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Paulson K, Logie N, Han G, Tilley D, Menon G, Menon A, Nelson G, Phan T, Murray B, Ghosh S, Pearcey R, Huang F, Wiebe E. Adjuvant Radiotherapy in Stage II Endometrial Cancer: Selective De-intensification of Adjuvant Treatment. Clin Oncol (R Coll Radiol) 2023; 35:e94-e102. [PMID: 36150980 DOI: 10.1016/j.clon.2022.08.034] [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: 02/11/2022] [Revised: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
AIMS Risk stratification, including nodal assessment, allows for selective de-intensification of adjuvant radiotherapy in stage II endometrial cancer. Patterns of treatment and clinical outcomes, including the use of reduced volume 'mini-pelvis' radiotherapy fields, were evaluated in a population-based study. MATERIALS AND METHODS All patients diagnosed with pathological stage II endometrial cancer between 2000 and 2014, and received adjuvant radiotherapy in a regional healthcare jurisdiction were reviewed. Registry data were supplemented by a comprehensive review of patient demographics, disease characteristics and treatment details. The Charlson Comorbidity Score was calculated. Survival and recurrence data were analysed. RESULTS In total, 264 patients met the inclusion criteria. Most patients had endometrioid histology (83%); 41% of patients had International Federation of Gynecologists and Obstetricians grade 1 disease. Half (49%) had surgical nodal evaluation; 11% received chemotherapy. Most patients (59%) were treated with full pelvic radiotherapy fields ± brachytherapy. Seventeen per cent of patients received mini-pelvis radiotherapy ± brachytherapy, whereas 24% received brachytherapy alone. Five-year recurrence-free survival was 87% for the entire cohort, with no significant difference by adjuvant radiotherapy approach. Only one patient receiving mini-pelvis radiotherapy ± brachytherapy recurred in the pelvis but outside of the mini-pelvis field. Recorded late toxicity rates were highest for full pelvis radiotherapy + brachytherapy. CONCLUSION Risk stratification in a real-world setting allowed for selective de-intensification of adjuvant radiation with equivalent outcomes for stage II endometrial cancer. Mini-pelvis radiotherapy combined with brachytherapy is effective in highly selected patients, with the potential to decrease toxicity without compromising local control. Brachytherapy should be considered in low-risk stage II patients.
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Affiliation(s)
- K Paulson
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - N Logie
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - G Han
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - D Tilley
- Cancer Control, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
| | - G Menon
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - A Menon
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - G Nelson
- Cancer Control, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
| | - T Phan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - B Murray
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - S Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - R Pearcey
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - F Huang
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - E Wiebe
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
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Yang F, Ghosh S, Yee D, Patel S, Parliament M, Usmani N, Danielson B, Amanie J, Pearcey R, Pederson J, Murtha A. Conventional vs. Hypofractionation Radiation for High-Risk Prostate Cancer Patients (CHIRP): 24 Months Patient-Reported Quality of Life Outcomes of the Randomized Phase II CHIRP Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dinakaran D, Baker S, Ghila A, Jin Z, Warkentin B, Moore R, Hendzel M, Fallone G, Pearcey R. Effect of Magnetic Field During Radiotherapy on Double-Strand DNA Breaks and Cell Proliferation on Prostate, Cervical, and Breast Cancer Cells. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1094] [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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Paulson K, Logie N, Han G, Tilley D, Menon G, Phan T, Nelson G, Murray B, Ghosh S, Pearcey R, Huang F, Wiebe E. Patterns of Recurrence By Adjuvant Radiation Therapy Type for Stage II Endometrial Cancer: A Provincial Review. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1771] [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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Huang F, Dinakaran D, Wiebe E, Rose B, Read W, Pearcey R, Menon G. Intracavitary/Interstitial MR-Based Cervix Brachytherapy: First Look at Implant Quality. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wang M, Hwang M, Ghosh S, Severin D, Nijjar T, Chu K, Gabos Z, Debenham B, Yee D, Tankel K, Roa W, Pearcey R, Joseph K, Danielson B, Fairchild A. Documentation of Driving Recommendations for Patients Receiving Whole Brain Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Logie N, Paulson K, Ghosh S, Murray B, Menon G, Pearcey R, Huang F, Wiebe E. Patterns of Recurrence Following “Minipelvis” Radiation Therapy for Pathological STAGE II Endometrial Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jastaniyah N, Murray B, Wachowicz K, Yahya A, Pearcey R. EP-1659: An observatory study of organ motion in patients with cervical cancer using cinematic-magnetic resonance imaging. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31777-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Amanie J, Jans HS, Wuest M, Pervez N, Murtha A, Usmani N, Yee D, Pearcey R, Danielson B, Patel S, Macewan R, Field C, Robinson D, Wilson J, Lewis D, Parliament M, McEwan AJB. Analysis of intraprostatic therapeutic effects in prostate cancer patients using [(11)C]-choline pet/ct after external-beam radiation therapy. ACTA ACUST UNITED AC 2013; 20:104-10. [PMID: 23559873 DOI: 10.3747/co.20.1217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The objective of the present study was to analyze, with relatively high sensitivity and specificity, uptake properties of [(11)C]-choline in prostate cancer patients by means of positron-emission tomography (pet)/computed tomography (ct) imaging using objectively defined pet parameters to test for statistically significant changes before, during, and after external-beam radiation therapy (ebrt) and to identify the time points at which the changes occur. METHODS The study enrolled 11 patients with intermediate-risk prostate cancer treated with ebrt, who were followed for up to 12 months after ebrt. The [(11)C]-choline pet scans were performed before treatment (baseline); at weeks 4 and 8 of ebrt; and at 1, 2, 3, 6, and 12 months after ebrt. RESULTS Analysis of [(11)C]-choline uptake in prostate tissue before treatment resulted in a maximum standardized uptake value (suvmax) of 4.0 ± 0.4 (n = 11) at 40 minutes after injection. During week 8 of ebrt, the suvmax declined to 2.9 ± 0.1 (n = 10, p < 0.05). At 2 and 12 months after ebrt, suvmax values were 2.3 ± 0.3 (n = 10, p < 0.01) and 2.2 ± 0.2 (n = 11, p < 0.001) respectively, indicating that, after ebrt, maximum radiotracer uptake in the prostate was significantly reduced. Similar effects were observed when analyzing the tumour:muscle ratio (tmr). The tmr declined from 7.4 ± 0.6 (n = 11) before ebrt to 6.1 ± 0.4 (n = 11, nonsignificant) during week 8 of ebrt, to 5.6 ± 0.03 (n = 11, p < 0.05) at 2 months after ebrt, and to 4.4 ± 0.4 (n = 11, p < 0.001) at 12 months after ebrt. CONCLUSIONS Our study demonstrated that intraprostatic [(11)C]-choline uptake in the 11 analyzed prostate cancer patients significantly declined during and after ebrt. The pet parameters SUVmax and tmr also declined significantly. These effects can be detected during radiation therapy and up to 1 year after therapy. The prognostic value of these early and statistically significant changes in intraprostatic [(11)C]-choline pet avidity during and after ebrt are not yet established. Future studies are indicated to correlate changes in [(11)C]-choline uptake parameters with long-term biochemical recurrence to further evaluate [(11)C]-choline pet changes as a possible, but currently unproven, biomarker of response.
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Affiliation(s)
- J Amanie
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
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Pervez N, Krauze AV, Yee D, Parliament M, Mihai A, Ghosh S, Joseph K, Murtha A, Amanie J, Kamal M, Pearcey R. Quality-of-life outcomes in high-risk prostate cancer patients treated with helical tomotherapy in a hypofractionated radiation schedule with long-term androgen suppression. ACTA ACUST UNITED AC 2012; 19:e201-10. [PMID: 22670110 DOI: 10.3747/co.19.915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We examined the impact of hypofractionated radiation therapy and androgen suppression therapy (AST) on quality of life (QOL) in high-risk prostate cancer patients. METHODS Between March 2005 and March 2007, 60 patients with high-risk prostate cancer were enrolled in a prospective phase ii study. All patients received 68 Gy (2.72 Gy per fraction) to the prostate gland and 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes in 25 fractions over 5 weeks. Of the 60 patients, 58 received ast. The University of California-Los Angeles Prostate Cancer Index questionnaire was used to prospectively measure QOL at baseline (month 0) and at 1, 6, 12, 18, 24, 30, and 36 months after radiation treatment. The generalized estimating equation approach was used to compare the QOL scores at 1, 6, 12, 18, 24, 30, and 36 months with those at baseline. RESULTS We observed a significant decrease in QOL items related to bowel and sexual function. Several QOL items related to bowel function were significantly adversely affected at both 1 and 6 months, with improvement toward 6 months. Although decreased QOL scores persisted beyond the 6-month mark, they began to re-approach baseline at the 18- to 24-month mark. Most sexual function items were significantly adversely affected at both 1 and 6 months, but the effects were not considered to be a problem by most patients. A complete return to baseline was not observed for either bowel or sexual function. Urinary function items remained largely unaffected, with overall urinary function being the only item adversely affected at 6 months, but not at 1 month. Urinary function returned to baseline and remained unimpaired from 18 months onwards. CONCLUSIONS In our study population, who received hypofractionated radiation delivered using dynamic intensity-modulated radiotherapy with inclusion of the pelvic lymph nodes, and 2-3 years of ast prescription, QOL with respect to bowel and sexual function was significantly affected; QOL with respect to urinary function was largely unaffected. Our results are comparable to those in other published studies.
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Affiliation(s)
- N Pervez
- Radiation Oncology, Cross Cancer Institute, Edmonton, AB.
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Menon G, Sloboda R, Ghosh S, Dundas G, Pearcey R, Huang F. Sci-Sat AM: Brachy - 08: MRI-guided planning and maximum achievable HR-CTV doses in cervix brachytherapy. Med Phys 2012; 39:4646. [DOI: 10.1118/1.4740215] [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: 11/07/2022] Open
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Menon G, Sloboda R, Dundas G, Pearcey R, Read W. Maximum HR-CTV Doses Achievable in MR-Guided Intracavitary Brachytherapy for Cervix Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1001] [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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Drodge S, Pervez N, Ghosh S, Mackenzie M, Yee D, Mihai A, Murtha A, Amanie J, Fallone G, Pearcey R. Late Toxicity in High-risk Prostate Cancer Treated with Androgen Suppression and Hypofractionated Intensity Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wu J, Skarsgard D, El-Gayed A, Pervez N, Tai P, Brasher P, Sia M, Robinson J, Joseph K, Pearcey R. 4-Year Outcomes of Hypofractionated Image-Guide Radiotherapy (55 Gy/16 fractions/4 weeks) for Low and Intermediate Risk Prostate Cancer: A Multicenter Study. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Cuartero J, Eiriksson L, Steed H, Dundas G, Danielson B, Capstick V, Schepansky A, Zhu Q, Pearcey R. Outcomes of Adjuvant Intracavitary Brachytherapy Alone in Surgically Staged I/II, Grade 3 Endometrial Adenocarcinoma: The Cross Cancer Institute Experience from 1995 to 2006. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Amanie J, McEwan A, Parliament M, Postema E, Jans HS, Pearcey R, Pervez N, Murtha A, Usmani N, Yee D. 75 PRELIMINARY REPORT OF PROSTATE PET IMAGING USING 11C – CHOLINE BEFORE, DURING AND AFTER RADIOTHERAPY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Danielson B, Pearcey R, Bass B, Pickles T, Owen J, Brundgae M, Mackillop W. 198 A FRAMEWORK FOR MEASURING QUALITY OF CARE: AN ILLUSTRATION IN PROSTATE CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72585-9] [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: 11/30/2022]
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Chowdhury R, Field C, Dundas G, Pervez N, MacKenzie M, Fallone G, Pearcey R. 159 THE FEASIBILITY AND IMPACT OF INCREASING THE EXTERNAL BEAM COMPONENT OF RADIATION THERAPY (RT) IN CERVIX CANCER PATIENTS USING DYNAMIC HELICAL IMRT, PLANNED WITH MRI/CT FUSION. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Danielson B, Winget M, Gao Z, Murray B, Pearcey R. Palliative Radiotherapy for Women with Breast Cancer. Clin Oncol (R Coll Radiol) 2008; 20:506-12. [DOI: 10.1016/j.clon.2008.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 02/18/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
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Small C, Chowdhury R, Mackenzie M, Fallone G, Pearcey R, Pervez N. Is the Dose We See the Dose We Get? Analysis of DVHs using Daily Tomotherapy Based MVCT Contouring of Prostate, Bladder and Rectum, to Assess the Actual Dose Received during Treatment as Opposed to Planned DVH. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1139] [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: 10/21/2022]
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Le D, Pervez N, Parliament M, Yee D, Amanie J, Mihai A, Murtha A, Field G, Fallone G, Pearcey R. Interfractional and Intrafractional Movement of the Prostate Gland Assessed with MVCT. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chowdhury R, Small C, Mackenzie M, Pearcey R, Pervez N. Changes in 3T-MRI Prostate Volumes in High Risk Prostate Cancer Treated with Hypofractionated Radiation using Dynamic IMRT and Varying Hormonal Therapy Duration. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1173] [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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Pervez N, Pearcey R, Parliament M, Yee D, Amanie J, Murtha A, Wachowicz K, Field C, Mackenzie M, Fallone G. Acute Toxicity Results Using Dynamic Intensity Modulated Radiotherapy (dIMRT) in High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1463] [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: 10/22/2022]
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Le D, Pervez N, Parliament M, Yee D, Amanie J, Mihai A, Murtha A, Field G, Fallone G, Pearcey R. Daily Movement of Prostate Gland and Seminal Vesicles Assessed With Megavoltage CT in Patients Undergoing Hypofractionated/Dose Escalated Conformal Treatment by Tomotherapy for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1473] [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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Yee D, Pearcey R, Dundas G, Hanson J, Mackenzie M, Robinson D, Underwood L, Field C, Urtasun R, Pervez N, Fallone G. 170 Comparison of tomotherapy versus four-field pelvic box altered fractionation radiotherapy treatment plans for locally advanced squamous cell carcinoma of the cervix. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Braithwaite L, Wu J, Karachewsky R, Skarsgard D, El-Gayedz A, Pearcey R, Joseph K, Newcomb C. 189 Accuracy and variability of image-guided radiotherapy during hypofractionated treatment for prostate cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80930-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miao G, Pearcey R, Mackillop W. 197 The impact of adoption of concurrent, cisplatin-based chemo-radiotherapy on the outcome of cervical cancer in ontario: A population-based cohort study. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Field C, MacKenzie M, Rathee S, Murray B, Robinson D, Abdulkarim B, Dundas G, Murtha A, Parliament M, Pearcey R, Pervez N, Roa W, Scrimger R, Severin D, Sinha R, Urtasun R, van Vulpen M, Yee D, Fallone G. 197 Introduction of image-guided adaptive radiotherapy techniques. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pervez N, Pearcey R, Dundas G, Mackenzie M, Sinha R, Urtasun R, Yee D, Fields C, Halls S, Rivest R, Syme A, Fallone G. Image Fusion and Tomotherapy Treatment Planning for ca. Cervix. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.591] [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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Wu J, Skarsgardz D, Pearcey R, Cadman P, Murray B, Newcomb C. 124 Early experience of a multicentre phase i/11 study of hypofractionated radiotherapy (55 Gy/16 fractions/4 weeks) for localized prostate cancer. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pervez N, Pearcey R, Mackenzie M, Halls S, Dundas G, Wachowicz K, Rivest R, Fallone G. 47 Tomotherapy Treatment Planning Improves Therapeutic Ratio Using 3T MRI Imaging in Cervical Cancer. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80208-7] [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: 11/30/2022]
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Pearcey R, Brundage M, Drouin P, Jeffrey J, Johnston D, Lukka H, MacLean G, Souhami L, Stuart G, Tu D. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 2002; 20:966-72. [PMID: 11844818 DOI: 10.1200/jco.2002.20.4.966] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To test the hypothesis that cisplatin (CDDP) administered concurrently with standard radiotherapy (RT) would improve pelvic control and survival in patients with advanced squamous cell cancer of the cervix. PATIENTS AND METHODS A total of 259 patients with International Federation of Gynecology and Obstetrics stage IB to IVA squamous cell cervical cancer with central disease greater-than-or-equal 5 cm or histologically confirmed pelvic lymph node involvement were randomized to receive RT (external-beam RT plus brachytherapy) plus weekly CDDP chemotherapy (40 mg/m(2)) (arm 1) or the same RT without chemotherapy (arm 2). RESULTS A total of 253 patients were available for analysis. Median follow-up was 82 months. No significant difference was found in progression-free survival (P =.33). No significant difference in 3- and 5-year survival rates was found (69% v 66% and 62% v 58%, respectively; P =.42). The hazard ratio for survival (arm 2 to arm 1) was 1.10 (95% confidence interval, 0.75 to 1.62). CONCLUSION This study did not show a benefit to either pelvic control or survival by adding concurrent weekly CDDP chemotherapy in a dose of 40 mg/m(2) to radical RT as given in this trial. Careful attention to RT details is important for achieving optimum outcome for patients with this disease.
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Affiliation(s)
- R Pearcey
- Department of Oncology, University of Alberta, Edmonton, Canada.
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Abstract
PURPOSE To analyze the impact of pathology review in gynecologic malignancies. METHODS AND MATERIALS For all new gynecologic patients seen between December 2, 1993 and January 4, 1996, we conducted a retrospective chart review to determine if a pathology review by the institute's consultant pathologist changed the diagnosis, and if so whether the change altered patient management. A total of 514 patients were seen, of whom 120 had cervical cancer, 226 had endometrial cancer, 122 had a primary ovarian or peritoneal malignancy, 9 had a vaginal malignancy, 28 had vulvar cancer, and 9 had a miscellaneous gynecologic malignancy. RESULTS On pathology review the diagnosis changed for 200 of 599 specimens (33%). This altered management for 63 of 514 patients (12%). For patients with cervical cancer, the grade of tumor was the main change in pathologic diagnosis, with occasional change in the presence of lymph vascular invasion. These did not translate into patient management alterations. Eight patients (1.5%) had management alterations. The changes in depth of invasion and vascular invasion altered management for 3 patients. Changes in pap smears resulted in two management alterations, and changes in histologic diagnoses altered management for 3 cases. For endometrial primaries the changes in pathologic diagnosis included grade, depth of invasion, and the presence of cervical involvement. This did alter management in 40 cases (8%). For the ovarian malignancies, the main changes were grade, extent of disease, or histologic classification, some of which (10 patients, 2%) resulted in altered management. One patient with a vaginal lesion had the diagnosis changed, which did alter management. Of the patients diagnosed with vulvar cancer, the pathologic diagnosis changed for 11 patients. This included changes in grade and depth of invasion. This altered management of 2 patients. The remaining miscellaneous gynecologic malignancies had only two diagnosis changes that altered management. CONCLUSIONS Pathologic review of gynecologic malignancies is justified as it can alter patient management. In addition, the process facilitates cooperation of the multidisciplinary team and provides a valuable educational forum to enhance patient care.
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Affiliation(s)
- S Chafe
- Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada.
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Craighead PS, Pearcey R, Stuart G. A phase I/II evaluation of tirapazamine administered intravenously concurrent with cisplatin and radiotherapy in women with locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2000; 48:791-5. [PMID: 11020576 DOI: 10.1016/s0360-3016(00)00720-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This is a Phase I/II dose escalation study to determine the tolerable dose of tirapazamine (TPZ), and the toxicity of a regimen using TPZ with cisplatin, and radiotherapy in women with locally advanced cervical cancer. METHODS AND MATERIALS Eligible women for this study were those with a diagnosis of locally advanced cervix cancer, who were less than 75 years of age, having provided informed consent, and who had undergone the necessary prestudy investigations. External-beam radiotherapy (RT) was given to a minimum dose of 4500 cGy in 25 fractions (Day 1-35), and brachytherapy then delivered to bring the total dose at point A to 8500 cGy. The first dose level of the study used TPZ 190 mg/m(2) and cisplatin 75 mg/m(2) on Days 1, 15, and 29 of RT. TPZ 160 mg/m(2) alone was used on Days 8, 10, 12 and 22, 24, 26 of RT. A conventional dose-escalation step method was then used to determine the maximum tolerated dose (MTD) of TPZ. RESULTS Four patients were treated at Level 1, 6 at Level 2, and 5 at Level 3. Only 1 patient experienced a dose-limiting toxicity (DLT) at Level 2, but 2 of the 5 patients at Level 3 incurred DLTs. Level 2 was declared the MDT (TPZ 290 mg/m(2) on Days 1, 15, 29 and 220 mg/m(2) on Days 8, 10, 12 and 22, 24, 26). At 6 months, 13 of 15 patients had complete pelvic control of disease. CONCLUSION Level 2 of this regime was identified as the MDT. The use of TPZ with concurrent cisplatin and pelvic radiotherapy has acceptable toxicity and should be considered for further Phase 2 testing in view of the promising responses noted.
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Affiliation(s)
- P S Craighead
- Department of Oncology, University of Calgary, Alberta, Calgary, Canada.
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Macann AM, Britten RA, Poppema S, Pearcey R, Rosenberg E, Allalunis-Turner MJ, Murray D. DNA double-strand break rejoining in human follicular lymphoma and glioblastoma tumor cells. Oncol Rep 2000. [DOI: 10.3892/or.7.2.299] [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: 11/06/2022] Open
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Macann AM, Britten RA, Poppema S, Pearcey R, Rosenberg E, Allalunis-Turner MJ, Murray D. DNA double-strand break rejoining in human follicular lymphoma and glioblastoma tumor cells. Oncol Rep 2000; 7:299-303. [PMID: 10671675] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Follicle center cell lymphoma is among the most radioresponsive of human cancers. To assess whether this radioresponsiveness might be a result of a compromised ability of the tumor cells to accomplish the biologically-effective repair of DNA double-strand breaks (DSBs), we have measured i) the extent of the mechanical rejoining of radiation-induced DSBs in biopsy-derived follicle center cell lymphoma cells and ii) the fidelity with which nuclear protein extracts from these cells rejoin restriction enzyme-induced DSBs. Cell suspensions derived from two lymphoma biopsies, designated FCL1 and FCL2, as well as two established human glioblastoma cell lines, M059J and M059K, were exposed to 30 Gy of gamma-rays and evaluated for their ability to rejoin DSBs using a Southern transfer-pulsed-field gel electrophoresis assay. The fidelity of rejoining of restriction enzyme-induced DSBs was assessed using a cell-free plasmid reactivation assay. Both lymphoma suspensions rejoined DSBs relatively slowly and exhibited a similar phenotype to the known DSB-rejoining deficient M059J line. The level of DSB mis-rejoining in the cell-free plasmid reactivation assay was also similar in M059J and FCL2 cells and was considerably ( approximately 6-fold) higher than in M059K cells. Because of insufficient numbers of cells, we were unable to perform this assay with the FCL1 lymphoma. These limited data suggest that follicle center cell lymphoma cells may be intrinsically deficient in performing the biologically-effective rejoining of DSBs. Such a deficiency might contribute to the radioresponsiveness of this disease and may be exploitable in the development of improved treatment strategies, such as radioimmunotherapy.
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Affiliation(s)
- A M Macann
- Department of Oncology, The University of Alberta, Edmonton, Alberta, Canada
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Petereit DG, Pearcey R. Literature analysis of high dose rate brachytherapy fractionation schedules in the treatment of cervical cancer: is there an optimal fractionation schedule? Int J Radiat Oncol Biol Phys 1999; 43:359-66. [PMID: 10030262 DOI: 10.1016/s0360-3016(98)00387-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A literature review and analysis was performed to determine whether or not efficacious high dose rate (HDR) brachytherapy fractionation schedules exist for the treatment of cervical cancer. METHODS AND MATERIALS English language publications from peer reviewed journals were assessed to calculate the total contribution of dose to Point A from both the external and intracavitary portions of radiation for each stage of cervical cancer. Using the linear quadratic formula, the biologically effective dose to the tumor, using an alpha/beta = 10, was calculated to Point A (Gy10) in order to determine a dose response relationship for local control and survival. Significant complications were assessed by calculating the dose to the late-responding tissues at Point A using an alpha/beta = 3 (Gy3) as a surrogate for normal tissue tolerance, since few publications list the actual bladder and rectal doses. RESULTS For all stages combined, the median external beam fractionation schedule to Point A was 40 Gy in 20 fractions, while the median HDR fractionation schedule was 28 Gy in 4 fractions. For stages IB, IIB, and IIIB the median biologically effective dose to Point A (Gy10) was 96, 96 and 100 Gy10s, respectively. No correlation was identified between Point A BED (Gy10s) to either survival or pelvic control. A dose response relationship could also not be identified when correlating Point A Gy3s to complications. CONCLUSION A dose response relationship could not be identified for either tumor control nor late tissue complications. These findings do not necessarily question the validity of the linear quadratic model, as much as they question the quality of the current HDR brachytherapy literature as it is currently presented and reported. Most of the HDR publications report inadequate details of the dose fractionation schedules. Only a minority of publications report significant complications using the actuarial method. In the future, all HDR publications for the treatment of cervical cancer should provide accurate fractionation details for each stage of disease, while reporting actuarial complication rates. The optimal fractionation schedule for treating cervical cancer using HDR brachytherapy is still unknown, and presently can be based only on single institutions with significant experience.
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Affiliation(s)
- D G Petereit
- University of Wisconsin Medical School, Madison, USA
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Hodson DI, Bruera E, Eapen L, Groome P, Keane T, Larsson S, Pearcey R. The role of palliative radiotherapy in advanced head and neck cancer. Can J Oncol 1996; 6 Suppl 1:54-60. [PMID: 8853539] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The role of radiotherapy in the palliation of patients with advanced cancer of the head and neck is not clear. Several distinctive characteristics of advanced head and neck cancer contribute to the complexities in the choice of appropriate palliative management strategies. Palliative treatment may be the appropriate management for a proportion of patients with advanced disease, but the current stage groupings of head and neck cancer are not sufficient for use in the reliable identification of such a patient group. Controversy arises because of the difficulties in distinguishing patients who should be offered conventional treatment with curative intent from those appropriate for treatment with palliative intent. A structured review of the cancer and quality of life literature identified 298 references pertaining to palliative radiotherapy in head and neck cancer, 26 of which met the criteria for inclusion in this review. An expert panel discussed the literature, and concluded that insufficient information precluded estimations of the frequency, degree of, or duration of symptomatic relief that radiation offered to those patients not cured of their disease. Moreover, the currently available literature does not address the toxicity or appropriate dose and fractionation of palliative radiotherapy in this setting. Further studies are necessary to evaluate clinical endpoints appropriate to the use of radiotherapy in the palliative management of patients with advanced head and neck cancer. Studies are also needed to refine the current clinical classification of patients, allowing the identification of patients suitable for palliative management.
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Affiliation(s)
- D I Hodson
- Department of Radiation Oncology, Hamilton Regional Cancer Centre, McMaster University, Ontario
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Suit H, Allam A, Allalunis-Turner J, Brock W, Girinsky T, Hill S, Hunter N, Milas L, Pearcey R, Peters L. Is tumor cell radiation resistance correlated with metastatic ability? Cancer Res 1994; 54:1736-41. [PMID: 8137288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients who experience local failure following radiation treatment of epithelial malignancies exhibit a substantially higher rate of distant metastasis than those patients who achieve permanent local control. This fact has raised concern that the local failure to control the primary/regional tumor may serve as a marker of a particularly malignant neoplasm, i.e., high metastatic activity and radiation resistance. If this were true, there would be no gains in survival by increasing the efficacy of treating the primary/regional disease because the new local controls would develop distant metastasis. To investigate this concept, the relationship between distant metastasis probability and tumor cell radiation resistance has been studied by examining laboratory and clinical data (in vitro and in vivo assays) from six collaborating centers. TCD50s (radiation dose which inactivates half of the irradiated tumors) and incidence of distant metastasis in mice with local control have been evaluated for 24 murine tumor systems. SF2s (surviving fraction after 2 Gy) were determined in vitro for cell lines from 8 human, 13 mouse, and 15 rat tumors/tumor sublines and the metastatic activity assessed after injection of the cells into syngeneic murine hosts and xenogenic hosts for the human tumors. SF2s of cells from carcinomas of the head/neck, cervix, and endometrium which were controlled locally by radiation +/- surgery from four centers were compared for those which did and those which did not metastasize. The total number of patients studied was 222. The cumulative distributions of SF2s of locally controlled tumors which did and did not metastasize were not different in each of the data sets. Similarly, there was no demonstrable relationship between TCD50s and metastatic frequency in local control mice. Furthermore, the SF2s of murine and human tumor cell lines did not track with metastatic activity. Radiation sensitivity of clinical and laboratory tumors did not correlate with metastatic activity in studies of data from six centers.
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Affiliation(s)
- H Suit
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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Pearcey R, Dundas G, Schepansky A, Birchall I, Capstick V, MacLean G, Hugh J. 'Is there a role for adjuvant pelvic radiotherapy after radical hysterectomy in early stage cervical cancer?'. Int J Gynecol Cancer 1992; 2:56. [PMID: 11576236 DOI: 10.1046/j.1525-1438.1992.02010056.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Pearcey
- Cross Cancer Institute Northern Alberta Cancer Program 11560 University Avenue Edmonton Alberta Canada T6G 1Z2
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Abstract
Radiation-induced bladder and rectal complications are recognized complications of intracavitary therapy. In clinical studies the correlation between dose calculated and complications seen are inconsistent. The inconsistency is also present when utilizing the reference points recommended by the ICRU. We attempted to illustrate this inconsistency when looking at the bladder or rectum in intracavitary treatments. If reference points are inconsistent with maximum doses (which directly affect morbidity), their application is dubious.
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Affiliation(s)
- J Palmer
- Dept. of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
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Pearcey R, Calvert R, Mehta A. Disposition of ifosfamide in patients receiving ifosfamide infusion therapy for the treatment of cervical carcinoma. Cancer Chemother Pharmacol 1988; 22:353-5. [PMID: 3168149 DOI: 10.1007/bf00254245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The disposition of ifosfamide was investigated in nine patients receiving a total of 23 72-h infusions. There was no linear relationship between steady-state plasma concentrations and either vomiting or CNS toxicity. The steady-state plasma concentrations were reproducible within patients, but there was a wide variation between patients. The progress of the disease did not affect the disposition of ifosfamide.
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Affiliation(s)
- R Pearcey
- University Department of Radiotherapy, Cookridge Hospital, Leeds, UK
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