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Giammarile F, Knoll P, Kunikowska J, Paez D, Estrada Lobato E, Mikhail-Lette M, Wahl R, Holmberg O, Abdel-Wahab M, Scott AM, Delgado Bolton RC. Guardians of precision: advancing radiation protection, safety, and quality systems in nuclear medicine. Eur J Nucl Med Mol Imaging 2024; 51:1498-1505. [PMID: 38319322 PMCID: PMC11043166 DOI: 10.1007/s00259-024-06633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the rapidly evolving field of nuclear medicine, the paramount importance of radiation protection, safety, and quality systems cannot be overstated. This document provides a comprehensive analysis of the intricate regulatory frameworks and guidelines, meticulously crafted and updated by national and international regulatory bodies to ensure the utmost safety and efficiency in the practice of nuclear medicine. METHODS We explore the dynamic nature of these regulations, emphasizing their adaptability in accommodating technological advancements and the integration of nuclear medicine with other medical and scientific disciplines. RESULTS Audits, both internal and external, are spotlighted for their pivotal role in assessing and ensuring compliance with established standards, promoting a culture of continuous improvement and excellence. We delve into the significant contributions of entities like the International Atomic Energy Agency (IAEA) and relevant professional societies in offering universally applicable guidelines that amalgamate the latest in scientific research, ethical considerations, and practical applicability. CONCLUSIONS The document underscores the essence of international collaborations in pooling expertise, resources, and insights, fostering a global community of practice where knowledge and innovations are shared. Readers will gain an in-depth understanding of the practical applications, challenges, and opportunities presented by these regulatory frameworks and audit processes. The ultimate goal is to inspire and inform ongoing efforts to enhance safety, quality, and effectiveness in nuclear medicine globally.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.
| | - Peter Knoll
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Diana Paez
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Enrique Estrada Lobato
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail-Lette
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Richard Wahl
- Washington University in St Louis School of Medicine, St. Louis, USA
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ola Holmberg
- Department of Nuclear Safety and Security, Radiation Safety and Monitoring Section, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Department of Nuclear Science and Applications, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), La Rioja, Logroño, Spain
- Servicio Cántabro de Salud, Santander, Spain
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Mikhail-Lette M, Cordero L, Lievens Y, Al-Ibraheem A, Urbain JL, Chera B, Muylle K, Vaandering A, Rosa AA, Cerci JJ, Sathekge M, Minjgee M, Nansalmaa E, Erdenechimeg S, Ruiz RL, Scott A, Paez D, Giammarile F, Veduta A, Minoshima E, Vichare S, Abdel-Wahab M. Six country vignettes: Strengthening radiotherapy and theranostics. J Cancer Policy 2024; 40:100471. [PMID: 38556128 DOI: 10.1016/j.jcpo.2024.100471] [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: 11/29/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.
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Affiliation(s)
- Miriam Mikhail-Lette
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria.
| | - Lisbeth Cordero
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Jean-Luc Urbain
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Bhishamjit Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Aude Vaandering
- Department of Radiation Oncology, Université Catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Arthur Accioly Rosa
- Department of Radiation Oncology, Oncoclínicas Salvador and Hospital Santa Izabel, Salvador, Bahia, Brazil
| | - Juliano Julio Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | | | | | | | - Rolando Loría Ruiz
- Radiation Therapy Center Siglo 21, Hospital México and Clínica Bíblica, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Andrew Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Diana Paez
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Francesco Giammarile
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Anna Veduta
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Erika Minoshima
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Shrikant Vichare
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - May Abdel-Wahab
- International Atomic Energy Agency Department of Nuclear Sciences and Applications, Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
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Anakwenze CP, Allanson E, Ewongwo A, Lumley C, Bazzett-Matabele L, Msadabwe SC, Kamfwa P, Shouman T, Lombe D, Rubagumya F, Polo A, Ntekim A, Vanderpuye V, Ghebre R, Kochbati L, Awol M, Gnangnon FHR, Snyman L, Fokom Domgue J, Incrocci L, Ndlovu N, Razakanaivo M, Abdel-Wahab M, Trimble E, Schmeler K, Simonds H, Grover S. Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa. Int J Radiat Oncol Biol Phys 2024; 118:595-604. [PMID: 37979709 DOI: 10.1016/j.ijrobp.2023.10.036] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/09/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. METHODS AND MATERIALS We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. RESULTS Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. CONCLUSIONS We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Allanson
- Division of Obstetrics & Gynecology, King Edward Memorial Hospital for Women, Subiaco, Australia, and Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | | | - Christian Lumley
- Office of Global Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana, and Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Paul Kamfwa
- Gynecologic Oncology Unit, Cancer Diseases Hospital, Lusaka, Zambia
| | | | - Dorothy Lombe
- Cancer Screening, Treatment and Support Cluster, Health New Zealand, Palmerston North, New Zealand
| | - Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda, and Division of Cancer Care and Epidemiology and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | - Atara Ntekim
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lofti Kochbati
- Department of Radiotherapy, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - Munir Awol
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Freddy Houéhanou Rodrigue Gnangnon
- Department of Visceral Surgery, National Teaching Hospital of Cotonou, Cotonou, Benin, Department of Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, Limoges, France, and Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
| | - Leon Snyman
- Department Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Joël Fokom Domgue
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, and Faculty of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, University of Yaoundé, Yaoundé, Cameroon
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe, and Department of Radiotherapy and Oncology, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Malala Razakanaivo
- Department of Radiotherapy, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo, Madagascar
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Cape Town, South Africa, and Department of Oncology, University Hospitals Plymouth Trust, Plymouth, United Kingdom
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Grover S, Lichter KE, Likhacheva A, Jang JW, Ning MS, Robin TP, Small W, Kudchadker RJ, Swamidas J, Chopra S, Rai B, Sharma SD, Sharma DN, Kuppusamy T, Yang R, Berger D, Mendez LC, Glaser S, Erickson DL, Chino J, Mourtada F, Abdel-Wahab M, Jhingran A, Simonds H, Mahantshetty U. The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries. Brachytherapy 2023; 22:716-727. [PMID: 37704540 DOI: 10.1016/j.brachy.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. METHODS AND MATERIALS ABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. RESULTS The ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. CONCLUSIONS This ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Anna Likhacheva
- Department of Radiation Oncology, Sutter Health Sacramento, Sacramento, CA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Matthew S Ning
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Rajat J Kudchadker
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhavana Rai
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dutt Sharma
- Department of Radiation Oncology, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Daya N Sharma
- Department of Radiation Oncology, Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India
| | - Thayalan Kuppusamy
- Department of Radiation Oncology, Dr Kamakshi Memorial Hospital, Chennai, Tamil Nadu, India
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China
| | - Daniel Berger
- Department of Nuclear Sciences and Division of Human Health, Section of Dosimetry and Medical Radiation Physics, International Atomic Energy Agency, Vienna, Austria
| | - Lisbeth Cordero Mendez
- Division of Human Health, Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Delnora L Erickson
- Department of Radiation Oncology, Walter Reed National Military Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Junzo Chino
- Deptartment of Radiation Oncology, Duke Cancer Center, Durham, NC
| | - Firas Mourtada
- Department of Radiation Oncology, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Sidney Kimmel Cancer Center, Newark, DE
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Division of Human Health, Section of Applied Radiation Biology and Radiotherapy, International Atomic Energy Agency, Vienna, Austria
| | - Anuja Jhingran
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Stellenbosch, South Africa
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Beckett M, Goethals L, Kraus RD, Denysenko K, Gentile MFBM, Pynda Y, Abdel-Wahab M. Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States. Int J Radiat Oncol Biol Phys 2023; 117:e6. [PMID: 37785808 DOI: 10.1016/j.ijrobp.2023.06.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Sufficient radiotherapy capacity at the country level is commonly seen in high income countries and is an essential factor in access to high quality cancer care. However, universal access is not always possible due to other factors beyond the commonly used parameter of machines per million population. This study aims to assess the barriers cancer patients in a high-income country face in accessing radiotherapy, and how this impacts cancer mortality. MATERIALS/METHODS This cross-sectional study utilized United States county level oncologic and demographic data obtained from Centers for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centers. Radiotherapy facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a radiotherapy center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratios. Variables that were deemed to be significant (p ≤ 0.05) on univariate analysis were then included in a step-wise backwards elimination method of multiple regression analysis. RESULTS Among the United States counties studied, 31.3% of counties have at least one radiotherapy facility and 8.3% have five or more radiotherapy facilities. Median linear distance from a county's centroid to the nearest radiotherapy center was 36 Km and the median county all-cancer mortality to incidence ratio (MIR) was 0.37. The ratio of radiotherapy centers, linear accelerators and brachy therapy units per 1 million people were significantly associated with all-cancer MIR (p<0.05). Greater distance to radiotherapy facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were statistically significant predictors of increased all-cancer MIR (R-squared: 0.2113, F = 94.22, p<0.001). CONCLUSION This analysis used unique high-quality datasets to identify significant barriers to radiotherapy access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts and novel strategies to address and minimize these barriers are needed to ensure access to care and improve oncologic outcomes.
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Affiliation(s)
- M Beckett
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - L Goethals
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - R D Kraus
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - K Denysenko
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - M F B M Gentile
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Y Pynda
- International Atomic Energy Agency, Vienna, Austria
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Elbanna M, Pynda Y, Kalinchuk O, Rosa AA, Abdel-Wahab M. Radiotherapy Resources in Latin America and the Caribbean: An International Atomic Energy Agency Analysis of Current and Projected Needs. Int J Radiat Oncol Biol Phys 2023; 117:S79. [PMID: 37784576 DOI: 10.1016/j.ijrobp.2023.06.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The inequitable access to radiotherapy (RT) is recognized to be a complex undertaking that will require sustained work identifying gaps and mobilizing efforts to fill in those gaps. Data can support policy-makers as they embark on programs to reduce premature mortality from cancer in their countries and regions. The purpose of this analysis is to identify the current gaps and needs in Latin America and the Caribbean (LAC). MATERIALS/METHODS We created a database of 41 countries in LAC using open-source data, including data on population size (UN Department of Economic and Social Affairs data), gross national income per capita (GNIPC) (World Bank Data), current and projected cancer incidence and mortality (Globocan 2020). The International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers (DIRAC) was used to identify the number and operational status of megavoltage (MV) teletherapy machines (Cobalt-60 and Linear Accelerators LINACs) and brachytherapy facilities (HDR and LDR). To calculate current and projected gaps in external beam RT (EBRT) facilities, we matched DIRAC data with Globocan cancer incidence data for 2020 and projections for 2025 and 2030 while applying a 64% optimal EBRT utilization rate (taking into account re-treatment). For brachytherapy, analysis took into account both HDR and LDR capacity and was primarily focused on needs based on current and projected incidence of cervical cancer cases in LAC. RESULTS EBRT was available in 32 (76%) of 41 countries. There were 742 RT centers in 32 countries with a total of 1131 MV units. Average coverage in 2022 based on an optimal utilization rate of 64% was 64%. LINACs accounted for 87% of the total MV units and Cobalt-60 capacity decreased to 13% of total teletherapy capacity compared to capacity in 2018. Most countries clustered in the same range of GNIPC to teletherapy units per 1000 cases, however outliers were most notable in the Caribbean. The median GNIPC was $6340 and the median MV units per 1000 cancer cases were 1.4. The current deficit in MV units is estimated at 672 megavoltage units and projected to be 2455 units by 2030 representing more than double the current capacity. 28 out of 41 countries (68%) had brachytherapy including 279 installed services, both HDR and LDR. At a 75% optimal utilization rate of brachytherapy in locally advanced cervical cancer, the current brachytherapy capacity in LAC could treat 108,420 patients with cervical cancer/year, which meets the current needs in the region albeit with significant inequity in distribution of resources. CONCLUSION There is 15% improvement in the current EBRT capacity in LAC compared to 2018. However, there is still shortage of at least 672 extra units needed. By 2030, the need for MV units will be double the current capacity. The current brachytherapy capacity meets needs albeit with inequitable distribution across the region primarily in the Caribbean.
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Affiliation(s)
- M Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Y Pynda
- International Atomic Energy Agency, Vienna, Austria
| | - O Kalinchuk
- International Atomic Energy Agency, Vienna, Austria
| | - A A Rosa
- Oncocliinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
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7
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Elbanna M, Pynda Y, Kalinchuk O, Rosa A, Abdel-Wahab M. Radiotherapy resources in Latin America and the Caribbean: a review of current and projected needs based on International Atomic Energy Agency data. Lancet Oncol 2023; 24:e376-e384. [PMID: 37657478 DOI: 10.1016/s1470-2045(23)00299-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/03/2023]
Abstract
The inequitable access to radiotherapy globally is a complex undertaking that will require sustained work identifying gaps and mobilising efforts to resolve. The purpose of this review is to identify gaps and needs in radiotherapy in Latin America and the Caribbean. Data from 41 countries in Latin America and the Caribbean on teletherapy megavoltage units and brachytherapy resources were extracted from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers. These data were then matched to open-source data from GLOBOCAN and World Bank Data which included data on population size, gross national income per capita, cancer incidence, and mortality. These data were matched to current and projected cancer incidence and mortality (as estimated by the Global Cancer Observatory in 2020) to calculate current and projected gaps in external beam radiotherapy facilities. For brachytherapy, the analysis was focused on cervical cancer and included high dose rate and low dose rate machines. As of Oct 22, 2022, external beam radiotherapy was available in 32 (78%) of 41 countries, representing 742 radiotherapy centres and 1122 megavoltage units. Average coverage was 63%. LINACs accounted for 85% (955 of 1122) of megavoltage units and Cobalt-60 capacity decreased to 12% compared with in 2018. Median megavoltage units per 1000 cancer cases were 0·8 (IQR 0·54-1·03). Most countries clustered in the same range of gross national income per capita for teletherapy units per 1000 cases at a median of US$9380. The current deficit in megavoltage units is estimated at 668 units and is projected to be 2455 units by 2030. 28 (68%) of 41 countries had 279 installed brachytherapy services, both high dose rate and low dose rate, which could treat 108 420 patients with cervical cancer per year and meet the current needs, albeit with inequitable distribution of resources. Overall, this review indicated a 15% improvement in the current external beam radiotherapy capacity in Latin America and the Caribbean compared with 2018. However, there is still a current shortage of at least 668 extra units. By 2030, the need for megavoltage units will be double the current capacity. There is inequitable distribution of brachytherapy resources across the region primarily in the Caribbean. Adoption of hypofractionation can help overcome machine shortage; however, it will present technical challenges that need to be taken into account. Rays of Hope, is a novel IAEA initiative that is designed to mobilise global efforts to address radiotherapy gaps while ensuring the highest return on investment.
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Affiliation(s)
- May Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Oleksandr Kalinchuk
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Arthur Rosa
- Department of Radiation Oncology, Oncoclinicas Salvador and Hospital Santa Izabel, Salvador, BA, Brazil
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
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8
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Beckett M, Goethals L, Kraus RD, Denysenko K, Barone Mussalem Gentiles MF, Pynda Y, Abdel-Wahab M. Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States. JCO Glob Oncol 2023; 9:e2300130. [PMID: 37769217 PMCID: PMC10581634 DOI: 10.1200/go.23.00130] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality. METHODS This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis. RESULTS Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001). CONCLUSION This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.
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Affiliation(s)
| | - Luc Goethals
- International Atomic Energy Agency, Vienna, Austria
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9
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Beckett M, Gaudet M, Bourque JM, Dennis K, Abdel-Wahab M. Equity in adjuvant radiotherapy utilization in locally advanced head and neck cancer: A SEER-data based study. Head Neck 2023; 45:921-930. [PMID: 36797802 DOI: 10.1002/hed.27319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Not all patients with locally advanced head and neck cancer (HNC) who are eligible for adjuvant radiotherapy (RT) following upfront surgery appear to receive it. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Selected patients from 2009 to 2018 had locally advanced HNC, underwent upfront surgery, and were eligible for adjuvant RT. Multivariable logistic regression and chi-squared test were used to analyze available patient and tumor characteristics. RESULTS Of 12 549 patients, 84.5% underwent adjuvant RT, 15.5% did not. Characteristics associated with lowest adjuvant RT utilization included cancers of the larynx (p < 0.0001) and gingivae (p < 0.0001), age 80 and above (p < 0.0001), unpartnered status (p < 0.0001), and residence within a nonmetropolitan area (p < 0.0024). CONCLUSIONS Tumor subsite, age, partnered status, and rural/urban residence correlate with omission of adjuvant RT in locally advanced HNC.
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Affiliation(s)
- Matthew Beckett
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jean-Marc Bourque
- Département Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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10
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Marin-Cuartas M, De Waha S, Naumann S, Deo V, Noack T, Hoyer A, Holzhey D, Leontyev S, Saeed D, Misfeld M, Ender J, Abdel-Wahab M, Desch S, Thiele H, Borger M, Kiefer P. Incidence and Outcomes of Emergent Intraprocedural Surgical Conversion during Transcatheter Aortic Valve Implantation: Insights from a Multicentric Germany-Wide Analysis. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761793] [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] [Indexed: 03/22/2023]
Affiliation(s)
- M. Marin-Cuartas
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - S. De Waha
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - S. Naumann
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - V.S. Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, United States
| | - T. Noack
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - A. Hoyer
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | | | - S. Leontyev
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - D. Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - M. Misfeld
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - J. Ender
- Department of Anesthesiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - M. Abdel-Wahab
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - S. Desch
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - H. Thiele
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - M. Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - P. Kiefer
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
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11
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Kraus RD, Weil CR, Abdel-Wahab M. Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2200215. [PMID: 36525619 PMCID: PMC10166538 DOI: 10.1200/go.22.00215] [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] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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12
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Veljkovikj I, Ilbawi AM, Roitberg F, Luciani S, Barango P, Corbex M, Dorji G, Gunawardena N, Johnson S, Juric A, Siewert K, Saporiti G, Nobile M, Sauvaget C, Vidanapathirana J, Wright B, Lishimpi K, Kaidarova D, Pomata A, Malick A, Dangou JM, Abdel-Wahab M, Weiderpass E, Mikkelsen B, Stevens LM. Evolution of the joint International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), and WHO cancer control assessments (imPACT Reviews). Lancet Oncol 2022; 23:e459-e468. [DOI: 10.1016/s1470-2045(22)00387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
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13
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Gaudet M, Bourque JM, Beckett M, Dennis K, Abdel-Wahab M. 12: Tumour and Patient Factors Influencing the Use of Adjuvant Radiotherapy in Locally Advanced Head and Neck Cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Gohmann R, Pawelka K, Seitz P, Heiser L, Krieghoff C, Lücke C, Gottschling S, Abdel-Wahab M, Gutberlet M. Kombinierte CT-Koronarangiographie und TAVI-Planung zum Ausschluss signifikanter koronarer Herzkrankheit: Zusätzlicher Nutzen der maschinenlernbasierten CT-FFR. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749819] [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] [Indexed: 11/06/2022]
Affiliation(s)
- R Gohmann
- Herzzentrum Leipzig GmbH, Abteilung für Radiologie, Leipzig
| | - K Pawelka
- Radiologie, Herzzentrum Leipzig, Leipzig
| | - P Seitz
- Radiologie, Herzzentrum Leipzig, Leipzig
| | - L Heiser
- Radiologie, Herzzentrum Leipzig, Leipzig
| | | | - C Lücke
- Radiologie, Herzzentrum Leipzig, Leipzig
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15
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Gohmann R, Seitz P, Pawelka K, Heiser L, Krieghoff C, Lücke C, Gottschling S, Abdel-Wahab M, Gutberlet M. Kombinierte CT-Koronarangiographie (cCTA) und TAVI-Planung: CT-FFR bei cCTAs ohne morphologische Anzeichen für obstruktive koronare Herzkrankheit. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749818] [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] [Indexed: 11/05/2022]
Affiliation(s)
- R Gohmann
- Herzzentrum Leipzig GmbH, Abteilung für Radiologie, Leipzig
| | - P Seitz
- Radiologie, Herzzentrum Leipzig, Leipzig
| | - K Pawelka
- Radiologie, Herzzentrum Leipzig, Leipzig
| | - L Heiser
- Radiologie, Herzzentrum Leipzig, Leipzig
| | | | - C Lücke
- Radiologie, Herzzentrum Leipzig, Leipzig
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16
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Lichter KE, Anderson J, Sim AJ, Baniel CC, Thiel CL, Chuter R, Collins A, Carollo E, Berg CD, Coleman CN, Abdel-Wahab M, Grover S, Singer L, Mohamad O. Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care. Int J Radiat Oncol Biol Phys 2022; 113:915-924. [PMID: 35841919 PMCID: PMC10024638 DOI: 10.1016/j.ijrobp.2022.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Katie E Lichter
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Justin Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Claire C Baniel
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Robert Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Amy Collins
- Health Care Without Harm, Reston, Virginia; Department of Emergency Medicine, MetroWest Medical Center, Framingham, Massachusetts
| | - Erin Carollo
- Loyola University Chicago-Stritch School of Medicine, Chicago, Illinois
| | | | - C Norman Coleman
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - May Abdel-Wahab
- Division of Human Health, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
| | - Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
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17
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Dee EC, Eala MAB, Small W, Gaffney DK, Tangco ED, Abdel-Wahab M, Grover S. Equity in Radiation Oncology Trials: from Knowledge Generation to Clinical Translation. Int J Radiat Oncol Biol Phys 2022; 113:511-512. [PMID: 35777396 PMCID: PMC10001240 DOI: 10.1016/j.ijrobp.2022.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah
| | - Enrico D Tangco
- Department of Radiation Oncology, The Medical City, Pasig City, Philippines
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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18
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Ono A, Murakami Y, Abdel-Wahab M, Nagata Y. Current update of treatment strategies for borderline resectable pancreatic cancer: a narrative review. J Gastrointest Oncol 2022; 13:885-897. [PMID: 35557564 DOI: 10.21037/jgo-21-829] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objective Borderline resectable pancreatic cancer (BRPC) is a tumor that infiltrates into the large blood vessels, with a high probability that the tumor will remain after surgical resection. To date, there has been no confirmed treatment strategy for BRPC. However, high-level studies, such as those using the intention-to-treat analysis, have recently been published. This review aimed to update the current status of treatment strategies for BRPC. Methods We searched for studies, including those investigating patients with BRPC, either treated by upfront surgery or with neoadjuvant treatment and reported the R0 resection rate and overall survival using an intention-to-treat analysis. Key Content and Findings Consequently, 22 articles were identified. Twelve were prospective studies. Six studies compared neoadjuvant therapy with upfront surgery, and both the R0 resection rate and overall survival in patients who underwent upfront surgery were significantly worse than in those who underwent neoadjuvant treatment in all studies. Six studies evaluated neoadjuvant chemotherapy, while 15 studies neoadjuvant chemoradiation. No reports showed the superiority or inferiority of the two methods, and the optimal regimen was not determined in either treatment. The high-precision radiation therapy techniques have been studied, but the optimal method and dose fractionation were unclear. Conclusions The current standard of care for the BRPC is neoadjuvant therapy. Although the optimal regimen of neoadjuvant therapy was not determined, several prospective trials are underway to identify the optimal neoadjuvant treatment.
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Affiliation(s)
- Ayaka Ono
- Hiroshima University School of Medicine, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - May Abdel-Wahab
- Division of human health, International Atomic Energy Agency, Vienna, Austria
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
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19
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Abdel-Wahab M. SP-0045 Inequalities in global access to radiotherapy services - An overview. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Hande V, Chopra S, Kalra B, Abdel-Wahab M, Kannan S, Tanderup K, Grover S, Zubizarreta E, Rubio JAP. Point-A vs. volume-based brachytherapy for the treatment of cervix cancer: A meta-analysis. Radiother Oncol 2022; 170:70-78. [PMID: 35259419 PMCID: PMC10042219 DOI: 10.1016/j.radonc.2022.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & PURPOSE To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer. MATERIALS & METHODS We conducted a meta-analysis of studies assessing the effects of point-A and volume-based brachytherapy on 3-year DFS. Studies including stage I-IVA cervical cancer patients were included if standard treatment of concomitant chemo-radiotherapy and high-dose- or pulsed dose rate BT was delivered. The primary outcome was 3-year DFS, and secondary outcomes were 3-year local control (LC), 3-year overall survival (OS) and late toxicity. A random-effects subgroup meta-analysis was done. RESULTS In total, 5499 studies were screened, of which 24 studies with 5488 patients were eligible. There was significant heterogeneity among point-A studies (1538 patients) (I2 = 82%, p < 0.05) relative to volume-based studies (3950 patients) (I2 = 58, p = 0.01). The 3-year DFS for point-A and volume-based studies were 67% (95% CI 60%-73%) and 79% (95% CI 76%-82%) respectively (p = 0.001). Three-year LC for point-A and volume-based studies were 86% (95% CI 81%-90%) and 92% (91%-94%) respectively (p = 0.01). The difference in 3-year OS (72% vs. 79%, p = 0.12) was not statistically significant. The proportion of prospectively enrolled patients was 23% for point-A studies and 33% for volume-based studies. There was no difference in late grade 3 or higher gastrointestinal (3% vs. 4%, p = 0.76) genitourinary toxicities (3% vs. 3% p = 0.45) between the two groups. CONCLUSION Volume-based BT results in superior 3-year DFS and 3-year LC. In the absence of randomized trials, this meta-analysis provides the best evidence regarding transition to 3D planning.
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Affiliation(s)
- Varsha Hande
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India; Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
| | - Babusha Kalra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - May Abdel-Wahab
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Sadhana Kannan
- Department of Epidemiology and Clinical Trials Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhaba National Institute, Navi Mumbai, India
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Surbhi Grover
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States; Botswana-UPenn Partnership, Gaborone, Botswana
| | - Eduardo Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jose Alfredo Polo Rubio
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
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21
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Von Roeder M, Maeder M, Wahl V, Stachel G, Thiele H, Desch S, Lurz P, Abdel-Wahab M. Prognostic significance of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left atrial reservoir strain (LARS) provides prognostic information in various patient groups and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral valve disease or impaired image quality. Aim of the current study is to elucidate the prognostic value of LASR in patients undergoing TAVI.
Methods
All consecutive patients undergoing TAVI at a single tertiary care hospital between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LASR was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber view. Patients were grouped in 3 tertiles according to LASR. Primary outcome was a composite of all-cause death and readmission for worsening heart failure.
Results
Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman.
LASR was significantly impaired over tertiles (T1 21.4 (IQR 18.3-24.5), T2 13.0 (IQR 11.3-14.6), T3 7.1 (IQR 5.4-8.4), p < 0.0001). The primary outcome occurred more often with impaired LASR (T1 7,4%, T2 13.4%, T3 25,7%).
On multivariable Cox-regression analysis LASR was a significant factor to predict outcome (HR 0.95, CI 0.91-0.99, p = 0.02).
Conclusion
Impaired LASR is associated with impaired outcomes in patients undergoing TAVI.
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Affiliation(s)
| | - M Maeder
- Heart Center of Leipzig, Leipzig, Germany
| | - V Wahl
- Heart Center of Leipzig, Leipzig, Germany
| | - G Stachel
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - P Lurz
- Heart Center of Leipzig, Leipzig, Germany
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22
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Hricak H, Ward ZJ, Atun R, Abdel-Wahab M, Muellner A, Scott AM. Increasing Access to Imaging for Addressing the Global Cancer Epidemic. Radiology 2021; 301:543-546. [PMID: 34581630 DOI: 10.1148/radiol.2021211351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hedvig Hricak
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
| | - Zachary J Ward
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
| | - Rifat Atun
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
| | - May Abdel-Wahab
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
| | - Ada Muellner
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
| | - Andrew M Scott
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (H.H., A.M.); Center for Health Decision Science (Z.J.W.) and Department of Global Health and Population (R.A.), Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Mass (R.A.); International Atomic Energy Agency, Division of Human Health, Vienna, Austria (M.A.W.); Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, Australia (A.M.S.); Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia (A.M.S.); School of Cancer Medicine, La Trobe University, Melbourne, Australia (A.M.S.); and Department of Medicine, University of Melbourne, Melbourne, Australia (A.M.S.)
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23
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Elmore SNC, Polo A, Bourque JM, Pynda Y, van der Merwe D, Grover S, Hopkins K, Zubizarreta E, Abdel-Wahab M. Radiotherapy resources in Africa: an International Atomic Energy Agency update and analysis of projected needs. Lancet Oncol 2021; 22:e391-e399. [PMID: 34478675 DOI: 10.1016/s1470-2045(21)00351-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 01/14/2023]
Abstract
The number of patients with cancer in Africa has been predicted to increase from 844 279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to analyse the gaps and needs of the continent for 2030 in the context of the UN Sustainable Development Goals. Data from 54 African countries on teletherapy megavoltage units and brachytherapy afterloaders were extracted from the Directory for Radiotherapy Centres, an electronic, centralised, and continuously updated database of radiotherapy centres. Cancer incidence and future predictions were taken from the GLOBOCAN 2018 database of the International Agency for Research on Cancer. Radiotherapy need was estimated using a 64% radiotherapy utilisation rate, while assuming a machine throughput of 500 patients per year. As of March, 2020, 28 (52%) of 54 countries had access to external beam radiotherapy, 21 (39%) had brachytherapy capacity, and no country had a capacity that matched the estimated treatment need. Median income was an important predictor of the availability of megavoltage machines: US$1883 (IQR 914-3269) in countries without any machines versus $4485 (3079-12480) in countries with at least one megavoltage machine (p=0·0003). If radiotherapy expansion continues at the rate observed over the past 7 years, it is unlikely that the continent will meet its radiotherapy needs. This access gap might impact the ability to achieve the Sustainable Development Goals, particularly the target to reduce preventable, premature mortality by a third, and meet the target of the cervical cancer elimination strategy of 90% with access to treatment. Urgent, novel initiatives in financing and human capacity building are needed to change the trajectory and provide comprehensive cancer care to patients in Africa in the next decade.
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Affiliation(s)
- Shekinah N C Elmore
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Harvard Radiation Oncology Program, Boston, MA, USA
| | - Alfredo Polo
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jean-Marc Bourque
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - Yaroslav Pynda
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kirsten Hopkins
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
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24
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Abdel-Wahab M, Gondhowiardjo SS, Rosa AA, Lievens Y, El-Haj N, Polo Rubio JA, Prajogi GB, Helgadottir H, Zubizarreta E, Meghzifene A, Ashraf V, Hahn S, Williams T, Gospodarowicz M. Global Radiotherapy: Current Status and Future Directions-White Paper. JCO Glob Oncol 2021; 7:827-842. [PMID: 34101482 PMCID: PMC8457786 DOI: 10.1200/go.21.00029] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Indexed: 12/02/2022] Open
Abstract
Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Soehartati S Gondhowiardjo
- Radiotherapy Department, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas of Indonesia, Jakarta, Indonesia
| | - Arthur Accioly Rosa
- Radiation Oncology, Hospital Portugues, Hospital Sao Rafael, Salvador, Brazil
| | | | - Noura El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Herdis Helgadottir
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ahmed Meghzifene
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Varisha Ashraf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Stephen Hahn
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Tim Williams
- South Florida Proton Therapy Institute, Delray Beach, FL
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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25
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Seitz P, Krieghoff C, Gottschling S, Lücke C, Abdel-Wahab M, Holzhey D, Gohmann RF, Gutberlet M. Pre-procedural high-pitch coronary CT angiography assessment of patients undergoing transcatheter aortic valve implantation (TAVI) without patient-specific adjustment: analysis of diagnostic performance. Clin Radiol 2021; 76:862.e29-862.e36. [PMID: 34261598 DOI: 10.1016/j.crad.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the ability to assess the coronary arteries using pre-procedural computed tomography (CT; high-pitch mode) in patients referred for transcatheter aortic valve implantation (TAVI). METHODS AND MATERIALS CT and invasive coronary angiography (ICA) were performed pre-TAVI in 100 patients (46 women; 79 ± 5.9 years). CT was performed in prospectively ECG-triggered high-pitch mode after intravenous administration of 70 ml iodinated contrast medium. Image quality was assessed using a four-point scale (graded 0-3). Significant coronary artery stenosis (≥50% diameter) was graded as either present or absent by one observer and in one-third of patients by two observers independently. ICA was the standard of reference. Results were reported per segment and per patient. RESULTS Twenty-two percent of patients had known coronary artery disease (CAD). In two cases, a coronary anomaly was detected. Diagnostic image quality (grade 1-3) was achieved in 30.3% of segments. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75%, 80.5%, 16%, and 98.5%, respectively. Significant coronary stenosis could be ruled out completely in all segments in three patients. The interrater agreement per patient was excellent (kappa = 1). CONCLUSION Relevant coronary findings can frequently be observed in high-pitch TAVI-planning CT. Despite the limitations of the technique and in patients referred to pre-TAVI evaluation (rapid heart rate, coronary calcifications, etc.), a valid evaluation of coronary arteries is possible in a considerable proportion of segments with a high NPV; however, few studies were completely free of motion artefacts to dependably exclude CAD using this technique in this challenging group of patients.
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Affiliation(s)
- P Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - C Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - S Gottschling
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - C Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - M Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Leipzig Heart Institute, Russenstraße 69a, 04289, Leipzig, Germany
| | - D Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - R F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103, Leipzig, Germany
| | - M Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Leipzig Heart Institute, Russenstraße 69a, 04289, Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103, Leipzig, Germany
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26
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Hawash Y, Ismail KH, Abdel-Wahab M. Shift in parasitic infections during the Corona pandemic: a hospital-based retrospective study. Trop Biomed 2021; 38:94-101. [PMID: 34172696 DOI: 10.47665/tb.38.2.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Corona pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) calls on the Saudi government to take action to control the infection. The government closed borders, prohibited travel, limited outdoor movements, and told primary and secondary care facilities to reduce all regular non-urgent health services. It is not known whether these measures have impacted the prevalence of parasitic intestinal infections. This study has therefore been carried out to investigate this issue. Dataset of 217 stool samples submitted to the King Faisal Medical Complex (KFMC) Microbiology Laboratory in Taif, Saudi Arabia for parasitological examination during the pandemic (January-June 2020) and 649 samples submitted during the corresponding months of the previous year (January-June 2019) were extracted and analyzed. Overall, 24.1% (209/866) of samples were parasitespositives; 26.6% (173/649) before and 16.5% (36/217) during the pandemic, with 79% reduction. There was a significant difference in gender-parasitism between the two periods where the majority of parasitism were for males (p<0.001). Infections were frequent in patients aged 5- 14 years both before (84/649; 12.9%) and during (12/217; 5.5%) the pandemic, with significant difference observed between the two cohorts (p<0.002). Moreover, the majority of infected patients were non-Saudi (67.9%; 142/209), with a significant difference in nationality reported, (p=0.024). Protozoa were identified in 21.8% (189) of all samples investigated, of which, Blastocystis hominis, Entamoeba coli, Giardia lamblia, Entamoeba histolytica/dispar and Cryptosporidium species were identified in 6.1% (53), 5.4% (47), 5.0% (44), 2.8% (25), and 2.3% (20), respectively. Helminths were diagnosed in 2.3% (20/866) of samples. Eggs of hookworm, Ascaris, Taenia spp, and Hymenolepis nana were detected in 0.9% (8), 0.5% (5), 0.3% (3) and 0.4% (4), respectively. In parallel with our research hypothesis, a substantial decrease in the burden of intestinal parasitic infections was recorded with the lock-down measures taken during the Corona pandemic.
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Affiliation(s)
- Y Hawash
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.,Molecular and Clinical Parasitology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - K H Ismail
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - M Abdel-Wahab
- Department of Medical Microbiology, King Faisal Medical Complex, Taif, KSA
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27
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Gohmann R, Pawelka K, Seitz P, Majunke N, Desch S, Lauten P, Holzhey D, Noak T, Kiefer P, Krieghoff C, Gottschling S, Lücke C, Wilde J, Ebel S, Borger M, Thiele H, Abdel-Wahab M, Gutberlet M. Combined Coronary CT-angiography And TAVI-planning For Ruling-out Significant Coronary Artery Disease: Added Value Of Machine-Learning Based CT-FFR. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Affiliation(s)
- Megan Kassick
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna 1400, Austria; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna 1400, Austria.
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29
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Ryckman JM, Reames BN, Klute KA, Hall WA, Baine MJ, Abdel-Wahab M, Lin C. The timing and design of stereotactic radiotherapy approaches as a part of neoadjuvant therapy in pancreatic cancer: Is it time for change? Clin Transl Radiat Oncol 2021; 28:124-128. [PMID: 33981865 PMCID: PMC8085778 DOI: 10.1016/j.ctro.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Stereotactic Radiotherapy (SRT) over 5-15 days can be interdigitated without delaying chemotherapy. Bridging chemotherapy may allow for extended intervals to surgery, potentially improving sterilization of surgical margins and overall survival. SRT for pancreatic adenocarcinoma should not be limited to the tumor, and should consider hypofractionated approaches to regional nodes.
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Affiliation(s)
- Jeffrey M. Ryckman
- Department of Radiation Oncology, West Virginia University Cancer Institute, Parkersburg, WV, USA
| | - Bradley N. Reames
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kelsey A. Klute
- Department of Medical Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael J. Baine
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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30
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Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong PL, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AM. Medical imaging and nuclear medicine: a Lancet Oncology Commission. Lancet Oncol 2021; 22:e136-e172. [PMID: 33676609 PMCID: PMC8444235 DOI: 10.1016/s1470-2045(20)30751-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.
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Affiliation(s)
- Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria; Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Diana Paez
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason S Lewis
- Department of Radiology and Molecular Pharmacology Programme, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Pharmacology and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Geraldine McGinty
- Departments of Radiology and Population Science, Weill Cornell Medical College, New York, NY, USA; American College of Radiology, Reston, VA, USA
| | - Wim J G Oyen
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lawrence N Shulman
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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31
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Anderson BO, Ilbawi AM, Fidarova E, Weiderpass E, Stevens L, Abdel-Wahab M, Mikkelsen B. The Global Breast Cancer Initiative: a strategic collaboration to strengthen health care for non-communicable diseases. Lancet Oncol 2021; 22:578-581. [PMID: 33691141 DOI: 10.1016/s1470-2045(21)00071-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Benjamin O Anderson
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland; School of Medicine, University of Washington, Seattle 98195, WA, USA.
| | - André M Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elena Fidarova
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Lisa Stevens
- Programme of Action for Cancer Therapy, International Atomic Energy Agency, Vienna, Austria
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Bente Mikkelsen
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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32
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Johnson S, Tittenbrun Z, Romero Y, Torode J, Frech S, Abdel-Wahab M, Juric A, Stevens L, Bray F, Piñeros M, Cleary J, Mattfeld E, Ilbawi A, Mikkelsen B. The World Cancer Declaration: time to consolidate wins and work towards 2025. Lancet Oncol 2021; 22:296-298. [PMID: 33548178 DOI: 10.1016/s1470-2045(21)00012-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Sonali Johnson
- Knowledge, Advocacy and Policy, Union for International Cancer Control, Geneva 1202, Switzerland.
| | - Zuzanna Tittenbrun
- Knowledge, Advocacy and Policy, Union for International Cancer Control, Geneva 1202, Switzerland
| | - Yannick Romero
- Knowledge, Advocacy and Policy, Union for International Cancer Control, Geneva 1202, Switzerland
| | - Julie Torode
- Special Projects, Union for International Cancer Control, Geneva 1202, Switzerland
| | | | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Arsen Juric
- Division of Programme of Action for Cancer Therapy, Department of Technical Cooperation, International Atomic Energy Agency, Vienna, Austria
| | - Lisa Stevens
- Division of Programme of Action for Cancer Therapy, Department of Technical Cooperation, International Atomic Energy Agency, Vienna, Austria
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Marion Piñeros
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - James Cleary
- Supportive Oncology program and IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth Mattfeld
- Prevention, Treatment and Rehabilitation Unit, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria
| | - André Ilbawi
- Department of Non-Communicable Diseases, WHO, Geneva, Switzerland
| | - Bente Mikkelsen
- Department of Non-Communicable Diseases, WHO, Geneva, Switzerland
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33
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Murakami M, Osuga K, Ohto H, Kamiya K, Saito K, Scholz U, Abdel-Wahab M. IAEA consultancy meeting on low-dose radiation for patients and population. Fukushima J Med Sci 2021; 67:89-93. [PMID: 34456223 PMCID: PMC8460281 DOI: 10.5387/fms.2021-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
This paper reports on the IAEA's Consultancy Meeting on "low-dose radiation for patients and population -Science, Technology and Society (STS) concepts for communication and perception among medical doctors and stakeholders-", which was held on October 21 and 22, 2020. The meeting consisted of seven presentation sessions, with a total of 27 presentations and 39 participants from seven countries. The meeting focused on various areas including environmental, food, and personal dosimetry;radiation and other secondary health effects after nuclear disasters;communication between medical professionals and patients or residents;and medical education on nuclear accidents. This meeting was convened to discuss STS perspectives related to nuclear emergencies, to share the findings of the Fukushima Health Management Survey and the current situation in Fukushima with international experts. The meeting confirmed the importance of coordinated recovery of affected areas and global preparedness in the aftermath of nuclear accidents.
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Affiliation(s)
- Michio Murakami
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenichi Osuga
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
| | - Kiyoshi Saito
- Fukushima Global Medical Science Center, Fukushima Medical University
| | - Uwe Scholz
- International Advisor Technical Cooperation
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency
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34
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Chan J, Friborg J, Zubizarreta E, van Eck J, Hanna T, Bourque J, Gaudet M, Dennis K, Olson R, Coleman C, Petersen A, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Feistritzer H, Jobs A, De Waha-Thiele S, Eitel I, Freund A, Abdel-Wahab M, Desch S, Thiele H. Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous randomized controlled trials (RCTs) indicated a benefit of multivessel percutaneous coronary intervention (PCI) compared to culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) without cardiogenic shock.
Purpose
To perform a pairwise meta-analysis of RCTs, already including the recently published COMPLETE (The Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI) trial, comparing multivessel PCI and culprit vessel-only PCI in STEMI patients without cardiogenic shock.
Methods
We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.
Results
Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6,314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p=0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p=0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p=0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p=0.09) was observed.
Conclusion
In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Jobs
- Heart Center of Leipzig, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | | | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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36
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Polo Rubio J, Zubizarreta E, Lievens Y, Barton M, Rodin D, Jake V, Grover S, Abdel-Wahab M. OC-0077: Factors Associated with the Global Availability of Radiotherapy Services: an IAEA analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Anker C, Dragovic J, Abdel-Wahab M, Bianchi N, Goodman K, Herman J, Jones W, Kennedy T, Konski A, Kumar R, Lee P, Russo S, Sharma N, Small W, Suh W, Tchelebi L, Jabbour S. American Radium Society (ARS) and American College of Radiology (ACR) Appropriate Use Criteria (AUC) Systematic Review and Guidelines for Operable Esophageal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Abdel-Wahab M, Rosenblatt E, Prajogi B, Zubizarretta E, Mikhail M. Opportunities in Telemedicine, Lessons Learned After COVID-19 and the Way Into the Future. Int J Radiat Oncol Biol Phys 2020; 108:438-443. [PMID: 32890528 PMCID: PMC7462967 DOI: 10.1016/j.ijrobp.2020.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Affiliation(s)
- May Abdel-Wahab
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria.
| | - Eduardo Rosenblatt
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Ben Prajogi
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarretta
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
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39
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Chan J, Zubizarreta E, van Eck JW, Hanna T, Bourque JM, Gaudet M, Dennis K, Olson R, Coleman CN, Abdel-Wahab M, Brundage M, Slotman B, Polo A. 33: Geographic Accessibility to Radiotherapy in Canada for Indigenous Populations: Highlighting The Inequities. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Soliman O, Abdel-Wahab M, Serruys P. Comments on: 'Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging'. Neth Heart J 2020; 28:559-560. [PMID: 32844317 PMCID: PMC7494688 DOI: 10.1007/s12471-020-01484-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- O Soliman
- CORRIB Core Lab and Research Center for Advanced Imaging, National University of Ireland, Galway, Ireland. .,Department of Cardiology, National University of Ireland, Galway, Ireland.
| | - M Abdel-Wahab
- Leipzig Heart Centre, University of Leipzig, Leipzig, Germany
| | - P Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland
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41
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Gallach M, Mikhail Lette M, Abdel-Wahab M, Giammarile F, Pellet O, Paez D. Addressing Global Inequities in Positron Emission Tomography-Computed Tomography (PET-CT) for Cancer Management: A Statistical Model to Guide Strategic Planning. Med Sci Monit 2020; 26:e926544. [PMID: 32848125 PMCID: PMC7476356 DOI: 10.12659/msm.926544] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background According to the World Health Organization (WHO), non-communicable diseases are responsible for 71% of annual global mortality. National governments and international organizations are increasingly considering medical imaging and nuclear medicine access data in strategies to address epidemiologic priorities. Our objective here was to develop a statistical model to assist countries in estimating their needs for PET-CT systems for the management of specific cancer types. Material/Methods We introduce a patient-centered statistical model based on country-specific epidemiological data, PET-CT performance, and evidence-based clinical guidelines for PET-CT use for cancer. The output of the model was integrated into a Bayesian model to rank countries or world regions that would benefit the most from upscaling PET-CT scanners. Results We applied our model to the IMAGINE database, recently developed by the International Atomic Energy Agency (IAEA). Our model indicates that at least 96 countries should upscale their PET-CT services and more than 200 additional PET-CT scanners would be required to fulfill their needs. The model also provides quantitative evidence indicating that low-income countries would benefit the most from increasing PET-CT provision. Finally, we discuss several cases in which the standard unit [number of scanners]/[million inhabitants] to guide strategic planning or address inequities is misleading. Conclusions Our model may help in the accurate delineation and further reduction of global inequities in access to PET-CT scanners. As a template, the model also has the potential to estimate the costs and socioeconomic impact of implementing any medical imaging modality for any clinical application.
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Affiliation(s)
- Miguel Gallach
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Miriam Mikhail Lette
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
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42
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Huang HL, Gnanasegaran G, Paez D, Fanti S, Hacker M, Sathekge M, Bom HS, Cerci JJ, Chiti A, Lan X, Herrmann K, Scott AM, Vinjamuri S, Dorbala S, Estrada E, Pellet O, Orellana P, El-Haj N, Giammarile F, Abdel-Wahab M, Bomanji J. Nuclear medicine services after COVID-19: gearing up back to normality. Eur J Nucl Med Mol Imaging 2020; 47:2048-2053. [PMID: 32367256 PMCID: PMC7197920 DOI: 10.1007/s00259-020-04848-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- H L Huang
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor, 235 Euston Road, London, UK.,Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospita, Bukit Merah, Singapore
| | | | - D Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - S Fanti
- Department of Oncology, Division of Nuclear Medicine, University of Bologna, Bologna, Italy
| | - M Hacker
- Department of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - M Sathekge
- Nuclear Medicine Department, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - H S Bom
- Department of Nuclear Medicine, Chonnam National University, Seoul, South Korea
| | - J J Cerci
- PET/CT Department at Quanta Diagnostics and Therapy, Curitiba, Brazil
| | - A Chiti
- Humanitas University and Humanitas Research Centre, Milan, Italy
| | - X Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
| | - S Vinjamuri
- Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - S Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - E Estrada
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - O Pellet
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - P Orellana
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - N El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - M Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor, 235 Euston Road, London, UK.
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43
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Griffin RJ, Ahmed MM, Amendola B, Belyakov O, Bentzen SM, Butterworth KT, Chang S, Coleman CN, Djonov V, Formenti SC, Glatstein E, Guha C, Kalnicki S, Le QT, Loo BW, Mahadevan A, Massaccesi M, Maxim PG, Mohiuddin M, Mohiuddin M, Mayr NA, Obcemea C, Petersson K, Regine W, Roach M, Romanelli P, Simone CB, Snider JW, Spitz DR, Vikram B, Vozenin MC, Abdel-Wahab M, Welsh J, Wu X, Limoli CL. Understanding High-Dose, Ultra-High Dose Rate, and Spatially Fractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:766-778. [PMID: 32298811 DOI: 10.1016/j.ijrobp.2020.03.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.
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Affiliation(s)
- Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, Rockville, Maryland
| | | | - Oleg Belyakov
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland, Baltimore, Maryland
| | - Karl T Butterworth
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Valentin Djonov
- Bern Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Sylvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Health Systems, Danville, Pennsylvania
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | | | - Kristoffer Petersson
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Roach
- Department of Radiation Oncology & Urology, University of California, San Francisco, San Francisco, California
| | | | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas R Spitz
- Free Radical & Radiation Biology Program, University of Iowa, Iowa City, Iowa
| | | | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology/DO/Radio-Oncology/CHUV, Lausanne University Hospital, Switzerland
| | - May Abdel-Wahab
- International Atomic Energy Agency Headquarters, Vienna International Centre, Vienna, Austria
| | - James Welsh
- Edward Hines VA Medical Center and Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, Florida; Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Charles L Limoli
- Department of Radiation Oncology, University of California-Irvine, Irvine, California.
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44
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Paez D, Gnanasegaran G, Fanti S, Bomanji J, Hacker M, Sathekge M, Bom HS, Cerci JJ, Chiti A, Herrmann K, Scott AM, Czernin J, El-Haj N, Estrada E, Pellet O, Orellana P, Giammarile F, Abdel-Wahab M. COVID-19 pandemic: guidance for nuclear medicine departments. Eur J Nucl Med Mol Imaging 2020; 47:1615-1619. [PMID: 32296886 PMCID: PMC7159284 DOI: 10.1007/s00259-020-04825-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D Paez
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria.
| | | | - S Fanti
- Department of Oncology, Division of Nuclear Medicine, University of Bologna, Bologna, Italy
| | - J Bomanji
- Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - M Hacker
- Division of Nuclear Medicine, Department of Nuclear Medicine Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - M Sathekge
- Nuclear Medicine Department, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - H S Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun, South Korea
| | - J J Cerci
- PET/CT Department at Quanta Diagnostics and Therapy, Curitiba, Brazil
| | - A Chiti
- Humanitas University and Humanitas Research Hospital, Milan, Italy
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
| | - J Czernin
- Ahmanson Translation Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - N El-Haj
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - E Estrada
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - O Pellet
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - P Orellana
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - F Giammarile
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - M Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
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45
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Huang HL, Gnanasegaran G, Paez D, Fanti S, Hacker M, Sathekge M, Bom HS, Cerci JJ, Chiti A, Lan X, Herrmann K, Scott AM, Vinjamuri S, Dorbala S, Estrada E, Pellet O, Orellana P, El-Haj N, Giammarile F, Abdel-Wahab M, Bomanji J. Correction to: Nuclear medicine services after COVID-19: gearing up back to normality. Eur J Nucl Med Mol Imaging 2020; 47:2220. [PMID: 32462399 PMCID: PMC7252414 DOI: 10.1007/s00259-020-04884-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors P. Orellana and N. El-Haj were inadvertently deleted in the original paper.
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Affiliation(s)
- H L Huang
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor, 235 Euston Road, London, UK
- Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Bukit Merah, Singapore
| | | | - D Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - S Fanti
- Department of Oncology, Division of Nuclear Medicine, University of Bologna, Bologna, Italy
| | - M Hacker
- Department of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - M Sathekge
- NuclearMedicine Department, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - H S Bom
- Department of Nuclear Medicine, Chonnam National University, Seoul, South Korea
| | - J J Cerci
- PET/CT Department at Quanta Diagnostics and Therapy, Curitiba, Brazil
| | - A Chiti
- Humanitas University and Humanitas Research Centre, Milan, Italy
| | - X Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - A M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
| | - S Vinjamuri
- Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
| | - S Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - E Estrada
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - O Pellet
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - P Orellana
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - N El-Haj
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - M Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, 5th Floor, 235 Euston Road, London, UK.
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46
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Chan J, Friborg J, Zubizarreta E, van Eck JW, Hanna TP, Bourque JM, Gaudet M, Dennis K, Olson R, Coleman CN, Petersen AJ, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Examining geographic accessibility to radiotherapy in Canada and Greenland for indigenous populations: Measuring inequities to inform solutions. Radiother Oncol 2020; 146:1-8. [DOI: 10.1016/j.radonc.2020.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
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47
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Russo S, Anker CJ, Abdel-Wahab M, Azad N, Das P, Dragovic J, Goodman KA, Herman JM, Jones W, Kennedy T, Konski A, Kumar R, Lee P, Patel NM, Sharma N, Small W, Suh WW, Jabbour SK. Executive Summary of the American Radium Society Appropriate Use Criteria for Local Excision in Rectal Cancer. Int J Radiat Oncol Biol Phys 2019; 105:977-993. [PMID: 31445109 PMCID: PMC11101014 DOI: 10.1016/j.ijrobp.2019.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
The goal of treatment for early stage rectal cancer is to optimize oncologic outcome while minimizing effect of treatment on quality of life. The standard of care treatment for most early rectal cancers is radical surgery alone. Given the morbidity associated with radical surgery, local excision for early rectal cancers has been explored as an alternative approach associated with lower rates of morbidity. The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines for the use of local excision in early stage rectal cancer that include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by a multidisciplinary expert panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. These guidelines are intended for the use of all practitioners and patients who desire information regarding the use of local excision in rectal cancer.
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Affiliation(s)
- Suzanne Russo
- Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio.
| | | | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, New York, New York
| | - Nilofer Azad
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Joseph M Herman
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Jones
- UT Health Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Andre Konski
- University of Pennsylvania Perelman School of Medicine, Chester County Hospital, West Chester, Pennsylvania
| | - Rachit Kumar
- Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Percy Lee
- University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, California
| | | | - Navesh Sharma
- Milton S. Hershey Cancer Institute, Hershey, Pennsylvania
| | | | - W Warren Suh
- Ridley-Tree Cancer Center Santa Barbara @ Sansum Clinic, Santa Barbara California
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48
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Russo S, Anker CJ, Abdel-Wahab M, Azad N, Bianchi N, Das P, Dragovic J, Goodman KA, Jones W, Kennedy T, Kumar R, Lee P, Sharma N, Small W, Suh WW, Jabbour SK. Executive Summary of the American Radium Society Appropriate Use Criteria for Treatment of Anal Cancer. Int J Radiat Oncol Biol Phys 2019; 105:591-605. [PMID: 31288054 PMCID: PMC11101015 DOI: 10.1016/j.ijrobp.2019.06.2544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Russo
- Case Western Reserve University School of Medicine and University Hospitals, Cleveland Ohio
| | | | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, New York City, New York
| | - Nilofer Azad
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nancy Bianchi
- University of Vermont Cancer Center, Burlington, Vermont
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - William Jones
- UT Health Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Rachit Kumar
- Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Percy Lee
- University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Navesh Sharma
- Milton S. Hershey Cancer Institute, Hershey, Pennsylvania
| | | | - W Warren Suh
- Ridley-Tree Cancer Center, Sansum Clinic, Santa Barbara, California
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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49
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Breitbart P, Minners J, Pache G, Hansson NC, Norgaard BL, De Backer O, Sondergaard L, Alsanjari O, Hildick-Smith D, Reinoehl J, Abdel-Wahab M, Loebig S, Neumann FJ, Ruile P. 94Course of contained annulus ruptures after TAVI: the ENCORE (European contained rupture)-registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An asymptomatic contained rupture (CR) of the aortic annulus is a rare complication of transcatheter aortic valve implantation (TAVI). Their clinical implication is unclear so far.
Purpose
To determine the long-term outcomes in patients with CR.
Methods
The ENCORE-registry is a multicenter registry (6 centers across Europe) of patients with CR diagnosed on post-TAVI computed tomography angiography (CTA) or transesophageal echocardiography (TEE).
Results
A total of 21 patients (mean age 81.9±4.1 years, 81% balloon-expandable TAVI-prostheses) were diagnosed with CR (62% located adjacent to the left coronary cusp, mean size of lesions was 15.3±6.9 x 8.5±3.3 x 8.5±2.3 mm). Seventeen were diagnosed among a total of 1602 consecutive routine post-TAVI CTA (incidence 1.1%), two in TEE and two in post-TAVI CTA (each conducted due to suspicion of periinterventional complications). During a mean follow-up of 2.3±1.7 years nine patients (43%) died from non-cardiac causes. None of the patients exhibited symptoms or underwent interventional treatment related to the CR, no sudden cardiac death occurred. A follow-up CTA, performed in eleven patients 240±176 days post-TAVI, revealed stable CR findings in seven, regression in one, and remission in three patients.
Conclusion
The results of our ENCORE-registry demonstrate a benign course of initially asymptomatic contained ruptures of the aortic annulus after TAVI supporting a watch-and-wait approach in these patients. Thus, no specific treatment seems to be necessary.
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Affiliation(s)
- P Breitbart
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - J Minners
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - G Pache
- University of Freiburg, Department of Radiology, Section of Cardiovascular Radiology, Freiburg, Germany
| | - N C Hansson
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - B L Norgaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - O De Backer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - O Alsanjari
- Sussex Cardiac Centre, Brighton, United Kingdom
| | | | - J Reinoehl
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology I, Freiburg, Germany
| | - M Abdel-Wahab
- Heart Center of Leipzig, Department of Cardiology, Leipzig, Germany
| | - S Loebig
- Robert Bosch Hospital, Division of Cardiology, Stuttgart, Germany
| | - F.-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - P Ruile
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
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50
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Haeck JD, Zimmermann FM, Van 'T Veer M, Neumann FJ, Triantafyllis AS, Abdel-Wahab M, Omerovic E, Boxma-De Klerk BM, Pijls NH, Richardt G, Tonino PA, Johnson NP, Smits PC. P1251Percutaneous coronary intervention versus medical therapy for coronary lesions with positive fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). A substudy of the COMPARE-ACUTE. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
International guidelines recommend performing percutaneous coronary intervention (PCI) on stable coronary lesions with a positive fractional flow reserve (FFR) to improve clinical outcomes. It remains unclear if FFR positive lesions with preserved coronary flow reserved (CFR) might be better treated medically.
Purpose
This study compared clinical outcomes between PCI and medical therapy for stable FFR-positive lesions with preserved CFR.
Methods
We performed a substudy of the randomized, multicenter COMPARE-ACUTE trial in which treated ST-elevation myocardial infarction patients with stable non-culprit lesions were randomized to either FFR-guided PCI or medical therapy. Based on baseline and hyperaemic pressure gradients, we computed the so-called pressure bounded-CFR (pb-CFR) and classified lesions as low (<2) or preserved (≥2). Our primary end point was a composite of death from any cause, non-fatal myocardial infarction, revascularization, or cerebrovascular events (MACCE) at 12 months.
Results
A total of 980 lesions from 885 subjects were included in this sub-study due to availability of baseline and hyperaemic pressure gradients. For the 462 lesions with FFR≤0.80, 249 had a pb-CFR<2 while 29 had a preserved CFR (pb-CFR≥2). The rate of MACCE at 1 year did not differ significantly between subjects with FFR≤0.80 and pb-CFR<2 versus FFR≤0.80 and pb-CFR≥2 (24% vs. 30%, p=0.44). Because of randomization, baseline characteristics were well balanced between subjects with FFR≤0.80 and pb-CFR≥2 who were treated by PCI or medical therapy. Importantly for subjects with FFR≤0.80 and pb-CFR≥2, MACCE occurred more frequently when treated medically compared with PCI (50% vs. 0% respectively, p=0.01).
Conclusions
In this post-hoc substudy from a large randomized controlled trial of 885 subjects with 980 lesions, a preserved pb-CFR≥2 did not associate with an improved clinical outcome when FFR≤0.80. Subjects with FFR-positive coronary lesions but a preserved pb-CFR experienced significantly worse clinical outcomes when treated medically instead of with PCI. These data suggest that a stenosis with a FFR≤0.80, even when pb-CFR remains preserved, benefits from treatment with PCI.
Acknowledgement/Funding
Maasstad Cardiovascular Research, Abbott Vascular and St. Jude Medical
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Affiliation(s)
- J D Haeck
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - F M Zimmermann
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - M Van 'T Veer
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | | | | | - E Omerovic
- University of Gothenburg, Cardiology, Gothenburg, Sweden
| | | | - N H Pijls
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - P A Tonino
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - N P Johnson
- McGovern Medical School at UTHealth, Medicine, Houston, United States of America
| | - P C Smits
- Maasstad Hospital, Cardiology, Rotterdam, Netherlands (The)
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