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Gorobets O, Keam B, Vinh-Hung V, Nguyen NP. Twenty-five Years Overall Survival Prognostic Value of the Lymph Node Ratio in De Novo Metastatic Breast Cancer. Anticancer Res 2024; 44:1995-2002. [PMID: 38677759 DOI: 10.21873/anticanres.17002] [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: 02/04/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM The lymph node ratio (LNR) indicates the number of involved lymph nodes divided by the number of lymph nodes found during axillary exploration. This study investigated the prognostic value of the LNR in de novo metastatic breast cancer (dnMBC). We hypothesized that LNR might predict long-term survival even in cases where the disease has already disseminated beyond the regional stage. PATIENTS AND METHODS Patients with dnMBC were selected from the Surveillance, Epidemiology, and End Results (SEER) 9-registries database 1988-2012. Positive lymph nodes (npos) were categorized as pN0 (npos=0), pN1 (npos=1 to 3), pN2 (npos=4 to 9), and pN3 (npos≥10). The LNR was categorized as Lnr0 (LNR=0), Lnr1 (LNR=0.01 to 0.20), Lnr2 (LNR=0.21 to 0.65), and Lnr3 (LNR≥0.65). The prognostic values were compared using Gini's mean difference Δ of the restricted mean overall survival time (RMST) according to npos versus LNR groups. RESULTS A total of 12,085 patients with dnMBC had LNR data. At 25 years follow-up, the npos RMSTs were 10.4, 5.1, 5.8, and 5.0 years, for pN0 to pN3, respectively. The npos Gini's Δ was 2.8 years (standard error ±0.2). The LNR RMSTs were 10.4, 9.9, 7.6, and 4.0 years for Lnr0 to Lnr3, respectively. Δ for LNR was 3.6 (±0.2) years. Among node positive cases, the LNR low-risk group had an RMST of 9.9 years, approaching node-negative cases, while the high-risk group had an RMST of 4.0 years. CONCLUSION LNR identified different prognostic groups, suggesting a possible role of lymph node involvement as a marker of lymphangiogenesis or lymphatic changes in the immune microenvironment, which warrants further investigation in dnMBC.
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Affiliation(s)
- Olena Gorobets
- Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Vincent Vinh-Hung
- Department of Radiotherapy, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France;
- International Geriatric Radiotherapy Group, Washington, DC, U.S.A
| | - Nam P Nguyen
- International Geriatric Radiotherapy Group, Washington, DC, U.S.A
- Department of Radiation Oncology, Howard University, Washington, DC, U.S.A
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Nguyen NP, Mohammadianpanah M, SunMyint A, Page BR, Vinh-Hung V, Gorobets O, Arenas M, Mazibuko T, Giap H, Vasileiou M, Dutheil F, Tuscano C, Karlsson ULFL, Dahbi Z, Natoli E, Li E, Kim L, Oboite J, Oboite E, Bose S, Vuong T. Immunotherapy and radiotherapy for older patients with locally advanced rectal cancer unfit for surgery or decline surgery: a practical proposal by the International Geriatric Radiotherapy Group. Front Oncol 2024; 14:1325610. [PMID: 38463223 PMCID: PMC10921228 DOI: 10.3389/fonc.2024.1325610] [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: 11/07/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
The standard of care for locally advanced rectal cancer is total neoadjuvant therapy followed by surgical resection. Current evidence suggests that selected patients may be able to delay or avoid surgery without affecting survival rates if they achieve a complete clinical response (CCR). However, for older cancer patients who are too frail for surgery or decline the surgical procedure, local recurrence may lead to a deterioration of patient quality of life. Thus, for clinicians, a treatment algorithm which is well tolerated and may improve CCR in older and frail patients with rectal cancer may improve the potential for prolonged remission and potential cure. Recently, immunotherapy with check point inhibitors (CPI) is a promising treatment in selected patients with high expression of program death ligands receptor 1 (PD- L1). Radiotherapy may enhance PD-L1 expression in rectal cancer and may improve response rate to immunotherapy. We propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced rectal cancer who are too frail for surgery or who decline surgery.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arthur SunMyint
- Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool, United Kingdom
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Bethesda, MD, United States
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
| | - Olena Gorobets
- Department of Oral Surgery, Martinique University, Fort de France, France
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University, University of Rovira, I Virgili, Tarragona, Spain
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Fabien Dutheil
- Department of Radiation Oncology, Clinique Sainte Clotilde, Saint Denis, La Reunion, Saint Denis, France
| | - Carmelo Tuscano
- Department of Radiation Oncology, A.O Bianchi Melacrino, Reggio Calabria, Italy
| | - ULF Lennart Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Zineb Dahbi
- Department of Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Elena Natoli
- Department of Radiation Oncology, University of Bologna, Bologna, Italy
| | - Eric Li
- Department of Pathology, Howard University, Washington, DC, United States
| | - Lyndon Kim
- Division of Neurooncology, Mt Sinai Hospital, New York, NY, United States
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Te Vuong
- Department of Radiation Oncology, Mc Gill University, Montreal, Canada
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Nguyen MD, Natchagande G, Gorobets O, Vinh-Hung V. Low-Dose Apalutamide in Nonmetastatic Castration-Resistant Prostate Cancer: A Case Report. Cureus 2024; 16:e54197. [PMID: 38371433 PMCID: PMC10874470 DOI: 10.7759/cureus.54197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
The effect of low-dose apalutamide in nonmetastatic castration-resistant prostate cancer is unknown. We report the observation of therapy being administered at 25% of the recommended dose in an 80-year-old patient. Despite treatment discontinuation during COVID lockdowns, he survived three years without evidence of metastasis. This case gently invites us to reflect on the possibility of low-dose apalutamide in the elderly.
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Affiliation(s)
- Minh Dung Nguyen
- Orthopedics and Sport Medicine, Hospital of Orthopedics and Rehabilitation, Ho Chi Minh City, VNM
| | - Gilles Natchagande
- Urology, Centre Hospitalier Universitaire Départementale Ouémé Plateau (CHUD-OP) and Centre National Hospitalier Universitaire Hubert Koutoukou MAGA (CNHU-HKM), Cotonou, BEN
| | - Olena Gorobets
- Radiation Oncology, Centre Hospitalier Universitaire (CHU) de Martinique, Fort-de-France, FRA
| | - Vincent Vinh-Hung
- Radiation Oncology, Universitair Ziekenhuis (UZ) Brussel, Brussels, BEL
- Radiation Oncology, Centre Hospitalier Universitaire (CHU) de Martinique, Fort-de-France, FRA
- Radiation Oncology, Institut Bergonié, Bordeaux, FRA
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4
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Van Parijs H, Cecilia-Joseph E, Gorobets O, Storme G, Adriaenssens N, Heyndrickx B, Verschraegen C, Nguyen NP, De Ridder M, Vinh-Hung V. Lung-heart toxicity in a randomized clinical trial of hypofractionated image guided radiation therapy for breast cancer. Front Oncol 2023; 13:1211544. [PMID: 38053657 PMCID: PMC10694354 DOI: 10.3389/fonc.2023.1211544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Background TomoBreast hypothesized that hypofractionated 15 fractions/3 weeks image-guided radiation therapy (H-IGRT) can reduce lung-heart toxicity, as compared with normofractionated 25-33 fractions/5-7 weeks conventional radiation therapy (CRT). Methods In a single center 123 women with stage I-II operated breast cancer were randomized to receive CRT (N=64) or H-IGRT (N=59). The primary endpoint used a composite four-items measure of the time to 10% alteration in any of patient-reported outcomes, physician clinical evaluation, echocardiography or lung function tests, analyzed by intention-to-treat. Results At 12 years median follow-up, overall and disease-free survivals between randomized arms were comparable, while survival time free from alteration significantly improved with H-IGRT which showed a gain of restricted mean survival time of 1.46 years over CRT, P=0.041. Discussion The finding establishes TomoBreast as a proof-of-concept that hypofractionated image-guided radiation-therapy can improve the sparing of lung-heart function in breast cancer adjuvant therapy without loss in disease-free survival. Hypofractionation is advantageous, conditional on using an advanced radiation technique. Multicenter validation may be warranted. Trial registration https://clinicaltrials.gov/ct2/show/NCT00459628. Registered 12 April 2007.
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Affiliation(s)
- Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elsa Cecilia-Joseph
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Claire Verschraegen
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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Nguyen NP, Thariat J, Gorobets O, Vinh-Hung V, Kim L, Blanco SC, Vasileiou M, Arenas M, Mazibuko T, Giap H, Vincent F, Chi A, Loganadane G, Mohammadianpanah M, Rembielak A, Karlsson U, Ali A, Bose S, Page BR. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2023; 15:4981. [PMID: 37894347 PMCID: PMC10605563 DOI: 10.3390/cancers15204981] [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: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, 14000 Cain, France;
| | - Olena Gorobets
- Department of Oral Surgery, University of Martinique, 97213 Martinique, France;
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Sergio Calleja Blanco
- Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC 20059, USA;
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, 43204 Tarragona, Spain;
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System, Lawrenceburg, TN 29425, USA;
| | - Alexander Chi
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 101125, China;
| | | | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Agata Rembielak
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
- Division of Cancer Sciences, Faculty of Biomedicine and Health, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Ahmed Ali
- Division of Hematology Oncology, Howard University, Washington, DC 20059, USA;
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore 21218, MD, USA;
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Nguyen NP, Karlsson UL, Lehrman D, Mazibuko T, Saghatelyan T, Thariat J, Baumert BG, Vinh-Hung V, Gorobets O, Giap H, Singh S, Chi A, Alessandrini G, Ahluwalia A, Durosinmi-Etti F, Zegarra Cárdenas J, Diabate K, Oboite J, Oboite E, Mehmood T, Vuong T, Kim L, Page BR. Impact of COVID-19 pandemic on older cancer patients: Proposed solution by the International Geriatric Radiotherapy Group. Front Oncol 2023; 13:1091329. [PMID: 36959795 PMCID: PMC10027708 DOI: 10.3389/fonc.2023.1091329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/18/2023] [Indexed: 03/09/2023] Open
Abstract
Older cancer patients are disproportionally affected by the Coronavirus 19 (COVID-19) pandemic. A higher rate of death among the elderly and the potential for long-term disability have led to fear of contracting the virus in these patients. This fear can, paradoxically, cause delay in diagnosis and treatment that may lead to a poor outcome that could have been prevented. Thus, physicians should devise a policy that both supports the needs of older patients during cancer treatment, and serves to help them overcome their fear so they seek out to cancer diagnosis and treatment early. A combination of telemedicine and a holistic approach, involving prayers for older cancer patients with a high level of spirituality, may improve vaccination rates as well as quality of life during treatment. Collaboration between health care workers, social workers, faith-based leaders, and cancer survivors may be crucial to achieve this goal. Social media may be an important component, providing a means of sending the positive message to older cancer patients that chronological age is not an impediment to treatment.
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Affiliation(s)
- Nam Phong Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Ulf Lennart Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - David Lehrman
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Thandeka Mazibuko
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tatul Saghatelyan
- Department of Radiation Oncology, National Center of Oncology, Yerevan, Armenia
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, Cain, France
| | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de La Polynesie Francaise, Tahiti, French Polynesia
| | - Olena Gorobets
- Department of Oral Surgery, Centre Hospitalier Universitaire de Martinique, Martinique, France
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Sankalp Singh
- Department of Radiation Oncology, Army Hospital (Research & Referral), New Delhi, India
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing, China
| | | | - Abhinav Ahluwalia
- Department of Radiation Oncology, Advanced Care Oncology Center, Dubai, United Arab Emirates
| | | | - Jorge Zegarra Cárdenas
- Division of Medical Oncology, Regional Institute of Neoplastic Disease, Concepcion, Peru
| | | | - Joan Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton, United Kingdom
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY, United States
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, United States
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Vinh-Hung V, Gorobets O, Natchagande G, Sargos P, Yin M, Nguyen NP, Verschraegen C, Folefac E. Low-Dose Enzalutamide in Metastatic Prostate Cancer-Longevity Over Conventional Survival Analysis. Clin Genitourin Cancer 2022; 20:e473-e484. [PMID: 35778336 DOI: 10.1016/j.clgc.2022.05.012] [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: 03/01/2021] [Revised: 01/08/2022] [Accepted: 05/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Enzalutamide is an important drug in the treatment of prostate cancer. Standard dosing often requires dose reduction because of side effects. There is no information on survival outcomes with lower doses. We investigated the impact of starting enzalutamide at ≤ 50% dose on metastatic prostate cancer outcomes including patients' longevity. PATIENTS AND METHODS Records of metastatic prostate cancer patients treated with enzalutamide at one center were retrospectively reviewed. Low-dose enzalutamide (≤80 mg/day) was compared with standard-dose (160 mg/day). The primary objective was to compute the restricted mean survival time (RMST - time scale) and restricted mean attained age (RMAA - age scale) using the Irwin method. Secondary objectives included overall survival (OS), progression-free survival (PFS), and PSA progression per PCWG3 criteria (PSA PFS). We used the logrank test and the ∆ difference between RMSTs for comparison. RESULTS Of 111 patients treated, 32 received a low-dose and 79 the standard-dose. Low-dose patients had less prior abiraterone or chemotherapy (28.1% vs. 65.8%, P < .001); more testosterone assessment (65.6% vs. 40.5%, P = .016); poorer ECOG performance status (48.3% score ≥2 vs. 26.6%; P = .040), more comorbidities (75.9% vs. 46.3%; P = .010)) including increased cardiovascular disease (51.7% vs. 21.4%, P = .004). Baseline PSA value and doubling time at start of enzalutamide and distribution of metastases were similar between the groups. OS and PFS did not differ between low-dose and standard-dose. Patients on low-dose had a better longevity with significantly longer RMAA, 89.1 years, versus standard-dose RMAA of 83.8 years (∆ = 5.3 years, P = .003, logrank P = .025). In a subgroup analysis by age at start of enzalutamide, <75 versus ≥75 years old, longevity was also better with low-dose in younger patients (∆ = 2.9 years, P = .034, and older, ∆ = 3.3 years, P = .011). CONCLUSION The longevity advantage and reduced adverse events seen in patients with prostate cancer treated with low-dose enzalutamide warrants further investigation.
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Affiliation(s)
- Vincent Vinh-Hung
- Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | | | - Gilles Natchagande
- Centre National Hospitalier Universitaire Hubert K. MAGA, Cotonou, Benin
| | - Paul Sargos
- Département de radiothérapie, Institut Bergonié, Bordeaux, France
| | - Ming Yin
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Edmund Folefac
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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Gorobets O, Keam B, Vinh-Hung V, Nguyen N. OP13 Gini's mean difference comparing lymph node classifications in de novo metastatic breast cancer. ESMO Open 2022. [DOI: 10.1016/j.esmoop.2022.100698] [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: 12/31/2022] Open
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9
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Nguyen NP, Kim L, Thariat J, Baumert BG, Mazibuko T, Gorobets O, Vinh-Hung V, Giap H, Mehmood T, Vincent F, Chi A, Basu T, Loganadane G, Mohammadianpanah M, Karlsson U, Oboite E, Oboite J, Ali A, Page BR. Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2022; 14:5285. [PMID: 36358703 PMCID: PMC9654379 DOI: 10.3390/cancers14215285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
The standard of care for locally advanced head and neck cancer is concurrent chemoradiation or postoperative irradiation with or without chemotherapy. Surgery may not be an option for older patients (70 years old or above) due to multiple co-morbidities and frailty. Additionally, the standard chemotherapy of cisplatin may not be ideal for those patients due to oto- and nephrotoxicity. Though carboplatin is a reasonable alternative for cisplatin in patients with a pre-existing hearing deficit or renal dysfunction, its efficacy may be inferior to cisplatin for head and neck cancer. In addition, concurrent chemoradiation is frequently associated with grade 3-4 mucositis and hematologic toxicity leading to poor tolerance among older cancer patients. Thus, a new algorithm needs to be developed to provide optimal local control while minimizing toxicity for this vulnerable group of patients. Recently, immunotherapy with check point inhibitors (CPI) has attracted much attention due to the high prevalence of program death-ligand 1 (PD-L1) in head and neck cancer. In patients with recurrent or metastatic head and neck cancer refractory to cisplatin-based chemotherapy, CPI has proven to be superior to conventional chemotherapy for salvage. Those with a high PD-L1 expression defined as 50% or above or a high tumor proportion score (TPS) may have an excellent response to CPI. This selected group of patients may be candidates for CPI combined with modern radiotherapy techniques, such as intensity-modulated image-guided radiotherapy (IM-IGRT), volumetric arc therapy (VMAT) or proton therapy if available, which allow for the sparing of critical structures, such as the salivary glands, oral cavity, cochlea, larynx and pharyngeal muscles, to improve the patients' quality of life. In addition, normal organs that are frequently sensitive to immunotherapy, such as the thyroid and lungs, are spared with modern radiotherapy techniques. In fit or carefully selected frail patients, a hypofractionated schedule may be considered to reduce the need for daily transportation. We propose a protocol combining CPI and modern radiotherapy techniques for older patients with locally advanced head and neck cancer who are not eligible for cisplatin-based chemotherapy and have a high TPS. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Lyndon Kim
- Department of Neurology, Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA
| | | | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland
| | - Thandeka Mazibuko
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Olena Gorobets
- Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, 97213 Le Lamentin Martinique, France
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, 98716 Pirae, Tahiti, French Polynesia
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System-Lawrenceburg, Lawrenceburg, TN 38464, USA
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing 101149, China
| | - Trinanjan Basu
- Department of Radiation Oncology, HCG Cancer Center Borivali, and HCG ICS, Mumbai, Maharashtra 400092, India
| | | | | | - Ulf Karlsson
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Ahmed Ali
- Department of Hematology Oncology, Howard University, Washington, DC 20059, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21093, USA
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10
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Vinh-Hung V, Gorobets O, Duerinkcx A, Dutta S, Oboite E, Oboite J, Ali A, Mazibuko T, Karlsson U, Chi A, Lehrman D, Mohammed OH, Mohammadianpanah M, Loganadane G, Migliore N, Vasileiou M, Nguyen NP, Giap H. Is immunotherapy at reduced dose and radiotherapy for older patients with locally advanced non-small lung cancer feasible?—a narrative review by the international geriatric radiotherapy group. Transl Cancer Res 2022; 11:3298-3308. [PMID: 36237270 PMCID: PMC9552052 DOI: 10.21037/tcr-22-821] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022]
Abstract
Background and Objective The standard of care for locally advanced non-small cell lung cancer (NSCLC) is either surgery followed by adjuvant chemotherapy with or without radiotherapy or concurrent chemotherapy and radiotherapy. However, older patients (70 years old or above) with multiple co-morbidities may not be able to tolerate the combined treatment due to its toxicity. Since lung cancer prevalence increases significantly with age, a new algorithm needs to be investigated to allow curative treatment for those with locally advanced disease. Methods A literature search of the literature was conducted through PubMed and Google Scholar using search terms such as locally advanced NSCLC, older cancer patients, immunotherapy with check point inhibitors (CPI), and image-guided radiotherapy (IGRT). Abstracts were screened, full articles fitting the article topic were reviewed, and duplicated and non-English articles were excluded. Key Content and Findings Recently, CPI has been introduced and proven effective for selected patients with increased program death ligand 1 (PD-L1) expression (50% or above). A reduced dose for CPI (RDCPI) may be as effective as a full dose and may decrease treatment cost. New radiation technique such as IGRT may also minimize radiotherapy complication through normal lung and cardiac sparing. Conclusions IGRT and RDCPI may be an innovative option for older patients with locally advanced NSCLC and high PD-L1 expression and needs to be investigated in future prospective studies.
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Affiliation(s)
- Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, Papeete, Tahiti, French Polynesia
| | - Olena Gorobets
- Department of Oral Surgery, Centre Hospitalier Universitaire de Martinique, Le Lamentin, Martinique, France
| | - Andre Duerinkcx
- Department of Radiology, Howard University, Washington DC, USA
| | - Suresh Dutta
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington DC, USA
| | | | - Joan Oboite
- Department of Radiology, Howard University, Washington DC, USA
| | - Ahmed Ali
- Department of Radiology, Howard University, Washington DC, USA
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington DC, USA
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington DC, USA
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - David Lehrman
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington DC, USA
| | | | - Mohammad Mohammadianpanah
- Department of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Natalia Migliore
- Barretos School of Health Sciences Dr. Paulo Prata, Barretos, Sao Paulo, Brazil
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nam P. Nguyen
- Department of Radiology, Howard University, Washington DC, USA
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
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11
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Perrin J, Farid K, Van Parijs H, Gorobets O, Vinh-Hung V, Nguyen NP, Djassemi N, De Ridder M, Everaert H. Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis. World J Clin Oncol 2022; 13:287-302. [PMID: 35582655 PMCID: PMC9052070 DOI: 10.5306/wjco.v13.i4.287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) scan for determining overall survival (OS) in breast cancer (BC) patients is controversial.
AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years.
METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008. PET positivity was determined by anatomical region of interest (AROI) findings for breast and axillary, sternal, and distant sites. The prognostic role of PET was examined as a qualitative binary factor (positive vs negative status) and as a continuous variable [maximum standard uptake value (SUVmax)] in multivariate survival analyses using Cox proportional hazards models. Among the 104 identified patients who received PET, 36 were further analyzed for the SUVmax in the AROI.
RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary (P = 0.033), sternal (P = 0.033), and combined PET-axillary/sternal (P = 0.008) nodes. Poor disease-free survival was associated with PET-positive axillary status (P = 0.040) and combined axillary/sternal status (P = 0.023). Cox models confirmed the long-term prognostic value of combined PET-axillary/sternal status [hazard ratio (HR): 3.08, 95% confidence interval: 1.42-6.69]. SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25 (P = 0.048) and 1.54 (P = 0.029), corresponding to relative increase in the risk of death of 25% and 54% per SUVmax unit, respectively. In addition, the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor (P = 0.027), with 1.94 HR, indicating a two-fold relative increase of mortality risk.
CONCLUSION Preoperative PET is valuable for prediction of long-term survival. Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.
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Affiliation(s)
- Justine Perrin
- Nuclear Medicine, CHU de Martinique, Fort-de-France 97200, Martinique
| | - Karim Farid
- Nuclear Medicine, CHU de Martinique, Fort-de-France 97200, Martinique
| | | | - Olena Gorobets
- Head and Neck Surgery, CHU de Martinique, Fort-de-France 97200, Martinique
| | - Vincent Vinh-Hung
- Department of Radiotherapy, UZ Brussel, Brussels 1090, Belgium
- Department of Radiotherapie, Centre Hospitalier de Polynésie française, Papeete 98713, Tahiti, French Polynesia
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20060, United States
| | - Navid Djassemi
- Department of Pediatry, Hackensack University Medical Center, Hackensack, NJ 07601, United States
- Rady Children's Hospital, University of California San Diego, San Diego, CA 92123, United States
| | - Mark De Ridder
- Department of Radiotherapy, UZ Brussel, Brussels 1090, Belgium
| | - Hendrik Everaert
- Department of Nuclear Medicine, UZ Brussel, Brussels 1090, Belgium
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12
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Van Parijs H, Vinh-Hung V, Fontaine C, Storme G, Verschraegen C, Nguyen DM, Adriaenssens N, Nguyen NP, Gorobets O, De Ridder M. Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer. BMC Cancer 2021; 21:1177. [PMID: 34736429 PMCID: PMC8569957 DOI: 10.1186/s12885-021-08916-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Long-term prospective patient-reported outcomes (PRO) after breast cancer adjuvant radiotherapy is scarce. TomoBreast compared conventional radiotherapy (CR) with tomotherapy (TT), on the hypothesis that TT might reduce lung-heart toxicity. Methods Among 123 women consenting to participate, 64 were randomized to CR, 59 to TT. CR delivered 50 Gy in 25 fractions/5 weeks to breast/chest wall and regional nodes if node-positive, with a sequential boost (16 Gy/8 fractions/1.6 weeks) after lumpectomy. TT delivered 42 Gy/15 fractions/3 weeks to breast/chest wall and regional nodes if node-positive, 51 Gy simultaneous-integrated-boost in patients with lumpectomy. PRO were assessed using the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30. PRO scores were converted into a symptom-free scale, 100 indicating a fully symptom-free score, 0 indicating total loss of freedom from symptom. Changes of PRO over time were analyzed using the linear mixed-effect model. Survival analysis computed time to > 10% PRO-deterioration. A post-hoc cardiorespiratory outcome was defined as deterioration in any of dyspnea, fatigue, physical functioning, or pain. Results At 10.4 years median follow-up, patients returned on average 9 questionnaires/patient, providing a total of 1139 PRO records. Item completeness was 96.6%. Missingness did not differ between the randomization arms. The PRO at baseline were below the nominal 100% symptom-free score, notably the mean fatigue-free score was 64.8% vs. 69.6%, pain-free was 75.4% vs. 75.3%, and dyspnea-free was 84.8% vs. 88.5%, in the TT vs. CR arm, respectively, although the differences were not significant. By mixed-effect modeling on early ≤2 years assessment, all three scores deteriorated, significantly for fatigue, P ≤ 0.01, without effect of randomization arm. By modeling on late assessment beyond 2 years, TT versus CR was not significantly associated with changes of fatigue-free or pain-free scores but was associated with a significant 8.9% improvement of freedom from dyspnea, P = 0.035. By survival analysis of the time to PRO deterioration, TT improved 10-year survival free of cardiorespiratory deterioration from 66.9% with CR to 84.5% with TT, P = 0.029. Conclusion Modern radiation therapy can significantly improve long-term PRO. Trial registration Trial registration number ClinicalTrials.govNCT00459628, April 12, 2007 prospectively. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08916-z.
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Affiliation(s)
- Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium
| | - Vincent Vinh-Hung
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium. .,Centre Hospitalier Universitaire (CHU) de Martinique, Fort-de-France, France.
| | - Christel Fontaine
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium
| | | | - Dung M Nguyen
- School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
| | - Nele Adriaenssens
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium
| | | | - Olena Gorobets
- Centre Hospitalier Universitaire (CHU) de Martinique, Fort-de-France, France.,Ukrainian Military Medical Academy, Kiev, Ukraine
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090, Brussels, Belgium
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13
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Keam B, Gorobets O, Vinh-Hung V, Im SA. Lymph Node Ratio after Neoadjuvant Chemotherapy for Stage II/III Breast Cancer: Prognostic Value Measured with Gini's Mean Difference of Restricted Mean Survival Times. Cancer Inform 2021; 20:11769351211051675. [PMID: 34671180 PMCID: PMC8521726 DOI: 10.1177/11769351211051675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
Restricted mean survival time (RMST), recommended for reporting survival, lacks a tool to evaluate multilevel factors. The potential of the Gini’s mean difference of RMSTs (Δ) is explored in a comparison of a lymph node ratio-based classification (LNRc) versus a number-based classification (ypN) applied to stage II/III breast cancer patients who received neoadjuvant chemotherapy and underwent axillary dissection. Number of positive nodes (npos) classified patients into ypN0, npos = 0, ypN1, npos = [1,3], ypN2, npos = [4,9], and ypN3, npos ⩾ 10. Ratio npos/(number of nodes examined) of 0, (0,0.20], (0.20,0.65], and >0.65, classified patients into Lnr0 to Lnr3, respectively. Unadjusted and Cox-adjusted RMSTs were computed for the ypN and LNRc’s. At a follow-up time horizon of 72 months for 114 node-negative and 254 node-positive patients, unadjusted ypN0-ypN3 RMSTs were 62.4-41.4 months, Δ = 11.9 months (95%CI: 7.4-16.9), and Lnr0-Lnr3 62.4 to 36.3 months, Δ = 14.0 months (95%CI: 10.1-18.1). Cox models’ ypN1-ypN3 hazard ratios were 1.81-3.30, and Lnr1-Lnr3 1.52-4.39. Δ from Cox-fitted survival were ypN 8.1 months (95%CI: 5.9-10.5), LNRc 10.5 months (95%CI: 8.4-12.8). In conclusion, Gini’s mean difference is applicable to well established data in keeping with the literature on LNRc. It provides an alternative view on the improvement gained with a lymph node ratio-classification over using a number-classification.
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Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Olena Gorobets
- University Hospital of Martinique, Fort-de-France, Martinique, France
| | - Vincent Vinh-Hung
- University Hospital of Martinique, Fort-de-France, Martinique, France.,Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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14
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Wang X, Fargier-Bochaton O, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, Nguyen NP, Miralbell R, Vinh-Hung V. Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis. Strahlenther Onkol 2021; 197:317-331. [PMID: 33416915 PMCID: PMC7987627 DOI: 10.1007/s00066-020-01731-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. METHODS Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients' characteristics and their respective penalty scores. RESULTS Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6-70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). CONCLUSION Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.
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Affiliation(s)
- Xinzhuo Wang
- Radiation Oncology, Tianjin Union Medical Center, 300121 Tianjin, China
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | | | - Giovanna Dipasquale
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | - Mohamed Laouiti
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
- Service de radio-oncologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Melpomeni Kountouri
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
- Proton Therapy Centre, Quirónsalud, Madrid, Spain
- Institut Oncològic Teknon (IOT), Barcelona, Spain
| | - Vincent Vinh-Hung
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland
- CHU de Martinique, Fort-de-France, Martinique, France
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15
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Vinh-Hung V, Natchagande G, Joachim C, Gorobets O, Drame M, Bougas S, Folefac E, Nguyen NP, Verschraegen C, Yin M. Low-Dose Enzalutamide in Late-Elderly Patients (≥ 75 Years Old) Presenting With Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2020; 18:e660-e668. [DOI: 10.1016/j.clgc.2020.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
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16
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Vinh-Hung V, Wang X, Dipasquale G, Fargier-Bochaton O, Kountouri M, Laouiti M, Gorobets O, Miralbell R. Application Of The Mean Absolute Dose Deviation To The Dosimetric Gain Analysis Of Left Whole Breast Radiotherapy By Prone-Free Breathing Versus Supine-Deep Inspiration Breath Hold (DiBH). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.201] [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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17
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Heymann S, Dipasquale G, Nguyen NP, San M, Gorobets O, Leduc N, Verellen D, Storme G, Van Parijs H, De Ridder M, Vinh-Hung V. Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score. Technol Cancer Res Treat 2020; 19:1533033820947759. [PMID: 32940569 PMCID: PMC7502852 DOI: 10.1177/1533033820947759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: A 2-level factorial pilot study was conducted in 2007 just before starting a randomized clinical trial comparing tomotherapy and conventional radiotherapy (CR) to reduce cardiac and pulmonary adverse effects in breast cancer, considering tumor laterality (left/right), target volume (with/without nodal irradiation), surgery (tumorectomy/mastectomy), and patient position (prone/supine). The study was revisited using a penalty score based on the recently developed mean absolute dose deviation (MADD). Methods: Eight patients with a unique combination of laterality, nodal coverage, and surgery underwent dual tomotherapy and CR treatment planning in both prone and supine positions, providing 32 distinct combinations. The penalty score was applied using the weighted sum of the MADDs. The Lenth method for unreplicated 2-level factorial design was used in the analysis. Results: The Lenth analysis identified nodal irradiation as the active main effect penalizing the dosimetry by 1.14 Gy (P = 0.001). Other significant effects were left laterality (0.94 Gy), mastectomy (0.61 Gy), and interactions between left mastectomy (0.89 Gy) and prone mastectomy (0.71 Gy), with P-values between 0.005 and 0.05. Tomotherapy provided a small reduction in penalty (reduction of 0.54 Gy) through interaction with nodal irradiation (P = 0.080). Some effects approached significance with P-values > 0.05 and ≤ 0.10 for interactions of prone × mastectomy × left (0.60 Gy), nodal irradiation × mastectomy (0.59 Gy), and prone × left (0.55 Gy) and the main effect prone (0.52 Gy). Conclusions: The historical dosimetric analysis previously revealed the feasibility of tomotherapy, but a conclusion could not be made. The MADD-based score is promising, and a new analysis highlights the impact of factors and hierarchy of priorities that need to be addressed if major gains are to be attained.
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Affiliation(s)
| | | | - Nam P Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, USA
| | - Meymey San
- Khmer Soviet Friendship Hospital, Cambodia
| | - Olena Gorobets
- University Hospital of Martinique, Site Clarac, Martinique, France
| | - Nicolas Leduc
- University Hospital of Martinique, Site Clarac, Martinique, France
| | - Dirk Verellen
- Medical Physics, Faculty of Medicine and Health Sciences, Iridium Kankernetwerk and University of Antwerp, Wilrijk, Belgium.,Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- University Hospital of Martinique, Site Clarac, Martinique, France.,Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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