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Dengina N, Chernykh M, Degnin C, Chen Y, Tsimafeyeu I, Karaseva VV, Tjulandin S, Laktionov K, Thomas CR, Mitin T. Patterns of Care and Barriers to Utilization of Definitive Concurrent Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer in Russia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1378-1384. [PMID: 33533013 DOI: 10.1007/s13187-021-01966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Definitive concurrent chemoradiation (cCRT) is offered to only 3% of Russian patients with stage III NSCLC. To determine the patterns of care and barriers to cCRT utilization in Russia, we conducted a survey of practicing radiation oncologists (ROs). METHODS Electronic IRB-approved survey containing 15 questions was distributed to Russian ROs. Fisher's exact test or Cochran-Armitage test of trend was used to assess the associations between clinical experience, practice type, and patterns of care. RESULTS We analyzed 58 questionnaires completed by ROs-16 respondents from tertiary referral hospitals, and 42 from community or private centers. A total of 88% of respondents formulate treatment recommendations in multi-disciplinary tumor boards. For unresectable stage III NSCLC, the most common recommendation is sequential CRT (50%), followed by concurrent CRT (40%), with an observed higher utilization of cCRT in tertiary centers (9/16, 56% vs 14/42, 33%). Of the respondents, 31% do not offer cCRT to their pts. Among reasons for avoiding cCRT are (1) poor performance of pts (76%); (2) high toxicity of therapy (55%); (3) lack of consensus among tumor board members (33%); and (4) preference for sequential CRT (31%). Only 3% do not irradiate elective LNs. Eighty-six percent of respondents counsel their NSCLC pts regarding smoking cessation. CONCLUSIONS Despite level 1 evidence, cCRT is rarely used in Russia for pts with locally advanced NSCLC, and preference for sequential therapy and concerns over high toxicity are the most common barriers. Education of Russian ROs may increase cCRT utilization, leading to improved survival, notably in the era of maintenance immunotherapy.
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Affiliation(s)
- Natalia Dengina
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk, Oblast, Russia
| | | | - Catherine Degnin
- Biostatics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yiyi Chen
- Biostatics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA
| | | | | | | | | | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA
| | - Timur Mitin
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, OR, 97239, USA.
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Liu Y, Wang X, Xiao J, Sun J, Zhang Y. Prognostic value of postoperative change in liver stiffness in patients with HBV-related hepatocellular carcinoma. J Int Med Res 2021; 48:300060520908763. [PMID: 32290747 PMCID: PMC7158254 DOI: 10.1177/0300060520908763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate the prognostic value of change in liver stiffness following surgery, in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods Patients with HBV-related HCC were included. Preoperative (baseline) liver stiffness and postoperative dynamic change in liver stiffness was evaluated. Results Out of 158 patients in total, postoperative liver stiffness was increased in 98 patients and decreased in 60 patients compared with baseline values. Kaplan-Meier analysis revealed that patients with elevated liver stiffness had significantly worse overall survival outcomes than those with decreased liver stiffness. Similar trends were observed for diseases-free survival and recurrence outcomes. Multivariate analyses showed that Child–Turcotte–Pugh score (hazard ratio [HR] 1.209) and liver stiffness changes (HR 1.891) were independent factors associated with overall survival. Liver stiffness changes (HR 1.521) and α-fetoprotein level (HR 1.210) were found to be independent factors for disease-free survival in patients with HCC. Conclusion Increased postoperative liver stiffness may be an independent risk factor of HCC prognosis. Patients with increased liver stiffness following surgery should undergo additional examinations during follow-up.
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Affiliation(s)
- Youde Liu
- Department of Hepatology, Yantai Infectious Disease Hospital, Yantai, Shandong, China
| | - Xiumei Wang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jing Xiao
- Department of Ultrasonography, Jining No.1 People's Hospital, Jining, Shandong, China
| | - Jing Sun
- Department of Hepatology, Yantai Infectious Disease Hospital, Yantai, Shandong, China
| | - Yinghua Zhang
- Department of Ultrasonography, Jining No.1 People's Hospital, Jining, Shandong, China
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