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Mutch D, Gaffney D, Matias-Guiu X, Fotopoulou C, Concin N, Berek JS. Response: Analysis of adjuvant therapy in early staged endometrioid endometrial cancer-FIGO 2023 classification. Int J Gynaecol Obstet 2024; 165:1304-1305. [PMID: 38512105 DOI: 10.1002/ijgo.15478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Centro de Investigación Biomédica en Red de Cáncer, Instituto de Investigación Biomédica de BellvitgeHospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Barcelona, Spain
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen- Mitte, Essen, Germany
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
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Ladbury C, Sueyoshi MH, Brovold NM, Kumar R, Andraos TY, Gogineni E, Kim M, Klopp A, Albuquerque K, Kunos C, Leung E, Mantz C, Biswas T, Beriwal S, Small W, Erickson B, Gaffney D, Lo SS, Viswanathan AN. Stereotactic Body Radiation Therapy for Gynecologic Malignancies: A Case-Based Radiosurgery Society Practice Review. Pract Radiat Oncol 2024; 14:252-266. [PMID: 37875223 DOI: 10.1016/j.prro.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The use of stereotactic body radiation therapy (SBRT) for gynecologic malignancies is controversial. We discuss certain circumstances when highly precise SBRT may be a useful tool to consider in the management of selected patients. METHODS AND MATERIALS Case selection included the following scenarios, the first 2 with palliative intent, para-aortic nodal oligorecurrence of ovarian cancer, pelvic sidewall oligorecurrence of cervical cancer, and inoperable endometrial cancer boost after intensity modulated radiation to the pelvis treated with curative intent. Patient characteristics, fractionation, prescription dose, treatment technique, and dose constraints were discussed. Relevant literature to these cases was summarized to provide a framework for treatment of similar patients. RESULTS Treatment of gynecologic malignancies with SBRT requires many considerations, including treatment intent, optimal patient selection, fractionation selection, tumor localization, and plan optimization. Although other treatment paradigms including conventionally fractionated radiation therapy and brachytherapy remain the standard-of-care for definitive treatment of gynecologic malignancies, SBRT may have a role in palliative cases or those where high doses are not required due to the unacceptable toxicity that may occur with SBRT. CONCLUSIONS A case-based practice review was developed by the Radiosurgery Society to provide a practical guide to the common scenarios noted above affecting patients with gynecologic malignancies.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
| | - Mark H Sueyoshi
- Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Nellie M Brovold
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Therese Y Andraos
- Department of Radiation Oncology, The Ohio State University James Cancer Hospital, Columbus, Ohio
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University James Cancer Hospital, Columbus, Ohio
| | - Minsun Kim
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Charles Kunos
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | | | - Tithi Biswas
- Department of Radiation Oncology, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - William Small
- Department of Radiation Oncology, Loyola University Cardinal Bernardin Cancer Center, Chicago, Illinois
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Gaffney
- Department of Radiation Oncology, University of Utah Huntsman Cancer Institute, Salt Lake City, Utah
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, Maryland
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Roach E, Hutten R, Johnson S, Suneja G, Tward J, Petereit D, Gaffney D. The impact of a positive COVID-19 test on timeliness of radiation in patients receiving brachytherapy. Brachytherapy 2024; 23:360-367. [PMID: 38395662 DOI: 10.1016/j.brachy.2024.01.006] [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: 10/22/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Delays in initiating and completing brachytherapy may have adverse oncologic outcomes for patients with cervical, uterine, and prostate cancer. The impact of the COVID-19 pandemic on brachytherapy in the United States has not been well-characterized. OBJECTIVES We aim to evaluate how a positive COVID-19 test affected timeliness of treatment for patients undergoing brachytherapy for cervical, uterine, and prostate cancer. METHODS We queried the National Cancer Database to identify patients diagnosed with cervical, uterine, and prostate cancer in 2019 and 2020 who received brachytherapy in their treatment. Patients who tested positive for COVID-19 between cancer diagnosis and start of radiation were compared to those who did not test positive for COVID-19. Time in days from cancer diagnosis to initiation of radiation was compared using two-sample t-tests with p < 0.05 signifying significant differences. RESULTS We identified 38,341 patients with cervical (n = 6,925), uterine (n = 18,587), and prostate cancer (n = 12,829). Rates of COVID-19 positivity were cervical cancer (n = 135; 2%), uterine cancer (n = 236; 1.3%), and prostate cancer (n = 141; 1%). Of those, 35% of cervical, 49% of uterine, and 43% of prostate cancer patients tested positive between their cancer diagnosis and initiation of radiation. Median days to radiation was significantly longer in these patients: 78 versus 51 for cervical cancer (p < 0.01), 150 versus 104 for uterine cancer (p < 0.01), and 154 versus 124 for prostate cancer (p < 0.01). CONCLUSIONS For patients with cervical, uterine, and prostate cancer diagnosed between 2019-2020, testing positive for COVID-19 after their cancer diagnosis was associated with a delay to initiation of radiation by 4-7 weeks.
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Affiliation(s)
- Eric Roach
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
| | - Ryan Hutten
- Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, WI
| | - Skyler Johnson
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jonathan Tward
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Gaffney D, Matias-Guiu X, Mutch D, Scambia G, Creutzberg C, Fotopoulou C, Berek JS, Concin N. 2023 FIGO staging system for endometrial cancer: The evolution of the revolution. Gynecol Oncol 2024; 184:245-253. [PMID: 38447389 DOI: 10.1016/j.ygyno.2024.02.002] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Embracing the complex and diverse nature of the heterogenous group of malignancies that are included under the umbrella of "endometrial cancer" (EC) to better align prognosis with treatment recommendations, requires a more comprehensive staging system. Our goal at the development of the new FIGO staging was to provide 1) high accuracy in the predictive prognosis for a patient with EC, which is the genuine purpose of a staging system, and 2) identification of distinct treatment relevant subgroups. Since the publication of the 2009 staging system by the International Federation of Gynecology and Obstetrics (FIGO) 14 years ago (1, 2), our understanding of the biology and natural history of EC has undergone a radical transformation. The TGCA results in 2013 (3), and the many validation reports published since then (4-9), have taught us that "EC" is composed of at least four distinct molecularly defined diseases. Strong histopathologic markers reflecting tumor biology such as lymph vascular space invasion (LVSI) were identified. Importantly, anatomical borders were shown to lose their prognostic relevance for EC patients in the presence of dominant tumor biology-markers such as molecular subtypes/LVSI (10, 11). This emphasizes the integration of these novel markers into a prognostic staging system that aims to be relevant to patients. The 2023 FIGO staging system for EC harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features (12). It requires a change in our perception of a staging system, from a traditional purely anatomical borders-based system to an integrated staging system integrating anatomical borders and tumor biology as pivotal prognostic factors for EC patients while providing important information for treatment decision making. Therefore, the 2023 FIGO staging system demonstrates the logical next step in the evolution of the revolution in a patient-centric staging approach. Below, we elucidate the rationale for the FIGO 2023 endometrial cancer staging system.
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Affiliation(s)
- David Gaffney
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; Department of Gynaecology and Gynaecological Oncology, Medical University of Vienna, Vienna, Austria.
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Cruttenden J, Balogun OD, Gaffney D, Suneja G. Destigmatizing gynecologic cancers and prioritizing prospective radiotherapy studies. Gynecol Oncol 2024; 182:121-123. [PMID: 38262234 DOI: 10.1016/j.ygyno.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Jessica Cruttenden
- University of Utah, Department of Radiation Oncology, 1950 Circle of Hope Dr., Rm 1570, Salt Lake City, UT 84112, United States of America.
| | - Onyinye D Balogun
- Weill Cornell Medicine, Department of Radiation Oncology, 525 East 68th Street, New York, NY 10065, United States of America; New York Presbyterian Brooklyn Methodist Hospital, Department of Radiation Oncology, 506 6th Street, Brooklyn, NY 11215, United States of America
| | - David Gaffney
- University of Utah, Department of Radiation Oncology, 1950 Circle of Hope Dr., Rm 1570, Salt Lake City, UT 84112, United States of America; Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT 84112, United States of America
| | - Gita Suneja
- University of Utah, Department of Radiation Oncology, 1950 Circle of Hope Dr., Rm 1570, Salt Lake City, UT 84112, United States of America; Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT 84112, United States of America
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Zhao H, Sarkar V, St James S, Paxton A, Su FF, Price RG, Dial C, Poppe M, Gaffney D, Salter B. Verification of surface-guided radiation therapy (SGRT) alignment for proton breast and chest wall patients by comparison to CT-on-rails and kV-2D alignment. J Appl Clin Med Phys 2024; 25:e14263. [PMID: 38268200 PMCID: PMC10860439 DOI: 10.1002/acm2.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Surface-guided radiation therapy (SGRT) systems have been widely installed and utilized on linear accelerators. However, the use of SGRT with proton therapy is still a newly developing field, and published reports are currently very limited. PURPOSE To assess the clinical application and alignment agreement of SGRT with CT-on-rails (CTOR) and kV-2D image-guided radiation therapy (IGRT) for breast treatment using proton therapy. METHODS Four patients receiving breast or chest wall treatment with proton therapy were the subjects of this study. Patient #1's IGRT modalities were a combination of kV-2D and CTOR. CTOR was the only imaging modality for patients #2 and #3, and kV-2D was the only imaging modality for patient #4. The patients' respiratory motions were assessed using a 2-min surface position recorded by the SGRT system during treatment. SGRT offsets reported after IGRT shifts were recorded for each fraction of treatment. The agreement between SGRT and either kV-2D or CTOR was evaluated. RESULTS The respiratory motion amplitude was <4 mm in translation and <2.0° in rotation for all patients. The mean and maximum amplitude of SGRT offsets after application of IGRT shifts were ≤(2.6 mm, 1.6° ) and (6.8 mm, 4.5° ) relative to kV-2D-based IGRT; ≤(3.0 mm, 2.6° ) and (5.0 mm, 4.7° ) relative to CTOR-based IGRT without breast tissue inflammation. For patient #3, breast inflammation was observed for the last three fractions of treatment, and the maximum SGRT offsets post CTOR shifts were up to (14.0 mm, 5.2° ). CONCLUSIONS Due to the overall agreement between SGRT and IGRT within reasonable tolerance, SGRT has the potential to serve as a valuable auxiliary IGRT tool for proton breast treatment and may improve the efficiency of proton breast treatment.
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Affiliation(s)
- Hui Zhao
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Vikren Sarkar
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Sara St James
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Adam Paxton
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | | | - Ryan G. Price
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Christian Dial
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Matthew Poppe
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - David Gaffney
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Bill Salter
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
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Burt L, Gaffney D. Take Your Best Shot Upfront! Int J Radiat Oncol Biol Phys 2024; 118:319-320. [PMID: 38220251 DOI: 10.1016/j.ijrobp.2023.10.028] [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: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Lindsay Burt
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Concin N, Matias-Guiu X, Fotopoulou C, Creutzberg C, Mutch D, Gaffney D, Lindemann K, Kehoe S, Berek JS. Response: FIGO staging of endometrial cancer 2023. Int J Gynaecol Obstet 2024; 164:369-372. [PMID: 38055215 DOI: 10.1002/ijgo.15277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U. de Bellvitge and Hospital U. Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
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Lee SS, Weil CR, Boyd LR, DeCesaris C, Gaffney D, Suneja G. Trends in use of radiation therapy, chemotherapy, and combination chemoradiotherapy in advanced uterine cancer before, during, and after GOG 258. Int J Gynecol Cancer 2023; 33:1408-1418. [PMID: 37487661 DOI: 10.1136/ijgc-2023-004617] [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] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To explore the use of Gynecologic Oncology Group 258 (GOG 258) study regimens before, during, and after the study. METHODS Patients aged 18 years or older with endometrial cancer between 2004-2019 were identified in the National Cancer Database. Inclusion criteria were stage III or IVA of any histology and stage I-IVA clear cell or serous histologies with positive washings that received adjuvant therapy. Adjuvant therapy use was examined in the pre-GOG 258 era (before 2009), during GOG 258 enrollment and maturation (2010-2017), and after results presentation in 2017 (2018-2019). Two-sided Cochran-Armitage tests, Wilcoxen rank sum tests, and χ2 tests were used for continuous and categorical variables. Multi-variable logistic regression assessed factors associated with the receipt of chemoradiotherapy compared with chemotherapy only or radiation therapy only. RESULTS From 2004 to 2019, 41 408 high-risk endometrial cancer patients received adjuvant therapy (12% radiation therapy, 38% chemotherapy, 50% chemoradiotherapy). Chemoradiotherapy increased over the GOG 258 study period (40% before study opening, 54% during enrollment, and 59% after results). Serous (OR 0.6, 95% CI 0.6 to 0.7) and clear cell histology (0.7, 0.6 to 0.8), higher grade (0.8, 0.7 to 0.9), and lymph node positivity (0.8, 0.7 to 0.9) were negatively associated with receipt of chemoradiotherapy compared with single-modality treatment. Non-Hispanic Black ethnicity (0.8, 0.8 to 0.9) and residing ≥50 miles from the treatment facility (0.8, 0.7 to 0.9) were also negatively associated with chemoradiotherapy. Private insurance (1.2, 1.0 to 1.4) and treatment at community hospitals (1.2, 1.2 to 1.3) were positively associated with chemoradiotherapy. CONCLUSION Despite the lack of benefit in the GOG 258 experimental arm, chemoradiotherapy use increased during study enrollment and after results publication.
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Affiliation(s)
- Sarah S Lee
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leslie R Boyd
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Cristina DeCesaris
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
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Abstract
INTRODUCTION Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. METHODS The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. RESULTS Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. Stage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of "m" for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut). SUMMARY The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.
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Affiliation(s)
- Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA.
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen-Mitte, Essen, Germany
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Ladbury C, Harkenrider M, Taunk N, Fisher C, Mayadev J, Venkat P, Yashar C, Gaffney D, Beriwal S, Glaser S. A practical guide to hybrid interstitial/intracavitary brachytherapy for locally-advanced cervical cancer. Brachytherapy 2023; 22:640-648. [PMID: 37481370 DOI: 10.1016/j.brachy.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE In select cases of locally advanced cervical cancer, a hybrid brachytherapy (HBT) approach consisting of a combined intracavitary (IC)/insterstitial (IS) implant can yield improved target coverage and/or decreased organ at risk dose compared to IC techniques while limiting invasiveness compared to IS techniques. METHODS AND MATERIALS The technique involves placement of transvaginal and/or perineal needles in addition to the tandem and ring/ovoids using either a specialized applicator or free-hand placement. Following applicator and needle placement, brachytherapy may then be planned using principles similar to IC or IS techniques. During treatment planning, it can be helpful to obtain both MRI and CT imaging, as plastic MRI-compatible needles do not show up well on MRI. RESULTS In patients where acceptable target coverage cannot be achieved using IC alone or doses to nearby OAR are too high, HBT should be evaluated. HBT can improve both dose to target and OAR while sparing patients the morbidity of perineal template-based interstitial brachytherapy. Specific scenarios where HBT may be preferred include bulky residual primary tumor especially with poor response to EBRT, extension into the lateral parametrium, vaginal extension of tumor, and an asymmetric target. Use of HBT can typically permit extension of dose coverage by an additional 1-2 cm beyond what can be achieved with an IC alone technique. CONCLUSION HBT allows for improved therapeutic ratio by improving target volume coverage and/or lowering doses to OARs. Brachytherapists should be trained on the practical aspects of administering HBT to be able to offer a less invasive and impactful treatment option when appropriate.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Neil Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christine Fisher
- Department of Radiation Oncology School of Medicine, University of Colorado, Aurora, CO
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
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Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, Lindemann K, Mutch D, Concin N. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet 2023; 162:383-394. [PMID: 37337978 DOI: 10.1002/ijgo.14923] [Citation(s) in RCA: 109] [Impact Index Per Article: 109.0] [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] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies. METHODS The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system. RESULTS Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. Stage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of "m" for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut ). SUMMARY The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.
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Affiliation(s)
- Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford, UK
| | - Kristina Lindemann
- Department of Gynaecological Cancer, Oslo University Hospital, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
- Kliniken Essen-Mitte, Essen, Germany
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Chang CP, Wilson CM, Rowe K, Snyder J, Dodson M, Deshmukh V, Newman M, Fraser A, Smith K, Date A, Stanford JB, Gaffney D, Mooney K, Hashibe M. Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study. Support Care Cancer 2022; 31:51. [PMID: 36526929 PMCID: PMC9850804 DOI: 10.1007/s00520-022-07469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Treatment for gynecologic cancer is associated with sexual dysfunction, which may present during and/or after treatment. The aim of this study was to investigate the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study. We identified a cohort of 4863 endometrial, ovarian, and cervical cancer survivors diagnosed between 1997 and 2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors (N = 22,693). We used ICD-9 codes to identify sexual dysfunction. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for sexual dysfunction with adjustment for potential confounders. Approximately 6.6% of gynecologic cancer survivors had sexual dysfunction diagnoses 1-5 years after cancer diagnosis. Gynecologic cancer survivors had higher risks of overall sexual dysfunction (HR: 2.51, 95% CI: 2.16, 2.93), dyspareunia (HR: 3.27, 95% CI: 2.63, 4.06), and vaginal dryness (HR: 2.63, 95% CI: 2.21, 3.12) compared to a general population of women, 1-5 years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.61, 95% CI: 1.19, 2.31), radiation therapy (HR: 1.73, 95% CI: 1.29, 2.31), and chemotherapy (HR: 1.80, 95% CI: 1.30, 2.50). This large cohort study confirms that there is an increased risk of sexual dysfunction among gynecologic cancer survivors when compared to the general population. Further investigation is needed to address the risk factors for sexual dysfunction and to improve patient-provider communication, diagnosis, documentation, and treatment of sexual dysfunction among gynecologic cancer survivors.
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Affiliation(s)
- Chun-Pin Chang
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Christina M Wilson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Mark Dodson
- Intermountain Healthcare, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kathi Mooney
- College of Nursing, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
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Sherertz T, Jhingran A, Biagioli M, Gaffney D, Elshaikh M, Coleman RL, Harkenrider M, Kidd EA, Jolly S, Yashar C, Portelance L, Wahl A, Venkatesan A, Li L, Small W. Executive summary of the American Radium Society appropriate use criteria for management of uterine clear cell and serous carcinomas. Int J Gynecol Cancer 2022; 32:1549-1554. [PMID: 36423958 DOI: 10.1136/ijgc-2022-003673] [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: 11/25/2022] Open
Abstract
BACKGROUND Uterine clear cell and serous carcinomas have a high propensity for locoregional and distant spread, tend to be more advanced at presentation, and carry a higher risk of recurrence and death than endometrioid cancers. Limited prospective data exist to guide evidence-based management of these rare malignancies. OBJECTIVE The American Radium Society sought to summarize evidence-based guidelines developed by a multidisciplinary expert panel that help to guide the management of uterine clear cell and serous carcinomas. METHODS The American Radium Society Appropriate Use Criteria presented in this manuscript were developed by a multidisciplinary expert panel using an extensive analysis of current published literature from peer-reviewed journals. A well-established methodology (modified Delphi) was used to rate the appropriate use of diagnostic and therapeutic procedures for the management of uterine clear cell and serous carcinomas. RESULTS The primary treatment for non-metastatic uterine clear cell and serous carcinomas is complete surgical staging, with total hysterectomy, salpingo-oophorectomy, omentectomy, and lymph node staging. Even in early-stage disease, patients with uterine clear cell and serous carcinomas have a worse prognosis than those with type I endometrial cancers, warranting consideration for adjuvant therapy regardless of the stage. Given the aggressive nature of these malignancies, and until further research determines the most appropriate adjuvant therapy, it may be reasonable to counsel patients about combined-modality treatment with systemic chemotherapy and radiotherapy. CONCLUSION Patients diagnosed with uterine clear cell and serous carcinomas should undergo complete surgical staging. Multimodal adjuvant therapies should be considered in the treatment of both early-stage and advanced-stage disease. Further prospective studies or multi-institutional retrospective studies are warranted to determine optimal sequencing of therapy and appropriate management of patients based on their unique risk factors. Long-term surveillance is indicated due to the high risk of locoregional and distant recurrence.
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Affiliation(s)
- Tracy Sherertz
- Department of Radiation Oncology, Kaiser Permanente Washington Seattle-Capitol Hill Campus, Seattle, Washington, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine; Loyola University Chicago, Maywood, Illinois, USA
| | - Elizabeth A Kidd
- Stanford University School of Medicine, Stanford, California, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, La Jolla, California, USA
| | | | - Andrew Wahl
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Aradhana Venkatesan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linna Li
- Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, USA
| | - William Small
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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15
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Sherertz T, Jhingran A, Biagioli M, Gaffney D, Elshaikh M, Coleman RL, Harkenrider M, Kidd EA, Jolly S, Yashar C, Portelance L, Wahl A, Venkatesan A, Li L, Small W. Executive summary of the American Radium Society appropriate use criteria for management of uterine clear cell and serous carcinomas. Int J Gynecol Cancer 2022; 32:1549-1554. [PMID: 36423958 DOI: 10.1136/ijgc-2022-esgo.488] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Uterine clear cell and serous carcinomas have a high propensity for locoregional and distant spread, tend to be more advanced at presentation, and carry a higher risk of recurrence and death than endometrioid cancers. Limited prospective data exist to guide evidence-based management of these rare malignancies. OBJECTIVE The American Radium Society sought to summarize evidence-based guidelines developed by a multidisciplinary expert panel that help to guide the management of uterine clear cell and serous carcinomas. METHODS The American Radium Society Appropriate Use Criteria presented in this manuscript were developed by a multidisciplinary expert panel using an extensive analysis of current published literature from peer-reviewed journals. A well-established methodology (modified Delphi) was used to rate the appropriate use of diagnostic and therapeutic procedures for the management of uterine clear cell and serous carcinomas. RESULTS The primary treatment for non-metastatic uterine clear cell and serous carcinomas is complete surgical staging, with total hysterectomy, salpingo-oophorectomy, omentectomy, and lymph node staging. Even in early-stage disease, patients with uterine clear cell and serous carcinomas have a worse prognosis than those with type I endometrial cancers, warranting consideration for adjuvant therapy regardless of the stage. Given the aggressive nature of these malignancies, and until further research determines the most appropriate adjuvant therapy, it may be reasonable to counsel patients about combined-modality treatment with systemic chemotherapy and radiotherapy. CONCLUSION Patients diagnosed with uterine clear cell and serous carcinomas should undergo complete surgical staging. Multimodal adjuvant therapies should be considered in the treatment of both early-stage and advanced-stage disease. Further prospective studies or multi-institutional retrospective studies are warranted to determine optimal sequencing of therapy and appropriate management of patients based on their unique risk factors. Long-term surveillance is indicated due to the high risk of locoregional and distant recurrence.
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Affiliation(s)
- Tracy Sherertz
- Department of Radiation Oncology, Kaiser Permanente Washington Seattle-Capitol Hill Campus, Seattle, Washington, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine; Loyola University Chicago, Maywood, Illinois, USA
| | - Elizabeth A Kidd
- Stanford University School of Medicine, Stanford, California, USA
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, La Jolla, California, USA
| | | | - Andrew Wahl
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Aradhana Venkatesan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linna Li
- Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, USA
| | - William Small
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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16
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Hu S, Baraghoshi D, Chang C, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Smith K, Peoples AR, Gaffney D, Hashibe M. Mental health disorders among ovarian cancer survivors in a population-based cohort. Cancer Med 2022; 12:1801-1812. [PMID: 35773781 PMCID: PMC9883396 DOI: 10.1002/cam4.4976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/20/2021] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ovarian cancer is the fifth most common female cancer in the United States. There have been very few studies investigating mental health diagnoses among ovarian cancer survivors with long-term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. PATIENTS AND METHODS Cohorts of 1689 ovarian cancer patients diagnosed between 1996 and 2012 and 7038 women without cancer matched by age and birth state from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). RESULTS Ovarian cancer survivors experienced increased risks of mental illnesses within the first 2 years after cancer diagnosis (HR = 3.55, 95% CI = 3.04-4.14). The risks of depression among ovarian cancer survivors were nearly 3-fold within the first 2 years of cancer diagnosis (HR = 2.59, 95% CI = 1.94-3.47), and 1.69-fold at 2-5 years after cancer diagnosis (HR = 1.69, 95% CI = 1.18-2.42). Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR = 1.80, 95% CI = 1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR = 1.94, 95% CI = 1.56-2.40). CONCLUSIONS Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors.
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Affiliation(s)
- Siqi Hu
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - David Baraghoshi
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Chun‐Pin Chang
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Kerry Rowe
- Intermountain HealthcareSalt Lake CityUtahUSA
| | - John Snyder
- Intermountain HealthcareSalt Lake CityUtahUSA
| | | | - Michael Newman
- University of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Alison Fraser
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Pedigree and Population Resource, Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Ken Smith
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Pedigree and Population Resource, Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Anita R. Peoples
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Department of Radiation OncologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - David Gaffney
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Department of Population Health SciencesUniversity of Utah School of MedicineSalt Lake CityUtahUSA,Department of Radiation OncologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Mia Hashibe
- Huntsman Cancer InstituteSalt Lake CityUtahUSA,Division of Public Health, Department of Family and Preventive MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
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17
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Dood R, Trabert B, Werner TL, Gaffney D, Jarboe E. The time is now to start molecular subtyping high-intermediate and high-risk endometrial cancers. Int J Gynecol Cancer 2022; 32:ijgc-2022-003709. [PMID: 35705257 PMCID: PMC10243733 DOI: 10.1136/ijgc-2022-003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Robert Dood
- Department of Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Theresa L Werner
- University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Gaffney
- University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elke Jarboe
- University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Pathology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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18
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Huang YJ, Gaffney D. Brachytherapy: common pitfalls. Int J Gynecol Cancer 2022; 32:352-357. [DOI: 10.1136/ijgc-2021-002535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
Gynecologic radiation oncology is a demanding area of oncology requiring expertise in external beam and brachytherapy. Both physicians and physicists are called on to use their full complement of skills to employ state-of-the-art treatments to benefit patients. A wide variety of unusual presentations are frequent in gynecology, and hence, it is necessary to have a number of techniques available to offer the optimal treatments. The heterogeneity of treatments and the rarity of certain gynecological presentations lead to complexity and potential error. We reviewed previous gynecological high dose rate brachytherapy treatment images and plans for patients from the past decade and identified examples of common problems to share with the community. The strategies to prevent or recover from these pitfalls are also presented. With increasing number of applicator choices, it is critical for clinics to follow rigorous commissioning steps to ensure treatment process safety as described. The clinics should consider implementing a thorough on-boarding program and regular hands-on practice as a continuous quality improvement measure. The use of checklists can be invaluable and result in fewer human errors. Gynecological chart rounds that focus on brachytherapy are also encouraged. Lastly, an incident learning system to document small deviations that occur in the process, and a rigorous root cause analysis process could help prevent potential future incidents.
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Gaffney D, Creutzberg CL, Jhingran A. Special Issue: Radiation Oncology in Gynecologic Malignancies. Int J Gynecol Cancer 2022; 32:215. [DOI: 10.1136/ijgc-2022-003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
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20
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Parsons MW, Huang YJ, Burt L, Suneja G, Gaffney D. Vaginal cuff brachytherapy for endometrial cancer: a review of major clinical trials with a focus on fractionation. Int J Gynecol Cancer 2022; 32:311-315. [DOI: 10.1136/ijgc-2021-002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
The use of vaginal cuff brachytherapy in the adjuvant management of endometrial cancer has increased over time. Recommendations from the American Brachytherapy Society, American Society of Radiation Oncology, and European Society for Medical Oncology help to guide the application of vaginal cuff brachytherapy. However, wide variation in practice remains regarding treatment techniques. This article reviews the use of vaginal cuff brachytherapy in the post-operative management of endometrial cancer. It covers risk stratification, treatment rationale, outcomes, and treatment planning recommendations with a specific focus on dose-fractionation regimens. The authors performed a thorough literature review of articles pertinent to the goals of this review. Also presented are early results of the Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared with Standard of Care (SAVE) trial of a two-fraction vaginal cuff brachytherapy regimen.Adjuvant vaginal cuff brachytherapy for early-stage endometrial cancer results in excellent disease control with minimal toxicity. The PORTEC-2 trial showed that vaginal cuff brachytherapy is non-inferior to external beam radiation for vaginal recurrence in patients at high-intermediate risk. Vaginal cuff brachytherapy may also be used as a boost following external beam radiation in combination with chemotherapy for high-risk histologies. Numerous techniques can be used for vaginal cuff brachytherapy, including various medical devices, dose-fractionation schedules, and treatment planning approaches. The early control results of the SAVE trial are promising and we are hopeful that this trial establishes two fraction regimens as a viable option for vaginal cuff brachytherapy.
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Straubhar AM, Parsons MW, Francis S, Gaffney D, Maurer KA. Refusal of surgery and survival outcomes in endometrial cancer. Int J Gynecol Cancer 2021; 31:1236-1241. [PMID: 34385179 DOI: 10.1136/ijgc-2021-002692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer. METHODS From January 2004 to December 2015, the National Cancer Database was queried for patients with pathologically proven endometrial cancer who were recommended surgery and refused. Inverse probability of treatment weighting was used to account for differences in baseline characteristics between patients who underwent surgery and those who refused. Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival. RESULTS Of the 300 675 patients identified, 534 patients (0.2%) were recommended surgical treatment but refused: 18% (95/534) were age ≤40 years. The 5-year overall survival for all patients who refused surgery was significantly decreased compared with patients who underwent surgery (29.2% vs 71.9%, P<0.01). This was demonstrated at ages 41-64 years (65.5% vs 91.0%, P<0.01) and ≥65 years (23.4% vs 75.3%, P<0.01). The 5-year overall survival did not meet statistical significance at age ≤40 years (90.1% vs 87.8% P<0.19). However, there were few patients in this cohort. On multivariate analysis, factors associated with refusal of surgery included: Medicaid insurance, Black race, Hispanic Race, Charlson Comorbidity Index scores of 2 or greater, stage II or III, and if patient received external beam radiation therapy alone. Factors associated with undergoing surgery included: age greater than 41, stage IB, and if the patient received brachytherapy. CONCLUSIONS Refusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.
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Affiliation(s)
- Alli M Straubhar
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
| | - Matthew W Parsons
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Samual Francis
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, Utah, USA
| | - Kathryn A Maurer
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
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22
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Hu S, Baraghoshi D, Chang E, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Gaffney D, Smith K, Herget K, Peoples A, Hashibe M. Abstract 900: Mental health disorders among ovarian cancer survivors in a population-based cohort. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Ovarian cancer is the fifth most common female cancer in the United States. Although there have been many studies on self-reported QOL among ovarian cancer patients, there have been very few studies investigating mental disease diagnoses among ovarian cancer survivors with long term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. Cohorts of 1,689 ovarian cancer patients diagnosed between 1996 and 2012 and 7,038 women without cancer matched by age, birth state and follow up time from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Ovarian cancer survivors experienced increased risks of mental illnesses within the first two years after cancer diagnosis (HR=3.48, 95%CI=2.98-4.05) compared to the general population. The risks of depression among ovarian cancer survivors were 3-fold within the first two years of cancer diagnosis (HR=3.11, 95%CI=2.53-3.83), and 1.67-fold at 2-5 years after cancer diagnosis (HR=1.67, 95%CI=1.17-2.38). The risk of anxiety disorder among ovarian cancer survivors was 3.54-fold at 0-2 years (HR= 3.54, 95% CI= 2.87-4.38), and 1.86-fold at 2-5 years (HR= 1.86, 95% CI= 1.14-3.01). Elevated risk for adjustment disorders was observed among ovarian cancer survivors compared with the general population cohort between 0-2 years (HR= 3.96, 95% CI= 1.00-15.84) and between 2-5 years (HR= 3.96, 95% CI= 1.00-15.84). Cancer treatment and later diagnosis year were associated with increased risk of any mental illness at 0-2 years after cancer diagnosis among ovarian cancer survivors. Distant-stage cancer was an important risk factor compared to early-stage for both mental illness and depression among ovarian cancer survivors in all time periods. Ovarian cancer patients who had a mucinous histology subtype had 47% decreased risk of any mental illness and 67% decreased risk of depression at 0-2 years, compare to those with high-grade serous histology subtype. In addition, a baseline CCI score of 1+ and older age at diagnosis (>60 years old) were important for the increased risk of depression at 0-2 years or >5 year after cancer diagnosis, respectively. Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR=1.80, 95% CI=1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR=1.94, 95% CI=1.56-2.40).Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors.
Citation Format: Siqi Hu, David Baraghoshi, Esther Chang, Kerry Rowe, John Snyder, Vikrant Deshmukh, Michael Newman, Alison Fraser, David Gaffney, Ken Smith, Kimberly Herget, Anita Peoples, Mia Hashibe. Mental health disorders among ovarian cancer survivors in a population-based cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 900.
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Affiliation(s)
- Siqi Hu
- 1Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | - Kerry Rowe
- 2Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- 2Intermountain Healthcare, Salt Lake City, UT
| | | | - Michael Newman
- 3University of Utah Health Sciences Center, Salt Lake City, UT
| | | | | | - Ken Smith
- 1Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | - Mia Hashibe
- 1Huntsman Cancer Institute, Salt Lake City, UT
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23
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Chang CP, Wilson CM, Rowe K, Snyder J, Dodson M, Deshmukh V, Newman M, Fraser A, Smith K, Date A, Stanford JB, Gaffney D, Mooney K, Hashibe M. Abstract 899: Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Treatment for gynecologic cancer is associated with side effects including sexual dysfunction, that present during and after treatment, and can be long lasting. The aim of this study was to investigate the frequency and the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study.
Methods: We identified a cohort of 4,889 endometrial, ovarian and cervical cancer survivors diagnosed between 1997-2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors on birth year and birth state from the Utah Population Database (N=22,809). We used ICD-9 codes to identify sexual dysfunction including dyspareunia, vaginal dryness/atrophic vaginitis, decreased libido, and lack of arousal/orgasm. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for sexual dysfunction with adjustment for potential confounders, including race/ethnicity, baseline body mass index (BMI), and baseline Charlson Comorbidity Index (CCI).
Results: Gynecologic cancer survivors had higher risks of sexual dysfunction (HR: 2.52, 95% CI: 2.16, 2.93) compared to a general population of women 1-5 years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.59, 95% CI:1.19, 2.12), radiation therapy (HR: 1.65, 95% CI: 1.26, 2.16), and chemotherapy (HR: 1.53, 95% CI: 1.17, 2.01).
Conclusions: Although this large cohort study confirms an increased risk of sexual dysfunction among gynecologic cancer survivors, the proportion of cases documented with diagnosis codes was lower than those commonly reported by gynecologic cancer survivors (6% vs. 10-85%). Further investigation into this discrepancy is important in improving survivorship issues for gynecological cancer patients.
Sexual dysfunction among gynecologic cancer survivors and women from the general population**Gynecologic cancer survivorsOvarian cancer survivorsEndometrial cancer survivorsCervical cancer survivorsHR (95% CI)bHR (95% CI)bHR (95% CI)bHR (95% CI)bSexual dysfunctiona2.52 (2.16, 2.93)*2.76 (2.02, 3.76)*2.35 (1.88, 2.92)2.62 (1.83, 3.74)*Dyspareunia3.25 (2.62, 4.04)*3.20 (2.10, 4.88)*3.03 (2.16, 4.24)3.24 (2.04, 5.14)*Vaginal Dryness/Atrophic Vaginitis2.62 (2.21, 3.11)*3.43 (2.26, 5.22)2.49 (2.00, 3.09)*2.90 (1.77, 4.76)Abbreviation: HR, hazard ratio; CI, confidence interval. a. Sexual dysfunction included dyspareunia, vaginal dryness/atrophic vaginitis, decreased libido, lack of arousal/orgasm. b. Models adjusted for matching factors (birth year and birth state), race/ethnicity, baseline body mass index, baseline Charlson Comorbidity Index.*Proportional hazards assumption not met; flexible model was used.**1 to 5 years after cancer diagnosis
Citation Format: Chun-Pin Chang, Christina M. Wilson, Kerry Rowe, John Snyder, Mark Dodson, Vikrant Deshmukh, Michael Newman, Alison Fraser, Ken Smith, Ankita Date, Joseph B. Stanford, David Gaffney, Kathi Mooney, Mia Hashibe. Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 899.
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Affiliation(s)
| | | | - Kerry Rowe
- 2Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- 2Intermountain Healthcare, Salt Lake City, UT
| | | | | | | | | | - Ken Smith
- 3Huntsman Cancer Institute, Salt Lake City, UT
| | - Ankita Date
- 3Huntsman Cancer Institute, Salt Lake City, UT
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McCormack M, Gaffney D, Tan D, Bennet K, Chavez-Blanco A, Plante M. The Cervical Cancer Research Network (Gynecologic Cancer InterGroup) roadmap to expand research in low- and middle-income countries. Int J Gynecol Cancer 2021; 31:775-778. [PMID: 33632702 PMCID: PMC8108273 DOI: 10.1136/ijgc-2021-002422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is a global health problem which disproportionally affects women in low- and middle- income countries. The World Health Organization recently launched its global strategy to eliminate this disease in the next two decades. For those women diagnosed today with cervical cancer better strategies are needed to improve outcome and reduce treatment-related morbidity. Clinical trials are critical to shaping future treatment, and much has been achieved already. However, such opportunities are limited in low resource settings, and the Cervical Cancer Research Network is dedicated to expanding access to new technologies in surgery, radiation, and medical oncology. In this article we review the status of the trials portfolio and outline future objectives, including the launch of a number of research grants for aspiring or established researchers in low- and middle-income settings.
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Affiliation(s)
- Mary McCormack
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - David Tan
- National University Cancer Institute, Singapore
| | - Kathy Bennet
- Gynecologic Cancer InterGroup, Kingston, Ontario, Canada
| | | | - Marie Plante
- Department of Obstetrics, Gynecology and Reproduction, CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
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25
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Hu Q, Chang CP, Rowe K, Snyder J, Deshmukh V, Newman M, Fraser A, Smith K, Gren LH, Porucznik C, Stanford JB, Gaffney D, Henry NL, Lopez I, Hashibe M. Disparities in Cardiovascular Disease Risk Among Hispanic Breast Cancer Survivors in a Population-Based Cohort. JNCI Cancer Spectr 2021; 5:pkab016. [PMID: 33889806 PMCID: PMC8052955 DOI: 10.1093/jncics/pkab016] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background Breast cancer is the leading cause of cancer death among Hispanic women. The aim of our study was to estimate cardiovascular disease (CVD) risk among Hispanic and non-Hispanic White (NHW) breast cancer survivors compared with their respective general population cohorts. Methods Cohorts of 17 469 breast cancer survivors (1774 Hispanic and 15 695 NHW) in the Utah Cancer Registry diagnosed between 1997 and 2016, and 65 866 women (6209 Hispanic and 59 657 NHW) from the general population in the Utah Population Database were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CVD. Results The risk of diseases of the circulatory system was higher in Hispanic than NHW breast cancer survivors 1-5 years after cancer diagnosis, in comparison with their respective general population cohorts (HRHispanic = 1.94, 99% confidence interval [CI] = 1.49 to 2.53; HNHW = 1.38, 99% CI = 1.33 to 1.43; 2-sided Pheterogeneity = .01, respectively). Increased risks were observed for both Hispanic and NHW breast cancer survivors for diseases of the heart and the veins and lymphatics, compared with the general population cohorts. More than 5 years after cancer diagnosis, elevated risk of diseases of the veins and lymphatics persisted in both ethnicities. The CVD risk due to chemotherapy and hormone therapy was higher in Hispanic than NHW breast cancer survivors but did not differ for distant stage, higher baseline comorbidities, or baseline smoking. Conclusions We observed a risk difference for diseases of the circulatory system between Hispanic and NHW breast cancer survivors compared with their respective general population cohorts but only within the first 5 years of cancer diagnosis.
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Affiliation(s)
- Qingqing Hu
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Chun-Pin Chang
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christina Porucznik
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph B Stanford
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - David Gaffney
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Ivette Lopez
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA.,Utah Cancer Registry, Salt Lake City, UT, USA
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26
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Holcombe RF, Verschraegen CF, Chapman AE, Gaffney D, Goldberg RM, Mesa RA, Milhem M, Mims M, Mitchell EP, Mulkerin D, Vijayakumar S. Status of the Clinician Investigator in America: An Essential Healthcare Provider Driving Advances in Cancer Care. J Natl Compr Canc Netw 2021; 19:122-125. [PMID: 33545684 DOI: 10.6004/jnccn.2020.7685] [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: 10/01/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Translation of basic discoveries to clinical care for patients with cancer is a difficult process greatly enabled by physician-trained researchers. Three categories of physicians, with responsibilities spanning from laboratory and preclinical research to direct patient care, are involved in the translational research continuum: physician-scientist (PS), clinician investigator (CI), and academic clinician (AC). METHODS To define how protected time for research efforts is supported, the Association of American Cancer Institutes (AACI) conducted a survey of their member institutions, obtaining 56 responses documenting time spent in research and clinical activities across multiple cancer disciplines, and providing information about funding streams for the different categories of cancer physicians. RESULTS Responses showed that PSs and ACs are minimally involved in clinical research activities; the driver or clinical research in academic cancer centers is the CI. A significant concern was a lack of stable funding streams for nonbillable clinical research activities, putting the sustainability of the CI in jeopardy. Limited funding was derived from hospital sources, with most support derived from cancer center sources. CONCLUSIONS This study highlights the importance of the CI in translational cancer medicine and represents a call to action for institutions and research funding agencies to develop new programs targeted toward CI support to ensure continued progress against cancer.
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Affiliation(s)
| | - Claire F Verschraegen
- 2The Ohio State University, Comprehensive Cancer Center, James Cancer Hospital & Solove Research Institute, Columbus, Ohio
| | - Andrew E Chapman
- 3Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania
| | - David Gaffney
- 4Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Ruben A Mesa
- 6Mays Cancer Center, UT Health San Antonio, San Antonio, Texas
| | - Mohammed Milhem
- 7Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Martha Mims
- 8The Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, Houston, Texas
| | - Edith P Mitchell
- 3Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania
| | - Dan Mulkerin
- 9University of Wisconsin Carbone Cancer Center, Madison, Wisconsin; and
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27
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Small W, Peltecu G, Puiu A, Corha A, Cocîrṭă E, Cigăran RG, Plante M, Jhingran A, Stang K, Gaffney D, Bacon M, McCormack M. Cervical cancer in Eastern Europe: review and proceedings from the Cervical Cancer Research Conference. Int J Gynecol Cancer 2020; 31:1061-1067. [PMID: 33122244 DOI: 10.1136/ijgc-2020-001652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/27/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer is the third most common cancer among women worldwide, with a disproportionately high burden of disease in less-developed regions of the world. The Cervix Cancer Research Network was founded by the Gynecologic Cancer InterGroup with a mission to improve outcomes in cervical cancer by enhancing international access to clinical trials, specifically in under-represented, underdeveloped areas. The Cervix Cancer Research Network held its third international educational symposium in Bucharest in 2018 and is the subject of this report. The purpose of this symposium was to advance the international understanding of cervical cancer treatment patterns, to foster recruitment to Cervix Cancer Research Network clinical trials, and identify key Cervix Cancer Research Network clinical trial concepts to improve cervical cancer care worldwide.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Anastasia Puiu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Andrei Corha
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Elena Cocîrṭă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Ruxandra Gabriela Cigăran
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Marie Plante
- Department of Obstetrics, Gynecology and Reproduction, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kyle Stang
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Monica Bacon
- Cervical Cancer Research Network, Kingston, Ontario, Canada
| | - Mary McCormack
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Kim S, Rowe K, Snyder J, Fraser A, Smith K, Deshmukh VG, Newman M, Herget K, Chang CP, Ose D, Playdon MC, Gaffney D, Hashibe M. Abstract 5795: Long-term diabetes risk among ovarian cancer survivors in a population-based cohort study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective. In the United States, ovarian cancer is the eleventh most common female cancer and the fifth most common cause of cancer death among women. Although incidence and death rates have been declining over the last 10 years, the 5-year survival rate is 47.6%. Diabetes was the seventh leading cause of death in the United States and is associated with an increased mortality rate among cancer patients. While previous studies have examined the association between diabetes and the risk of ovarian cancer, there are very few studies investigating the risk of diabetes after an ovarian cancer diagnosis. We previously reported increased risks of type I and II diabetes among endometrial cancer survivors, but there is no previous study, to our knowledge, that examined the risk of diabetes among ovarian cancer survivors. The aim of this study was to investigate long-term diabetes risk among ovarian cancer survivors compared with a general population of women.
Methods. Ovarian cancer patients diagnosed from 1996 to 2012 in the Utah Cancer Registry were matched to up to 5 cancer-free women on birth state and birth year using the Utah Population Database. Diabetes diagnoses were identified with ICD-9 codes from statewide ambulatory surgery records, statewide inpatient databases and electronic medical records. We estimated hazard ratios with Cox Proportional Hazards models to: (1) investigate risk for diabetes after cancer diagnosis among ovarian cancer survivors compared with the general population, and (2) examine risk factors for type II diabetes among ovarian cancer survivors.
Results. A total 1,520 ovarian cancer patients and 5,709 women from the general population were included in the final cohort. A slightly higher proportion of ovarian cancer patients were obese at baseline (16.3%) than the general population cohort (14.9%). Ovarian cancer survivors had a higher risk of type II diabetes in the first year after cancer diagnosis (HR=3.09, 95%CI=2.09, 4.56) and overall (HR=1.52, 95%CI=1.23, 1.88) compared with the general population. However, associations between ovarian cancer and type II diabetes were not observed in the later follow up periods. High BMI was a significant risk factor for type II diabetes among ovarian cancer survivors, with a dose-response relation (overweight; HR=1.81, 95%CI=1.21, 2.71, obese; HR=2.48, 95%CI=1.61, 3.83, P-trend <0.001). Clinical factors such as cancer treatment, stage, and histology did not contribute to an increased risk of type II diabetes among ovarian cancer patients. Other factors such as race and baseline comorbidities were also not associated with type II diabetes risk among ovarian cancer patients.
Conclusion. Ovarian cancer survivors had an increased risk of type II diabetes compared with women in the general population. Risk was elevated only within the first year of cancer diagnosis, thus surveillance bias cannot be ruled out. Our findings suggest that the increased risk of type II diabetes does not persist beyond the first year after cancer diagnosis.
Citation Format: Seungmin Kim, Kerry Rowe, John Snyder, Alison Fraser, Ken Smith, Vikrant G. Deshmukh, Michael Newman, Kimberley Herget, Chun-Pin Chang, Dominik Ose, Mary C. Playdon, David Gaffney, Mia Hashibe. Long-term diabetes risk among ovarian cancer survivors in a population-based cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5795.
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Affiliation(s)
- Seungmin Kim
- 1Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- 2Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- 2Intermountain Healthcare, Salt Lake City, UT
| | - Alison Fraser
- 3Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Ken Smith
- 3Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | - Chun-Pin Chang
- 1Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Dominik Ose
- 7Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Mary C. Playdon
- 8Department of Nutrition and Integrative Physiology, College of Health, University of Utah, and Huntsman Cancer Institute, Salt Lake City, UT
| | - David Gaffney
- 9Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, UT
| | - Mia Hashibe
- 1Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
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Chang CP, Chen Y, Blackburn B, Abdelaziz S, Rowe K, Snyder J, Dodson M, Deshmukh V, Newman M, Stanford JB, Porucznik CA, Ose J, Fraser A, Smith K, Doherty J, Gaffney D, Hashibe M. Abstract 5797: Genitourinary disease risks among ovarian cancer survivors in a population-based cohort study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. While genitourinary complications during treatment for ovarian cancer are well known, long-term adverse outcomes in the growing population of ovarian cancer survivors have yet to be characterized. The aim of our study is to describe the incidence of genitourinary diseases among ovarian cancer survivors after ovarian cancer diagnosis, compared to the general female population.
Methods. We identified a cohort of 1,270 ovarian cancer survivors diagnosed between 1996 and 2012 in the Utah Cancer Registry, and up to five cancer-free women were matched to ovarian cancer survivors on birth year and state from the Utah Population Database (N=5,286). Genitourinary disease diagnoses were identified with ICD-9 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for genitourinary outcomes at 1 to <5 years after cancer diagnosis and 5+ years after cancer diagnosis with adjustment for potential confounders (e.g., race, baseline body mass index (BMI), and baseline Charlson Comorbidity Index (CCI)).
Results. Urinary system disorders were diagnosed more frequently in ovarian cancer survivors compared to women without cancer (34.6% vs 19.3%, p-value <0.001) in years 1-5 of follow up (HR: 2.53, 95% CI: 2.12-3.01). More than 5 years after cancer diagnosis, ovarian cancer survivors had a higher risk of hydronephrosis compared to the general population (HR: 9.10, 95% CI: 4.29-19.33). Genital organ disorders were also more common among ovarian cancer survivors (22.0%) compared to women in the general population (16.3%; HR: 1.89, 95% CI: 1.57-2.27). The risk of pelvic peritoneal adhesions was highest 1-5 years after cancer diagnosis (HR: 16.59, 95% CI: 7.00-39.34) and persisted 5+ years after cancer diagnosis (HR: 8.88, 95% CI: 1.88-41.91). A higher risk of urinary system disorders among ovarian cancer patients was associated with advanced cancer stage (HRadvanced vs. localized: 3.11, 95% CI: 2.18-4.45), older age at cancer diagnosis (HR80+ vs. 18-49: 2.85, 95% CI: 1.62-5.01), and higher baseline CCI score (HR2+ vs. 0: 2.71, 95% CI: 1.84-3.99). The associations remained when we restricted analyses to ovarian cancer survivors with high-grade serous ovarian cancer.
Conclusions. In this population-based cohort study, ovarian cancer survivors experienced increased risks of various genitourinary diseases for many years after cancer diagnosis. Understanding the multimorbidity trajectory for ovarian cancer survivors after cancer treatment is needed to ultimately improve clinical care after cancer diagnosis. The present results point to the importance of monitoring for genitourinary diseases among ovarian cancer survivors.
Citation Format: Chun-Pin Chang, Yuji Chen, Brenna Blackburn, Sarah Abdelaziz, Kerry Rowe, John Snyder, Mark Dodson, Vikrant Deshmukh, Michael Newman, Joseph B. Stanford, Christina A. Porucznik, Jennifer Ose, Alison Fraser, Ken Smith, Jennifer Doherty, David Gaffney, Mia Hashibe. Genitourinary disease risks among ovarian cancer survivors in a population-based cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5797.
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Affiliation(s)
- Chun-Pin Chang
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Yuji Chen
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Brenna Blackburn
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Sarah Abdelaziz
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- 2Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- 2Intermountain Healthcare, Salt Lake City, UT
| | - Mark Dodson
- 3Intermountain Healthcare, and University of Utah School of Medicine, Salt Lake City, UT
| | | | - Michael Newman
- 4University of Utah Health Sciences Center, Salt Lake City, UT
| | | | | | - Jennifer Ose
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ken Smith
- 6Huntsman Cancer Institute, Salt Lake City, UT
| | - Jennifer Doherty
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - David Gaffney
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
| | - Mia Hashibe
- 1University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT
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Laggis CW, Lamb A, Secrest AM, Ufkes N, Halwani AS, Tao R, Gaffney D, Miles RR, Florell SR, Wada D. Favourable outcomes in folliculotropic mycosis fungoides after multimodality treatment in a single institution. J Eur Acad Dermatol Venereol 2020; 35:e42-e45. [PMID: 32594555 DOI: 10.1111/jdv.16790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- C W Laggis
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - A Lamb
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - A M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - N Ufkes
- Medical University of South Carolina School of Medicine, Charleston, SC, USA
| | - A S Halwani
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncology, University of Utah, Salt Lake City, UT, USA
| | - R Tao
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - D Gaffney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - R R Miles
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - S R Florell
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - D Wada
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Straubhar A, Parsons M, Francis S, Gaffney D, Maurer K. Refusal of Surgery by Young Women (Age <41) with Endometrial Cancer Does Not Impact Overall Survival. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.100] [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: 11/26/2022]
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Sturdza A, Viswanathan AN, Erickson B, Yashar C, Bruggeman A, Feddock J, Klopp A, Beriwal S, Gaffney D, Han K, Kamrava M. American Brachytherapy Society working group report on the patterns of care and a literature review of reirradiation for gynecologic cancers. Brachytherapy 2020; 19:127-138. [PMID: 31917178 DOI: 10.1016/j.brachy.2019.11.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Recurrences of previously irradiated gynecological malignancies are uncommon. Standardized management of these cases is not well established. We aim to provide an in-depth literature review and present current practice patterns among an international group of experienced practitioners in the reirradiation setting of gynecologic cancers. METHODS AND MATERIALS An extensive literature search was performed and 35 articles were selected based on preset criteria. A 20-question online survey of 10 experts regarding their retreatment practices was also conducted. RESULTS The reviewed publications include a diverse group of patients, multiple treatment techniques, a range of total doses, local control, overall survival, and toxicity outcomes. Overall, local control ranged from 44% to 88% over 1-5 years with OS in the range of 39.5-82% at 2-5 years. Late G3-4 toxicity varied very broadly from 0% to 42.9%, with most papers reporting serious toxicities greater than 15%. The most common reirradiation technique utilized was brachytherapy. Some low-dose-rate data suggest improved outcomes with doses >50 Gy. The high-dose-rate data are more varied with some studies suggesting improved local control with doses >40 Gy. In general, a longer time interval between the first and second course of radiation as well as recurrences <2-4 cm tend to have improved outcomes. CONCLUSIONS Reirradiation with brachytherapy results in relatively reasonable local control and toxicities for women with recurrent gynecologic cancers. The appropriate dose for each case needs to be individualized given the heterogeneity of cases. Multidisciplinary management is critical to develop individualized plans and to clearly communicate potential side effects and expected treatment outcomes. TAKE HOME MESSAGE Reirradiation with brachytherapy is an acceptable effective organ preserving approach for recurrent gynecologic cancers with a reasonable local control and toxicity profile. Each case requires multidisciplinary management to develop an individualized approach. Monitoring for potential long-term toxicities is essential.
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Affiliation(s)
- Alina Sturdza
- Department of Radiation Oncology and Radiation Biology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Austria.
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego
| | - Andrew Bruggeman
- Department of Radiation Medicine and Applied Sciences, University of California San Diego
| | | | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman cancer center
| | - David Gaffney
- Department of Radiation Oncology, University of Utah
| | - Kathy Han
- Department of Radiation Oncology, University of Toronto
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Kim S, Park J, Chen Y, Rowe K, Snyder J, Fraser A, Smith K, Deshmukh VG, Newman M, Herget K, Porucznik CA, Ose D, Playdon M, Gaffney D, Hashibe M. Long-term diabetes risk among endometrial cancer survivors in a population-based cohort study. Gynecol Oncol 2020; 156:185-193. [PMID: 31839336 PMCID: PMC7083523 DOI: 10.1016/j.ygyno.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/24/2019] [Revised: 10/03/2019] [Accepted: 10/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The majority of endometrial cancer patients are overweight or obese at cancer diagnosis. Obesity is a shared risk factor for both endometrial cancer and diabetes, but it is unknown whether endometrial cancer patients have increased diabetes risks. The aim of our study was to investigate diabetes risk among endometrial cancer patients. METHODS Endometrial cancer patients diagnosed between 1997 and 2012 in Utah (n = 2,314) were identified. Women from the general population (n = 8,583) were matched to the cancer patients on birth year and birth state. Diabetes diagnoses were identified from electronic medical records and statewide healthcare facility databases. Cox proportional hazards models were used to estimate hazard ratios for diabetes after cancer diagnosis. RESULTS Endometrial cancer survivors had a significantly higher risk of type II diabetes when compared to women from the general population in the first year after cancer diagnosis (HR = 5.22, 95% CI = 4.05, 6.71), >1-5 years after cancer diagnosis (HR = 1.67, 95% CI = 1.31, 2.12), and >5 years after cancer diagnosis (HR = 1.65, 95% CI = 1.29, 2.11). Endometrial cancer patients who were obese at cancer diagnosis had a three-fold increase in type II diabetes risk (HR = 2.99, 95%CI = 2.59, 3.45). Although endometrial cancer patients diagnosed at distant stage had a higher risk of diabetes, cancer treatment did not appear to contribute to any diabetes risks. CONCLUSIONS In conclusion, endometrial cancer survivors had a higher risk of diabetes than women in the general population. These results suggest that long term monitoring for diabetes is indicated for endometrial cancer survivors.
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Affiliation(s)
- Seungmin Kim
- Huntsman Cancer Institute, Salt Lake City, UT, USA; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jihye Park
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yuji Chen
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Michael Newman
- University of Utah Health Care CMIO Office, Salt Lake City, UT, USA
| | | | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominik Ose
- Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Mary Playdon
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT, USA; Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Utah Cancer Registry, Salt Lake City, UT, USA.
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Adhikari E, Knypinski J, Rogers V, Gaffney D, McIntire D. Physiologic parameters and sepsis bundle initiation among third trimester gravidas with influenza-like illness, 2017-2018 influenza season. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.089] [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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Zhao H, Williams N, Poppe M, Sarkar V, Wang B, Rassiah-Szegedi P, Huang YJ, Kokeny K, Gaffney D, Salter B. Comparison of surface guidance and target matching for image-guided accelerated partial breast irradiation (APBI). Med Phys 2019; 46:4717-4724. [PMID: 31509632 DOI: 10.1002/mp.13816] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We investigate the feasibility of surface guided radiation therapy (SGRT) for accelerated partial breast irradiation (APBI) by comparing it with in-room, fan beam kV computed tomography on rails (CTOR) imaging of the targeted region. The uniqueness of our study is that all patients have multiple daily CTOR scans to compare corresponding SGRT AlignRT (VisionRT, United Kingdom) images to. METHODS/MATERIALS Twelve patients receiving APBI were enrolled in this study. Before each treatment fraction, after patients were setup on tattoos, SGRT was performed using AlignRT, and then target matching was performance using CTOR. The average and maximum difference in shifts between SGRT and CTOR were calculated and analyzed for each patient, so as the correlation between surgical cavity size and shift difference. RESULTS Our study showed that SGRT agreed well with CTOR for patients with small surgical cavity volume changes (<10%). There were nine patients who had a ≥5 mm maximum shift difference between SGRT and CTOR along any direction, and in two patients the difference was more than 10 mm (one patient with surgical cavity change 44.3% and one patient with 27 cc cavity volume decrease). All patients, except one, had a mean shift difference < 5 mm along any direction. CONCLUSION For the patients studied here, SGRT appears to be a reasonable and potentially valuable image guidance approach for APBI for patients who experience small changes in surgical cavity volume (<10%) between CT simulation and treatment. However, there is potential for larger alignment errors (up to 11 mm) when using SGRT for patients who experience larger surgical cavity changes.
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Affiliation(s)
- Hui Zhao
- University of Utah, Salt Lake City, UT, 84112, USA
| | - Ned Williams
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | | | | | - Brian Wang
- University of Louisville, 2301 S 3rd St, Louisville, KY, 40292, USA
| | | | | | | | | | - Bill Salter
- University of Utah, Salt Lake City, UT, 84112, USA
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Mileshkin L, Barnes E, Moore K, Gebski V, King M, Narayan K, Kolodziej I, Sjoquist K, Fyles A, Small W, Gaffney D, Quinn M, Andrews J, Thompson S, Huh W, Carlson M, Disilvestro P, Rischin D, Stockler M, Monk B. Disparities starting adjuvant chemotherapy for locally advanced cervix cancer in the international, academic, randomised, phase III OUTBACK trial (ANZGOG 0902, RTOG 1174, NRG 0274). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Soisson S, Ganz PA, Gaffney D, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Hanson HA, Wu YP, Stanford J, Al-Sarray A, Werner TL, Setiawan VW, Hashibe M. Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study. J Natl Cancer Inst 2019; 110:1342-1351. [PMID: 29741696 DOI: 10.1016/j.ygyno.2017.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 09/26/2017] [Revised: 12/20/2017] [Accepted: 03/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial cancer is the second most common cancer among female cancer survivors in the United States. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Studies that examine long-term cardiovascular outcomes among endometrial cancer survivors are critical. Methods Cohorts of 2648 endometrial cancer survivors diagnosed between 1997 and 2012 and 10 503 age-matched women from the general population were identified. Cardiovascular disease diagnoses were identified from electronic medical records and statewide ambulatory surgery and statewide inpatient data. Cox regression models were used to estimate hazard ratios (HRs) at one to five years, more than five to 10 years, and more than 10 years after cancer diagnosis. Results Between one and five years after diagnosis, increased cardiovascular risks among endometrial cancer survivors were observed for phlebitis, thrombophlebitis, and thromboembolism (HR = 2.07, 99% confidence interval [CI] = 1.57 to 2.72), pulmonary heart disease (HR = 1.74, 99% CI = 1.26 to 2.40), and atrial fibrillation (HR = 1.50, 99% CI = 1.07 to 2.11). At more than five to 10 years, some elevated risk persisted for cardiovascular diseases. Compared with patients who had surgery, patients who additionally had radiation therapy and/or chemotherapy were at increased risk for heart and circulatory system disorders between one and five years after cancer diagnosis. Older age and obesity were also risk factors for hypertension and heart disease among endometrial cancer survivors. Conclusions Endometrial cancer survivors are at higher risk for various adverse long-term cardiovascular outcomes compared with women from the general population. This study suggests that increased monitoring for cardiovascular diseases may be necessary for endometrial cancer patients for 10 years after cancer diagnosis.
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Affiliation(s)
- Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Mike Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Heidi A Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Yelena P Wu
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ali Al-Sarray
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Theresa L Werner
- Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
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Tao R, Ager B, Lloyd S, Torgeson A, Denney M, Gaffney D, Kharofa J, Lin SH, Koong AC, Anzai Y, Hoffman JM. Hypoxia imaging in upper gastrointestinal tumors and application to radiation therapy. J Gastrointest Oncol 2018; 9:1044-1053. [PMID: 30603123 DOI: 10.21037/jgo.2018.09.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Survival for upper gastrointestinal tumors remains poor, likely in part due to treatment resistance associated with intratumoral hypoxia. In this review, we highlight advances in nuclear medicine imaging that allow for characterization of in vivo tumor hypoxia in esophageal, pancreatic, and liver cancers. Strategies for adaptive radiotherapy in upper gastrointestinal tumors are proposed that would apply information gained through hypoxia imaging to the creation of personalized radiotherapy treatment plans able to overcome hypoxia-induced treatment resistance, minimize treatment-related toxicities, and improve patient outcomes.
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Affiliation(s)
- Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bryan Ager
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Torgeson
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Michelle Denney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jordan Kharofa
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yoshimi Anzai
- Department of Radiology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Soisson S, Ganz PA, Gaffney D, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Hanson HA, Wu YP, Stanford J, Al-Sarray A, Werner TL, Setiawan VW, Hashibe M. Long-term Cardiovascular Outcomes Among Endometrial Cancer Survivors in a Large, Population-Based Cohort Study. J Natl Cancer Inst 2018; 110:1342-1351. [PMID: 29741696 PMCID: PMC6292788 DOI: 10.1093/jnci/djy070] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/13/2018] [Accepted: 03/16/2018] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Endometrial cancer is the second most common cancer among female cancer survivors in the United States. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Studies that examine long-term cardiovascular outcomes among endometrial cancer survivors are critical. METHODS Cohorts of 2648 endometrial cancer survivors diagnosed between 1997 and 2012 and 10 503 age-matched women from the general population were identified. Cardiovascular disease diagnoses were identified from electronic medical records and statewide ambulatory surgery and statewide inpatient data. Cox regression models were used to estimate hazard ratios (HRs) at one to five years, more than five to 10 years, and more than 10 years after cancer diagnosis. RESULTS Between one and five years after diagnosis, increased cardiovascular risks among endometrial cancer survivors were observed for phlebitis, thrombophlebitis, and thromboembolism (HR = 2.07, 99% confidence interval [CI] = 1.57 to 2.72), pulmonary heart disease (HR = 1.74, 99% CI = 1.26 to 2.40), and atrial fibrillation (HR = 1.50, 99% CI = 1.07 to 2.11). At more than five to 10 years, some elevated risk persisted for cardiovascular diseases. Compared with patients who had surgery, patients who additionally had radiation therapy and/or chemotherapy were at increased risk for heart and circulatory system disorders between one and five years after cancer diagnosis. Older age and obesity were also risk factors for hypertension and heart disease among endometrial cancer survivors. CONCLUSIONS Endometrial cancer survivors are at higher risk for various adverse long-term cardiovascular outcomes compared with women from the general population. This study suggests that increased monitoring for cardiovascular diseases may be necessary for endometrial cancer patients for 10 years after cancer diagnosis.
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Affiliation(s)
- Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, UT
| | - John Snyder
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Yuan Wan
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Mike Newman
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Alison Fraser
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Ken Smith
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | | | - Heidi A Hanson
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Pedigree and Population Resources, Population Sciences, Salt Lake City, UT
| | - Yelena P Wu
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Ali Al-Sarray
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Theresa L Werner
- Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
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Harkenrider MM, Martin B, Nieto K, Small C, Aref I, Bergman D, Chundury A, Elshaikh MA, Gaffney D, Jhingran A, Lee L, Paydar I, Ra K, Schwarz J, Thorpe C, Viswanathan AN, Small W. Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma. Int J Radiat Oncol Biol Phys 2018; 101:1069-1077. [DOI: 10.1016/j.ijrobp.2018.04.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
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Affiliation(s)
- I A Greer
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - J H Winter
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - D Gaffney
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - K McLoughlin
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - J J F Belch
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - G Boyd
- Department of Respiratory Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
| | - C D Forbes
- University Dept. of Medicine, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK
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Abstract
The American Brachytherapy Society (ABS) and its membership seeks to benefit patients by promoting the highest possible standard for brachytherapy practice, support health care professionals through the encouragement of state of the art technology and education, promote clinical and laboratory research, and advocate for the socioeconomic aspects of brachytherapy. The 2017 ABS Annual Meeting took place is Boston, Massachusetts, United States from April 20–22, 2017. The theme “The Value of Brachytherapy in Multidisciplinary Cancer Care” drew a multitude of national and international speakers to present data and debate clinical indications, advancements in practice and the value of brachytherapy. With a focus on the advancement of brachytherapy for prostate cancer and the socioeconomic benefits of brachytherapy, the globally focused program hosted 93 speakers, 506 attendees, and exhibitors from 15 countries and featured 251 abstracts for presentation and display. The ABS Annual Meeting left attendees with initial data on timely and relevant topics such as outcomes following brachytherapy for recurrent prostate cancer following external beam radiotherapy, findings of prototype algorithms capable of rapidly generating prostate brachytherapy pre-operative treatment plans and results on the socioeconomic disparities impacting the utilization of brachytherapy for common malignancies. These novel findings, among many other thoughtful and thought-provoking presentations, gave meeting attendees knowledge of the current state of brachytherapy and future directions of the specialty.
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Affiliation(s)
- Peter F. Orio
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cathryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Dan Petereit
- Rapid City Regional Cancer Care Institute, Rapid City, South Dakota, USA
| | - Firas Mourtada
- Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, Delaware, USA
| | - Ann Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Steven Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kamrava M, Beriwal S, Erickson B, Gaffney D, Jhingran A, Klopp A, Park SJ, Viswanathan A, Yashar C, Lin L. American Brachytherapy Society recurrent carcinoma of the endometrium task force patterns of care and review of the literature. Brachytherapy 2017; 16:1129-1143. [PMID: 28888417 DOI: 10.1016/j.brachy.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this American Brachytherapy Society task force is to present a literature review and patterns of care by a panel of experts for the management of vaginal recurrence of endometrial cancer. METHODS AND MATERIALS In 2016, the American Brachytherapy Society Board selected a panel of experts in gynecologic brachytherapy to update our current state of knowledge for managing vaginal recurrence of endometrial cancer. Practice patterns were evaluated via an online survey and clinical updates occurred through a combination of literature review and clinical experience and/or expertise. RESULTS There are various retrospective series of patients treated with radiation for vaginal recurrence of endometrial cancer, which include a varied group of patients, multiple treatment techniques, and a range of total doses and demonstrate a wide scope of local control and overall survival outcomes. In the era of image-guided brachytherapy, high local control rates with low significant late-term morbidities can be achieved. Lower rates of local control and higher late-term toxicity are reported in the retreatment setting. In patients with no previous history of radiation treatment, external beam radiation therapy followed by brachytherapy boost should be used. There are varying practices with regard to the definition and appropriate doses of both the high-risk clinical target volume and the intermediate-risk clinical target volume in the setting of vaginal recurrence of endometrial cancer. There are limited data to provide appropriate dose constraints for some organs at risk with the majority of guidance taken from the definitive cervical cancer literature. CONCLUSIONS A summary of literature and expert practice patterns for patient selection, dose recommendations, and constraints are provided as guidance for practitioners.
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Affiliation(s)
- Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Anuja Jhingran
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sang June Park
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Akila Viswanathan
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, CA
| | - Lilie Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
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Francis SR, Frandsen J, Kokeny K, Gaffney D, Poppe M. (P011) Postmastectomy Radiotherapy for T3N0 Breast Cancers: A National Cancer Database Analysis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.108] [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: 11/15/2022]
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Wilson MK, Pujade-Lauraine E, Aoki D, Mirza MR, Lorusso D, Oza AM, du Bois A, Vergote I, Reuss A, Bacon M, Friedlander M, Gallardo-Rincon D, Joly F, Chang SJ, Ferrero AM, Edmondson RJ, Wimberger P, Maenpaa J, Gaffney D, Zang R, Okamoto A, Stuart G, Ochiai K. Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: recurrent disease. Ann Oncol 2017; 28:727-732. [PMID: 27993805 DOI: 10.1093/annonc/mdw663] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/23/2016] [Indexed: 12/19/2022] Open
Abstract
This manuscript reports the consensus statements regarding recurrent ovarian cancer (ROC), reached at the fifth Ovarian Cancer Consensus Conference (OCCC), which was held in Tokyo, Japan, in November 2015. Three important questions were identified: (i) What are the subgroups for clinical trials in ROC? The historical definition of using platinum-free interval (PFI) to categorise patients as having platinum-sensitive/resistant disease was replaced by therapy-free interval (TFI). TFI can be broken down into TFIp (PFI), TFInp (non-PFI) and TFIb (biological agent-free interval). Additional criteria to consider include histology, BRCA mutation status, number/type of previous therapies, outcome of prior surgery and patient reported symptoms. (ii) What are the control arms for clinical trials in ROC? When platinum is considered the best option, the control arm should be a platinum-based therapy with or without an anti-angiogenic agent or a poly (ADP-ribose) polymerase (PARP) inhibitor. If platinum is not considered the best option, the control arm could include a non-platinum drug, either as single agent or in combination. (iii) What are the endpoints for clinical trials in ROC? Overall survival (OS) is the preferred endpoint for patient cohorts with an expected median OS < or = 12 months. Progression-free survival (PFS) is an alternative, and it is the preferred endpoint when the expected median OS is > 12 months. However, PFS alone should not be the only endpoint and must be supported by additional endpoints including pre-defined patient reported outcomes (PROs), time to second subsequent therapy (TSST), or time until definitive deterioration of quality of life (TUDD).
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Grover S, Xu M, Jhingran A, Mahantshetty U, Chuang L, Small W, Gaffney D. Clinical trials in low and middle-income countries - Successes and challenges. Gynecol Oncol Rep 2017; 19:5-9. [PMID: 28004030 PMCID: PMC5157789 DOI: 10.1016/j.gore.2016.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/12/2016] [Accepted: 11/21/2016] [Indexed: 12/23/2022] Open
Abstract
Gynecologic malignancies affect women in low and middle-income countries (LMICs) at equal or higher rates compared to high income countries (HICs), yet practice guidelines based on clinical trials performed in HICs do not routinely account for resource disparities between these regions. There is a need and growing interest for executing clinical trials in LMICs. This has led to the creation of multinational cooperative groups and the initiation of several ongoing clinical trials in Mexico, China, and Korea. In this article we describe the challenges involved in initiating clinical trials in LMICs, review current efforts within surgical, medical, and radiation oncology, and introduce high priority topics for future research.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Melody Xu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Anuja Jhingran
- Division of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Linus Chuang
- Department of Gynecological Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, IL, United States
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, United States
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Patel SC, Frandsen J, Bhatia S, Gaffney D. Impact on survival with adjuvant radiotherapy for clear cell, mucinous, and endometriod ovarian cancer: the SEER experience from 2004 to 2011. J Gynecol Oncol 2016; 27:e45. [PMID: 27329193 PMCID: PMC4944012 DOI: 10.3802/jgo.2016.27.e45] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/12/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survival (OS) for stage (I-III) clear cell, mucinous, and endometriod ovarian cancer. METHODS We analyzed incidence, survival, and treatments from the Surveillance, Epidemiology, and End Results (SEER) Program from 2004 to 2011 for clear cell, mucinous, and endometriod histologies of the ovary for stages (I-III). We examined CSS and OS for all three histologies combined and each histology with relation to the use of adjuvant radiation therapy (RT). Survival analysis was calculated by Kaplan-Meier and log-rank analysis. RESULTS CSS was higher in individuals not receiving RT at 5 years (81% vs. 74%) and 10 years (74% vs. 65%, p=0.003). OS was higher in individuals not receiving RT at 5 years (76% vs. 73%) and 10 years (64% vs. 59%, p=0.039). Stage III patients receiving RT had a higher OS at 5 years (54% vs. 44%) and 10 year intervals (36% vs. 30%, p=0.037). Stage III patients with mucinous histology receiving RT had a higher OS at 5 years (50% vs. 36%) and 10 years (45% vs. 26%, p=0.052). CONCLUSION Those receiving RT had a lower CSS and OS at 5 and 10 years. However, subgroup analysis revealed a benefit of RT in terms of OS for all stage III patients and for stage III patients with mucinous histology.
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Affiliation(s)
- Sagar C Patel
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Jonathan Frandsen
- Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Sudershan Bhatia
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Radiation Oncology, Stratton VA Medical Center, Albany, NY, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, UT, USA
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Schwarz JK, Beriwal S, Esthappan J, Erickson B, Feltmate C, Fyles A, Gaffney D, Jones E, Klopp A, Small W, Thomadsen B, Yashar C, Viswanathan A. Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer. Brachytherapy 2015; 14:587-99. [PMID: 26186975 DOI: 10.1016/j.brachy.2015.06.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize recent advances and to generate general guidelines for the management of medically inoperable endometrial cancer patients with radiation therapy. METHODS Recent advances in the literature were summarized and reviewed by a panel of experts. Panel members participated in a series of conference calls and were surveyed to determine their current practices and patterns. This document was reviewed and approved by the full panel, the ABS Board of Directors and the ACR Commission on Radiation Oncology. RESULTS A transition from two-dimensional (2D) to three-dimensional (3D) treatment planning for the definitive treatment of medically inoperable endometrial cancer is described. Magnetic resonance (MR) imaging can be used to define the gross tumor volume (GTV), clinical target volume (CTV), and the organs at risk (OARs). Brachytherapy alone can be used for medically inoperable endometrial cancer patients with clinical Stage I cancer with no lymph node involvement and no evidence of deep invasion of the myometrium on MR imaging. In the absence of MR imaging, a combined approach using external beam and brachytherapy may be considered. CONCLUSIONS Recent advances support the use of MR imaging and 3D planning for brachytherapy treatment for medically inoperable endometrial cancer.
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Affiliation(s)
- Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jacqueline Esthappan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Colleen Feltmate
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Anthony Fyles
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, IL
| | - Bruce Thomadsen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Akila Viswanathan
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
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Nickman N, Ye X, Gaffney D, Barney R, Biskupiak J, Okano G, Lee V, Arellano J. Cost of palliative external beam radiotherapy (EBRT) use for bone metastases secondary to prostate cancer. J Community Support Oncol 2015; 13:95-103. [DOI: 10.12788/jcso.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/20/2022]
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