. The current findings establish a novel relationship between rs1801131 and working memory in medulloblastoma. Increases in homocysteine levels and oxidative damage from radiation may lead to adverse long-term outcomes. This establishes the need to look beyond leukemia and methotrexate treatment to consider the risk of MTHFR SNPs for medulloblastoma survivors.
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Affiliation(s)
| | - Courtney Keeler
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Bhakti Dwivedi
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tobey J MacDonald
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta GA, USA.,Emory University Medical School, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA.,Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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11
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Moke DJ, Song Z, Liu L, Hamilton AS, Deapen D, Freyer DR. A Population-Based Analysis of 30-Year Mortality among Five-Year Survivors of Adolescent and Young Adult Cancer: The Roles of Primary Cancer, Subsequent Malignancy, and Other Health Conditions. Cancers (Basel) 2021; 13:3956. [PMID: 34439115 DOI: 10.3390/cancers13163956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Cancer survivors are at risk for developing serious health problems and dying prematurely. Adolescents and young adults (AYAs, aged 15–39 years at diagnosis) are a unique population challenged with different cancer types and treatment toxicity than other age groups, impaired access to care, financial hardship, and psychosocial distress due to their life stage. Although 85% of AYAs with cancer are alive 5 years after diagnosis, in subsequent years, their survival is consistently lower and declines faster than the general population. However, knowledge regarding why these long-term survivors of AYA cancer die prematurely is incomplete. Therefore, we sought to provide a detailed report of all causes of death in this population, including recurrence of the first cancer, development of a different cancer type, or other health problems. Our results can help inform future research to develop safer cancer treatment and better long-term care that will improve the health and survival of this vulnerable population. Abstract Despite an aggregate 5-year survival of 85%, many adolescents and young adults (AYAs, 15–39 years old) treated for cancer die prematurely decades later. To develop a more complete understanding of this problem, particularly the role of specific subsequent malignant neoplasms (SMNs), we used the SEER-9 registry to analyze causes of death (COD: Primary cancer, SMN, non-malignant conditions) among 162,317 AYAs diagnosed with first cancer between 1975–2012 and surviving 5 or more years. Cumulative mortality, attributable mortality, standardized mortality ratios (SMRs), and adjusted hazard ratios were determined for each cancer site and COD. At 30 years, cumulative mortality due to primary cancer was matched by that due to all other causes (12.8% 95% CI [12.5%, 13.0%] for primary cancer versus 12.8% [12.5%, 13.1%] for all other causes combined) in the combined cohort, and was overtaken by non-malignant conditions in Hodgkin lymphoma, testicular, cervical/uterine, and thyroid cancers. Overall, SMNs accounted for 20% of malignant deaths, the most common being lung/bronchus (25.6%), colorectal/liver/biliary/pancreas (19.1%), and breast (10.2%). For non-malignant conditions, excess risk was noted overall (SMR 1.37, 95% CI [1.34, 1.40]) and for infectious (1.97 [1.85, 2.10]), renal (1.85 [1.60, 2.13]), cardio/cerebrovascular (1.38 [1.33, 1.43]), and suicide (1.15 [1.04, 1.27]). Racial minorities were at significantly higher risk across all COD. Safer therapy, longitudinal monitoring, and primary/secondary preventive strategies are needed to reduce late mortality in this vulnerable population.
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12
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Levy CF, Presswala LS, Slomovic A, Stiefel J, Schulman-Rosenbaum R. Multidisciplinary management of endocrinopathies and treatment-related toxicities in patients with Bloom syndrome and cancer. Pediatr Blood Cancer 2021; 68:e28815. [PMID: 33226170 PMCID: PMC9171660 DOI: 10.1002/pbc.28815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022]
Abstract
The treatment of malignancy in cancer predisposition syndromes that also confer exquisite sensitivity to standard chemotherapy and radiation regimens remains a challenge. Bloom syndrome is one such disorder that is caused by a defect in DNA repair, predisposing to the development of early-onset age-related medical conditions and malignancies. We report on two patients with Bloom syndrome who responded well to chemotherapy despite significant alterations to standard protocols necessitated by hypersensitivity. Both patients experienced severe toxicities and exacerbation of endocrine comorbidities during chemotherapy. A multidisciplinary team of oncologists and endocrinologists is best suited to care for this patient population.
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Affiliation(s)
| | | | - Alana Slomovic
- Department of Pediatrics, Cohen Children’s Medical Center
| | - Jessica Stiefel
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center
| | - Rifka Schulman-Rosenbaum
- Division of Endocrinology, Department of Medicine, Long Island Jewish Medical Center, Associate Professor, Zucker School of Medicine at Hofstra/Northwell
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13
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Mohata S, Kumar HS, Sharma N, Jhakhar SL, Beniwal S, Harsh KK. Acute treatment-related toxicity in elderly patients with good performance status compared to young patients in locally advanced esophageal carcinoma treated by definitive chemoradiation: A retrospective comparative study. J Cancer Res Ther 2020; 16:116-119. [PMID: 32362620 DOI: 10.4103/jcrt.jcrt_878_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The benefit of definitive chemoradiotherapy (CRT) in elderly patients with locally advanced esophageal cancer is not well established. We perform a single institutional retrospective study of CRT in terms of toxicity in elderly patients (age more than 60 years) as compared with young cohort (age <60 years) in locally advanced nonmetastatic esophageal cancer. Patients and Methods A total 145 of patients, 79 in young age (Group A) and 66 patients of elder age (Group B) with Stage II and III squamous cell carcinoma of the esophagus with ECOG PS of 0-1, who had undergone definitive CRT at our institute from January 2015 to November 2018 were selected for this analysis. Chemotherapy was cisplatin (40 mg/m2) given concurrently on weekly basis with radiotherapy (RT). Total prescribed dose of RT was 50.4 Gy at the rate of 1.8 Gy per fraction. Median age was 40 years (25-60 years) and 65 years (60-75 years) in young and elderly group, respectively. Follow-up is done at median of 28 months (1-48 months) after treatment. Results Acute Grade 2-3 esophagitis was seen in 48.10% in young cohort, while it was 60.6% in older group. Grade 2-3 nausea and vomiting was seen in 32.91% in young age patients, while it was 45.5% in elder patients. No statistically significant difference is seen in acute treatment-related toxicity in young and elderly group. Conclusion Our conclusion is that patients with adequate functional status should not be excluded from curative CRT based on age alone.
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Affiliation(s)
- Shweta Mohata
- Department of Radiotherapy, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
| | - H S Kumar
- Department of Radiotherapy, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
| | - Neeti Sharma
- Department of Radiotherapy, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
| | - Shankar Lal Jhakhar
- Department of Radiotherapy, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
| | - Surendra Beniwal
- Department of Medical Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
| | - Kamlesh Kumar Harsh
- Department of Radiotherapy, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
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14
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Elitzur S, Arad-Cohen N, Barzilai-Birenboim S, Ben-Harush M, Bielorai B, Elhasid R, Feuerstein T, Gilad G, Gural A, Kharit M, Litichever N, Nirel R, Weinreb S, Wolach O, Toren A, Izraeli S, Jacoby E. Blinatumomab as a bridge to further therapy in cases of overwhelming toxicity in pediatric B-cell precursor acute lymphoblastic leukemia: Report from the Israeli Study Group of Childhood Leukemia. Pediatr Blood Cancer 2019; 66:e27898. [PMID: 31264788 DOI: 10.1002/pbc.27898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 01/11/2023]
Abstract
Tremendous progress in the therapy of pediatric acute lymphoblastic leukemia (ALL) has been achieved through combination cytotoxic chemotherapy, leading to high cure rates, at the cost of significant life-threatening toxicity. The bispecific T-cell engager blinatumomab, recently approved for relapsed/refractory ALL, has a unique nonmyelotoxic toxicity profile. As blinatumomab causes B-cell depletion, the safety of its use during severe chemotherapy-induced toxicity is unclear. We report 11 pediatric patients with ALL, treated with blinatumomab following overwhelming chemotherapy-associated toxicity, with recovery of all patients and successful bridging to further antileukemia therapy. Blinatumomab can be considered for rare patients who cannot tolerate cytotoxic therapy.
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Affiliation(s)
- Sarah Elitzur
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shlomit Barzilai-Birenboim
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Ben-Harush
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Bella Bielorai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Elhasid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Hemato-Oncology, Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Feuerstein
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Gil Gilad
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gural
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mira Kharit
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Naomi Litichever
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ronit Nirel
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Sigal Weinreb
- Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Amos Toren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Izraeli
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Jacoby
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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15
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Loh KP, Mohile SG, Epstein RM, McHugh C, Flannery M, Culakova E, Lei L, Wells M, Gilmore N, Babu D, Whitehead MI, Dale W, Hurria A, Wittink M, Magnuson A, Conlin A, Thomas M, Berenberg J, Duberstein PR. Willingness to bear adversity and beliefs about the curability of advanced cancer in older adults. Cancer 2019; 125:2506-2513. [PMID: 30920646 DOI: 10.1002/cncr.32074] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/07/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Older patients with advanced cancer who are 100% certain they will be cured pose unique challenges for clinical decision making, but to the authors' knowledge, the prevalence and correlates of absolute certainty about curability (ACC) are unknown. METHODS Cross-sectional data were collected in a geriatric assessment trial. ACC was assessed by asking patients, "What do you believe are the chances that your cancer will go away and never come back with treatment?" Response options were 100% (coded as ACC), >50%, 50/50, <50%, 0%, and uncertain. The willingness to bear adversity in exchange for longevity was assessed by asking patients to consider trade-offs between survival and 2 clinical outcomes that varied in abstractness: 1) maintaining quality of life (QOL; an abstract outcome); and 2) specific treatment-related toxicities (eg, nausea/vomiting, worsening memory). Logistic regression was used to assess the independent associations between willingness to bear adversity and ACC. RESULTS Of the 524 patients aged 70 to 96 years, approximately 5.3% reported that there was a 100% chance that their cancer would be cured (ACC). ACC was not found to be significantly associated with willingness to bear treatment-related toxicities, but was more common among patients who were willing to trade QOL for survival (adjusted odds ratio, 4.08; 95% CI, 1.17-14.26). CONCLUSIONS Patients who were more willing to bear adversity in the form of an abstract state, namely decreased QOL, were more likely to demonstrate ACC. Although conversations regarding prognosis should be conducted with all patients, those who are willing to trade QOL for survival may especially benefit from conversations that focus on values and emotions.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ronald M Epstein
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Division of Palliative Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Colin McHugh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Eva Culakova
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lianlian Lei
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Megan Wells
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nikesha Gilmore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Dilip Babu
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mary I Whitehead
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arti Hurria
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Marsha Wittink
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington
| | - Melanie Thomas
- Southeast Clinical Oncology Research Consortium (SCOR), Winston-Salem, North Carolina
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii
| | - Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, New Brunswick, New Jersey
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16
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Schuurhuizen CS, Verheul HM, Braamse AM, Buffart LM, Bloemendal HJ, Dekker J, Konings IR. The predictive value of cumulative toxicity for quality of life in patients with metastatic colorectal cancer during first-line palliative chemotherapy. Cancer Manag Res 2018; 10:3015-3021. [PMID: 30214296 PMCID: PMC6124444 DOI: 10.2147/cmar.s166468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Studies evaluating new systemic agents tend to report severe toxicities only, while the cumulative effect of multiple lower grade adverse events (AEs) may have an additional negative impact on patient quality of life (QOL). In the current observational cohort study, we evaluated whether, in patients with metastatic colorectal cancer receiving first-line chemotherapy, cumulative toxicity comprising all grades of AEs is more predictive for QOL than cumulative toxicity due to only high-grade AEs. Methods One hundred and five patients starting treatment completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaire at baseline and 10 weeks. AEs, clinical outcomes, and demographics were retrieved from patient records. Cumulative toxicity scores were calculated in three ways: total number of high-grade AEs, total number of all-grade AEs, and total number of AEs multiplied by their grade (the severity score). Relations between cumulative toxicity scores and QOL were studied using multivariable linear regression analyses. Results The mean age of patients was 65 years, 68% were male, and 84% received oxaliplatin-based chemotherapy. A higher total number of AEs of all grades (B=−2.4, 95% CI=–3.9; −0.9) and the severity score (B=–1.4, 95% CI=–2.3; −0.5) were predictive for clinically relevant changes in physical QOL, whereas the total high-grade AEs was not. None of the cumulative toxicity scores were predictive for global QOL. Conclusion Cumulative toxicity scores comprising all grades of AEs provide a better measure of treatment burden than a toxicity score comprising high-grade AEs only. Physical QOL seems to be more affected by AEs than global QOL. Our results emphasize that future clinical trials should present cumulative toxicity scores comprising all AE grades as well as physical QOL instead of global QOL.
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Affiliation(s)
- Claudia Sew Schuurhuizen
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands, .,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk Mw Verheul
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands,
| | - Annemarie Mj Braamse
- Department of Medical Psychology, Academic Medical Center Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands, .,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Medical Psychology, Academic Medical Center Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Haiko J Bloemendal
- Department of Medical Oncology, Meander Medical Center, Amersfoort, The Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Inge Rhm Konings
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands,
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17
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Denton CC, Rawlins YA, Oberley MJ, Bhojwani D, Orgel E. Predictors of hepatotoxicity and pancreatitis in children and adolescents with acute lymphoblastic leukemia treated according to contemporary regimens. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26891. [PMID: 29218844 PMCID: PMC7522002 DOI: 10.1002/pbc.26891] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatotoxicity and pancreatitis are common treatment-related toxicities (TRTs) during contemporary treatment regimens for acute lymphoblastic leukemia (ALL). Limited detailed data from Children's Oncology Group (COG) regimens has been previously reported to enable identification of patient and treatment risk factors for these toxicities and their impact on outcomes. PROCEDURE We analyzed a retrospective pediatric ALL cohort treated at a single institution according to COG regimens from 2008 to 2015. The primary endpoint was cumulative incidence of study-defined "severe" hepatotoxicity (Common Terminology Criteria for Adverse Events [CTCAE] Grade ≥ 4 transaminitis or Grade ≥ 3 hyperbilirubinemia) and clinically significant pancreatitis (any grade). Pancreatitis was additionally classified using the Ponte di Legno (PdL) toxicity criteria. Secondary endpoints were chemotherapy interruptions, early disease response (end of induction [EOI] minimal residual disease [MRD]), and event-free survival (EFS). RESULTS We identified 262 patients, of whom 71 (27%) and 28 (11%) developed hepatotoxicity and pancreatitis, respectively. Three cases of pancreatitis did not fulfill PdL criteria despite otherwise consistent presentations. Both TRTs occurred throughout therapy, but approximately 25% of hepatotoxicity (18/71) and pancreatitis (8/28) occurred during induction alone. Both obesity and age (≥10 years) were identified as predictors of hepatotoxicity (subdistribution hazard ratio [SHR] obesity = 1.75, 95% confidence interval [95% CI] 1.04-2.96; SHR age ≥10 = 1.9, 95% CI 1.19-3.10) and pancreatitis (SHR obesity = 2.18, 95% CI 1.01-4.67; SHR age ≥ 10 = 2.76, 95% CI 1.19-6.39, P = 0.018). Dose interruptions were common but neither toxicity influenced EOI MRD nor EFS. CONCLUSIONS Obese and/or older children are particularly at risk for hepatotoxicity and pancreatitis, and may benefit from toxicity surveillance and chemoprotective strategies to prevent or mitigate associated morbidity.
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Affiliation(s)
- Christopher C. Denton
- Division of Hematology, Oncology, & BMT, Children’s Hospital Los Angeles, Los Angeles, California
| | - Yasmin A. Rawlins
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Matthew J. Oberley
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deepa Bhojwani
- Division of Hematology, Oncology, & BMT, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Etan Orgel
- Division of Hematology, Oncology, & BMT, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
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18
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Xu Y, Guo Q, Lin J, Chen B, Wen J, Lu T, Xu Y, Zhang M, Pan J, Lin S. Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Onco Targets Ther 2016; 9:6835-6841. [PMID: 27853378 PMCID: PMC5104288 DOI: 10.2147/ott.s117676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM To evaluate the impact of percutaneous endoscopic gastrostomy (PEG) tube on nutritional status, treatment-related toxicity, and treatment tolerance in patients with locally advanced nasopharyngeal carcinoma (NPC) who underwent chemoradiotherapy. PATIENTS AND METHODS We enrolled 133 consecutive non-metastatic NPC (III/IV stage) patients, who were treated with prophylactic PEG feeding before the initiation of concurrent chemoradiotherapy (CCRT) between June 1, 2010 and June 30, 2014. Meanwhile, another 133 non-PEG patients, who were matched for age, gender, and tumor, node, metastases stage, were selected as historical control cohort. Weight and nutritional status changes from pre-radiotherapy to the end of radiotherapy were evaluated, and treatment tolerance and related acute toxicities were analyzed as well. RESULTS We found that significantly more patients (91.73%) in the PEG group could finish two cycles of CCRT, when compared with those in the non-PEG group (57.89%) (P<0.001). We also indicated that more patients (50.38%) in the non-PEG group experienced weight loss of ≥5%, while the phenomenon was only found in 36.09% patients in the PEG group (P=0.019). In addition, the percentage of patients who lost ≥10% of their weight was similar in these two groups. Changes in albumin and prealbumin levels during radiotherapy in the non-PEG group were higher than those obtained for the PEG group with significant differences (P-values of 0.023 and <0.001, respectively). Furthermore, patients in the PEG group had significantly lower incidence of grade III acute mucositis than those in the non-PEG group (22.56% vs 36.84%, P=0.011). Tube-related complications occurred only in 14 (10.53%) patients in the PEG group, including incision infection of various degrees. CONCLUSION PEG and intensive nutrition support may help to minimize body weight loss, maintain nutritional status, and offer better treatment tolerance for patients with locally advanced NPC who underwent CCRT.
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Affiliation(s)
- Yun Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jin Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Bijuan Chen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jiangmei Wen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Tianzhu Lu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Mingwei Zhang
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
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19
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Ganti A, Liu W, Luo S, Sanfilippo KM, Roop R, Lynch R, Riedell P, O'Brian K, Colditz GA, Carson KR. Impact of body mass index on incidence of febrile neutropenia and treatment-related mortality in United States veterans with diffuse large B-cell lymphoma receiving rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone. Br J Haematol 2014; 167:699-702. [PMID: 25040880 DOI: 10.1111/bjh.13026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Arun Ganti
- Saint Louis Veterans Affairs Medical Center, Research Service, Saint Louis, MO, USA; Washington University School of Medicine, Saint Louis, MO, USA
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