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Fischer GF, Brügge D, Andratschke N, Baumert BG, Bosetti DG, Caparrotti F, Herrmann E, Papachristofilou A, Rogers S, Schwyzer L, Zwahlen DR, Hundsberger T, Putora PM. Postoperative radiotherapy for meningiomas - a decision-making analysis. BMC Cancer 2022; 22:492. [PMID: 35509011 PMCID: PMC9066948 DOI: 10.1186/s12885-022-09607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background The management of meningiomas is challenging, and the role of postoperative radiotherapy is not standardized. Methods Radiation oncology experts in Swiss centres were asked to participate in this decision-making analysis on the use of postoperative radiotherapy (RT) for meningiomas. Experts from ten Swiss centres agreed to participate and provided their treatment algorithms. Their input was converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies in clinical routine. Results Several criteria used for decision-making in postoperative RT in meningiomas were identified: histological grading, resection status, recurrence, location of the tumour, zugzwang (therapeutic need to treat and/or severity of symptoms), size, and cell division rate. Postoperative RT is recommended by all experts for WHO grade III tumours as well as for incompletely resected WHO grade II tumours. While most centres do not recommend adjuvant irradiation for WHO grade I meningiomas, some offer this treatment in recurrent situations or routinely for symptomatic tumours in critical locations. The recommendations for postoperative RT for recurrent or incompletely resected WHO grade I and II meningiomas were surprisingly heterogeneous. Conclusions Due to limited evidence on the utility of postoperative RT for meningiomas, treatment strategies vary considerably among clinical experts depending on the clinical setting, even in a small country like Switzerland. Clear majorities were identified for postoperative RT in WHO grade III meningiomas and against RT for hemispheric grade I meningiomas outside critical locations. The limited data and variations in clinical recommendations are in contrast with the high prevalence of meningiomas, especially in elderly individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09607-z.
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Affiliation(s)
- Galina Farina Fischer
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
| | - Detlef Brügge
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Davide Giovanni Bosetti
- Clinic of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Evelyn Herrmann
- Department of Radiation Oncology, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | | | - Susanne Rogers
- Radiation Oncology Centre KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Lucia Schwyzer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Thomas Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Clinical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Aeppli S, Schmaus M, Eisen T, Escudier B, Grünwald V, Larkin J, McDermott D, Oldenburg J, Porta C, Rini BI, Schmidinger M, Sternberg CN, Rothermundt C, Putora PM. First-line treatment of metastatic clear cell renal cell carcinoma: a decision-making analysis among experts. ESMO Open 2021; 6:100030. [PMID: 33460963 PMCID: PMC7815472 DOI: 10.1016/j.esmoop.2020.100030] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The treatment landscape of metastatic clear cell renal cell carcinoma (mccRCC) has been transformed by targeted therapies with tyrosine kinase inhibitors (TKI) and more recently by the incorporation of immune checkpoint inhibitors (ICI). Today, a spectrum of single agent TKI to TKI/ICI and ICI/ICI combinations can be considered and the choice of the best regimen is complex. MATERIALS AND METHODS We performed an updated decision-making analysis among 11 international kidney cancer experts. Each expert provided their treatment strategy and relevant decision criteria in the first line treatment of mccRCC. After the collection of all input a list of unified decision criteria was determined and compatible decision trees were created. We used a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees, to determine the most common treatment recommendations as well as deviations. RESULTS Diverse parameters were considered relevant for treatment selection, various drugs and drug combinations were recommended by the experts. The parameters, chosen by the experts, were performance status, International Metastatic renal cell carcinoma Database Consortium (IMDC) risk group, PD-L1 status, zugzwang and contraindication to immunotherapy. The systemic therapies selected for first line treatment were sunitinib, pazopanib, tivozanib, cabozantinib, ipilimumab/nivolumab or pembrolizumab/axitinib. CONCLUSION A wide spectrum of treatment recommendations based on multiple decision criteria was demonstrated. Significant inter-expert variations were observed. This demonstrates how data from randomized trials are implemented differently when transferred into daily practice.
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Affiliation(s)
- S Aeppli
- Division of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - M Schmaus
- Department of Radiotherapy and Radiation Oncology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - T Eisen
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, UK
| | | | - V Grünwald
- Interdisciplinary GU Oncology, Clinic for Urology and Clinic for Tumour Research, University Hospital Essen, Essen, Germany
| | - J Larkin
- The Royal Marsden Hospital, London, UK
| | - D McDermott
- Beth Israel Deaconess Medical Centre, Boston, USA
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway
| | - C Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
| | - B I Rini
- Division of Hematology and Oncology, Vanderbilt University Medical Centre, Nashville, USA
| | - M Schmidinger
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Centre, Medical University of Vienna, Austria
| | - C N Sternberg
- Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, USA
| | - C Rothermundt
- Division of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - P M Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Steffen T, Eden J, Bijelic L, Glatzer M, Glehen O, Goéré D, de Hingh I, Li Y, Moran B, Morris D, Piso P, Quadros C, Rau B, Sugarbaker P, Yonemura Y, Putora PM. Patient Selection for Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Cancer: Consensus on Decision Making Among International Experts. Clin Colorectal Cancer 2020; 19:277-284. [PMID: 32912822 DOI: 10.1016/j.clcc.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) treatment for patients with peritoneal metastases is complex. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has continued to be debated. The aim of the present study was to assess the consensus among international experts for decision-making regarding the use of CRS and HIPEC for patients with CRC. MATERIALS AND METHODS Of 15 experts invited, 12 had provided their decision algorithms for CRS and HIPEC for patients with, or at high risk of, peritoneal metastases from CRC. Using the objective consensus method, the results were transformed into decision trees to provide information on the consensus and discordance. RESULTS Only 1 scenario was found for which the consensus on performing HIPEC had reached 100%. The scenario was the treatment of young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of < 16 in the presence of certain risk factors. Five major decision criteria were identified: age, PCI, completeness of cytoreduction, extent of extraperitoneal metastases (EoMs), and, in the case of unverified EoMs, additional risk factors. Consensus was found regarding refraining from using HIPEC for older patients with a high PCI. The consensus further increased when addressing incomplete cytoreduction and an extensive extent of EoMs. CONCLUSION A definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance; however, owing to the heterogeneity of each individual situation, the impracticality of presenting the information through decision trees, and the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice could not be achieved.
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Affiliation(s)
- Thomas Steffen
- Department of Surgery, Hospital of the Canton of St Gallen, St Gallen, Switzerland.
| | - Janina Eden
- Department of Surgery, Hospital of the Canton of St Gallen, St Gallen, Switzerland
| | - Lana Bijelic
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA
| | - Markus Glatzer
- Department of Radiation Oncology, Hospital of the Canton of St Gallen, St Gallen, Switzerland
| | - Olivier Glehen
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon, France
| | - Diane Goéré
- Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Ignace de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Beijing, People's Republic of China
| | - Brandon Moran
- Peritoneal Malignancy Institute, North-Hampshire Hospital, Basingstoke, United Kingdom
| | - David Morris
- Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Pompiliu Piso
- Department of Surgical Oncology, Hospital Barmherzige Brueder, Regensburg, Germany
| | - Claudio Quadros
- Surgical Oncology Unit, São Rafael Hospital, Salvador, Bahia, Brazil
| | - Beate Rau
- Department of General Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Sugarbaker
- Peritoneal Surface Oncology Unit, MedStar Washington Hospital Center, Washington, DC
| | - Yutaka Yonemura
- Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Paul Martin Putora
- Department of Radiation Oncology, Hospital of the Canton of St Gallen, St Gallen, Switzerland
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Panje CM, Glatzer M, Sirén C, Plasswilm L, Putora PM. Treatment Options in Oncology. JCO Clin Cancer Inform 2019; 2:1-10. [PMID: 30652608 DOI: 10.1200/cci.18.00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multiple treatment strategies exist for many oncologic problems. In this review, we provide a summary of various reasons for the existence of multiple treatment options in oncology, including factors that concern the treating physician (eg, treatment preferences), environmental factors (eg, financial, regulatory, and scientific aspects), and individual patient-specific factors (eg, medical condition, preferences). We demonstrate the vital role of available treatment options and their origins for clinical decision making and patient communication. These aspects are particularly helpful in the process of shared decision making, which is increasingly favored in situations where there are multiple medically reasonable options.
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Affiliation(s)
- Cédric M Panje
- Cédric M. Panje, Markus Glatzer, Ludwig Plasswilm, and Paul M. Putora, Kantonsspital St Gallen; Charlotta Sirén, Institute of Technology Management, University of St Gallen, St Gallen; and Ludwig Plasswilm and Paul M. Putora, University of Bern, Bern, Switzerland
| | - Markus Glatzer
- Cédric M. Panje, Markus Glatzer, Ludwig Plasswilm, and Paul M. Putora, Kantonsspital St Gallen; Charlotta Sirén, Institute of Technology Management, University of St Gallen, St Gallen; and Ludwig Plasswilm and Paul M. Putora, University of Bern, Bern, Switzerland
| | - Charlotta Sirén
- Cédric M. Panje, Markus Glatzer, Ludwig Plasswilm, and Paul M. Putora, Kantonsspital St Gallen; Charlotta Sirén, Institute of Technology Management, University of St Gallen, St Gallen; and Ludwig Plasswilm and Paul M. Putora, University of Bern, Bern, Switzerland
| | - Ludwig Plasswilm
- Cédric M. Panje, Markus Glatzer, Ludwig Plasswilm, and Paul M. Putora, Kantonsspital St Gallen; Charlotta Sirén, Institute of Technology Management, University of St Gallen, St Gallen; and Ludwig Plasswilm and Paul M. Putora, University of Bern, Bern, Switzerland
| | - Paul M Putora
- Cédric M. Panje, Markus Glatzer, Ludwig Plasswilm, and Paul M. Putora, Kantonsspital St Gallen; Charlotta Sirén, Institute of Technology Management, University of St Gallen, St Gallen; and Ludwig Plasswilm and Paul M. Putora, University of Bern, Bern, Switzerland
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Bedke J, Grimm MO, Grünwald V. Collection of real-world data on nivolumab's effectiveness in renal cell carcinoma: rationale for an observational study. Future Oncol 2018; 14:1023-1034. [DOI: 10.2217/fon-2017-0637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Renal cell carcinoma (RCC) represents the seventh (men) respectively tenth (women) most frequent cancer in western countries. After one or more lines of VEGF-targeted therapy, immunotherapy with nivolumab is strongly recommended in patients with metastatic RCC. Nivolumab is the first, and so far, only approved PD-1 immune checkpoint inhibitor to demonstrate a gain in overall survival in RCC. We describe herein design and rationale of trial CA209653 (‘NIS NORA’), a prospective, noninterventional cohort study investigating the effectiveness of nivolumab. This systematic collection of real-world effectiveness data will recruit 323 patients with advanced RCC to provide a precise estimate for overall survival over a 5-year follow-up period (Trial registration: NCT02940639).
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Affiliation(s)
- Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Viktor Grünwald
- Department of Hematology, Hemostasis, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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6
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Zumstein V, Betschart P, Abt D, Schmid HP, Panje CM, Putora PM. Surgical management of urolithiasis - a systematic analysis of available guidelines. BMC Urol 2018; 18:25. [PMID: 29636048 PMCID: PMC5894235 DOI: 10.1186/s12894-018-0332-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Background Several societies around the world issue guidelines incorporating the latest evidence. However, even the most commonly cited guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) leave the clinician with several treatment options and differ on specific points. We aimed to identify discrepancies and areas of consensus between guidelines to give novel insights into areas where low consensus between the guideline panels exists, and therefore where more evidence might increase consensus. Methods The webpages of the 61 members of the Societé Internationale d’Urologie were analysed to identify all listed or linked guidelines. Decision trees for the surgical management of urolithiasis were derived, and a comparative analysis was performed to determine consensus and discrepancies. Results Five national and one international guideline (EAU) on surgical stone treatment were available for analysis. While 7 national urological societies refer to the AUA guidelines and 11 to the EAU guidelines, 43 neither publish their own guidelines nor refer to others. Comparative analysis revealed a high degree of consensus for most renal and ureteral stone scenarios. Nevertheless, we also identified a variety of discrepancies between the different guidelines, the largest being the approach to the treatment of proximal ureteral calculi and larger renal calculi. Conclusions Six guidelines with recommendations for the surgical treatment of urolithiasis to support urologists in decision-making were available for inclusion in our analysis. While there is a high grade of consensus for most stone scenarios, we also detected some discrepancies between different guidelines. These are, however, controversial situations where adequate evidence to assist with decision-making has yet to be elicited by further research.
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Affiliation(s)
- Valentin Zumstein
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. .,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Patrick Betschart
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Cedric Michael Panje
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, lnselspital, Bern University Hospital, Bern, Switzerland
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7
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Prognostic effect of cytoreductive nephrectomy in synchronous metastatic renal cell carcinoma: a comparative study using inverse probability of treatment weighting. World J Urol 2017; 36:417-425. [PMID: 29256020 DOI: 10.1007/s00345-017-2154-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/08/2017] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To test the hypothesis that cytoreductive nephrectomy (CN) improves overall survival (OS) of patients with synchronous metastatic renal cell carcinoma (mRCC), who subsequently receive targeted therapies (TT). METHODS We identified 261 patients who received TT for synchronous mRCC with or without prior CN. To achieve balance in baseline characteristics between groups, we used the inverse probability of treatment weighting (IPTW) method. We conducted OS analyses, including IPTW-adjusted Kaplan-Meier curves, Cox regression models, interaction term, and landmark and sensitivity analyses. RESULTS Of the 261 patients, 97 (37.2%) received CN and 164 (62.8%) did not. IPTW-adjusted analyses showed a statistically significant OS benefit for patients treated with CN (HR 0.63, 95% CI 0.46-0.83, P = 0.0015). While there was no statistically significant difference in OS at 3 months (P = 0.97), 6 months (P = 0.67), and 12 months (P = 0.11) from diagnosis, a benefit for the CN group was noted at 18 months (P = 0.005) and 24 months (P = 0.004). On interaction term analyses, the beneficial effect of CN increased with better performance status (P = 0.06), in women (P = 0.03), and in patients with thrombocytosis (P = 0.01). CONCLUSIONS IPTW-adjusted analysis of our patient cohort suggests that CN improves OS of patients with synchronous mRCC treated with TT. On the whole, the survival difference appears after 12 months. Specific subgroups may particularly benefit from CN, and these subgroups warrant further investigation in prospective trials.
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8
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Rothermundt C, Fischer GF, Bauer S, Blay JY, Grünwald V, Italiano A, Kasper B, Kollár A, Lindner LH, Miah A, Sleijfer S, Stacchiotti S, Putora PM. Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey. Oncologist 2017; 23:461-467. [PMID: 29192019 DOI: 10.1634/theoncologist.2017-0391] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/02/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre- and postoperative chemotherapy is unclear and debated among experts. MATERIALS AND METHODS Medical oncology experts of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group were asked to participate in this survey on the use of pre- and postoperative chemotherapy in STS. Experts from 12 centers in Belgium, France, Germany, Great Britain, Italy, Switzerland, and The Netherlands agreed to participate and provided their treatment algorithm. Answers were converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies. RESULTS Several criteria used for decision-making in extremity STS were identified: chemosensitivity, fitness, grading, location, and size. In addition, resectability and resection status were relevant in the pre- and postoperative setting, respectively. Preoperative chemotherapy is considered in most centers for marginally resectable tumors only. Yet, in some centers, neoadjuvant chemotherapy is used routinely and partially combined with hyperthermia. Although most centers do not recommend postoperative chemotherapy, some offer this treatment on a regular basis. Radiotherapy is an undisputed treatment modality in extremity STS. CONCLUSION Due to lacking evidence on the utility of pre- and postoperative chemotherapy in localized extremity STS, treatment strategies vary considerably among European experts. The majority recommended neoadjuvant chemotherapy for marginally resectable grade 2-3 tumors; the majority did not recommend postoperative chemotherapy in any setting. IMPLICATIONS FOR PRACTICE The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre- and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision-making process among 12 European experts on systemic therapy for STS. A wide range of recommendations among experts regarding the use of perioperative chemotherapy was discovered. Discrepancies in the use of decision criteria were also uncovered, including the definition of what constitutes high-risk cancer, which is a basis for many to recommend chemotherapy. Before any standardization is possible, a common use of decision criteria is necessary.
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Affiliation(s)
- Christian Rothermundt
- Division of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Galina F Fischer
- Division of Radio Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | | | - Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | - Antoine Italiano
- Early Phase Trials and Sarcoma Units, Institut Bergonié, Bordeaux, France
| | - Bernd Kasper
- Tumor Centre and Centre of Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Attila Kollár
- Division of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - Lars H Lindner
- Sarcoma Centre, University Hospital Munich - Campus Grosshadern, Munich, Germany
| | - Aisha Miah
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Paul Martin Putora
- Division of Radio Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, lnselspital, Bern University Hospital, University of Bern, Switzerland
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9
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Panje CM, Glatzer M, von Rappard J, Rothermundt C, Hundsberger T, Zumstein V, Plasswilm L, Putora PM. Applied Swarm-based medicine: collecting decision trees for patterns of algorithms analysis. BMC Med Res Methodol 2017; 17:123. [PMID: 28814269 PMCID: PMC5559810 DOI: 10.1186/s12874-017-0400-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The objective consensus methodology has recently been applied in consensus finding in several studies on medical decision-making among clinical experts or guidelines. The main advantages of this method are an automated analysis and comparison of treatment algorithms of the participating centers which can be performed anonymously. METHODS Based on the experience from completed consensus analyses, the main steps for the successful implementation of the objective consensus methodology were identified and discussed among the main investigators. RESULTS The following steps for the successful collection and conversion of decision trees were identified and defined in detail: problem definition, population selection, draft input collection, tree conversion, criteria adaptation, problem re-evaluation, results distribution and refinement, tree finalisation, and analysis. CONCLUSION This manuscript provides information on the main steps for successful collection of decision trees and summarizes important aspects at each point of the analysis.
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Affiliation(s)
- Cédric M. Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | | | | | - Thomas Hundsberger
- Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ludwig Plasswilm
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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10
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Schindler E, Amantea MA, Karlsson MO, Friberg LE. A Pharmacometric Framework for Axitinib Exposure, Efficacy, and Safety in Metastatic Renal Cell Carcinoma Patients. CPT Pharmacometrics Syst Pharmacol 2017; 6:373-382. [PMID: 28378918 PMCID: PMC5488123 DOI: 10.1002/psp4.12193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 01/15/2023] Open
Abstract
The relationships between exposure, biomarkers (vascular endothelial growth factor (VEGF), soluble VEGF receptors (sVEGFR)-1, -2, -3, and soluble stem cell factor receptor (sKIT)), tumor sum of longest diameters (SLD), diastolic blood pressure (dBP), and overall survival (OS) were investigated in a modeling framework. The dataset included 64 metastatic renal cell carcinoma patients (mRCC) treated with oral axitinib. Biomarker timecourses were described by indirect response (IDR) models where axitinib inhibits sVEGFR-1, -2, and -3 production, and VEGF degradation. No effect was identified on sKIT. A tumor model using sVEGFR-3 dynamics as driver predicted SLD data well. An IDR model, with axitinib exposure stimulating the response, characterized dBP increase. In a time-to-event model the SLD timecourse predicted OS better than exposure, biomarker- or dBP-related metrics. This type of framework can be used to relate pharmacokinetics, efficacy, and safety to long-term clinical outcome in mRCC patients treated with VEGFR inhibitors. (ClinicalTrial.gov identifier NCT00569946.).
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Affiliation(s)
- E Schindler
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - M O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - L E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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