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Maemoto H, Kushi K, Owan I, Ariga T, Heianna J, Nishie A. Deterioration of Performance Status during Palliative Radiotherapy Suggests a Significant Short Survival Duration: Indicating the Necessities for Considering Radiotherapy Discontinuation. Curr Oncol 2024; 31:1752-1761. [PMID: 38668036 PMCID: PMC11049355 DOI: 10.3390/curroncol31040133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Discontinuation of palliative radiotherapy due to a patient's declining general condition poses a clinical dilemma for palliative care physicians. This study aimed to investigate the survival duration of patients whose performance status (PS) deteriorated during palliative radiotherapy and inform decisions regarding early treatment discontinuation. We retrospectively analyzed data from patients referred from our institute's palliative care department who underwent ≥10 fractions of palliative radiotherapy between March 2017 and December 2021. PS was assessed using the Eastern Cooperative Oncology Group (ECOG) scale. Survival duration was calculated from the final day of palliative radiotherapy to death using the Kaplan-Meier method. A total of 35 patients underwent palliative radiotherapy. Seven (20%) experienced deterioration in ECOG PS during treatment. Their median survival duration was significantly shorter at 22 days (95% confidence interval: 1-94 days) compared to 125 days (95% confidence interval: 82-150 days) for the 28 patients whose PS remained stable (p = 0.0007). Deterioration in ECOG PS during palliative radiotherapy signifies a markedly shorter survival duration. Careful assessment of a patient's condition throughout treatment is crucial, and early discontinuation should be considered if their general health worsens rather than strictly adhering to the initial schedule.
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Affiliation(s)
- Hitoshi Maemoto
- Division of Radiation Oncology, NHO Okinawa Hospital, Okinawa 901-2214, Japan
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
| | - Kazuaki Kushi
- Division of Palliative Care, NHO Okinawa Hospital, Okinawa 901-2214, Japan
| | - Isoko Owan
- Division of Pulmonary Medicine, NHO Okinawa Hospital, Okinawa 901-2214, Japan;
| | - Takuro Ariga
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
- Health Information Management Center, University of the Ryukyus Hospital, Okinawa 903-0213, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
| | - Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
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Saito T, Murotani K, Ito K, Nakamura N, Oya N. Bias due to statistical handling of death and reirradiation in the assessment of duration of response after palliative radiotherapy: a scoping review and analysis of clinical data. Br J Radiol 2023; 96:20220398. [PMID: 36125225 PMCID: PMC10997018 DOI: 10.1259/bjr.20220398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We investigated the influence of handling death and reirradiation on the estimation of duration of response (DOR). METHODS First, we performed a scoping review on methods to assess DOR in palliative radiotherapy. Second, we performed three different analyses on a subgroup of patients from a previously published prospective study. The first analysis was a competing risks analysis considering relapse of pain as the event of interest and death and reirradiation as competing events (Analysis A). The second and third analyses were standard survival analyses where the event of interest was a composite outcome of relapse of pain, death, or reirradiation (Analysis B) and relapse of pain (Analysis C), respectively. RESULTS Death was considered as an event of interest in less than half of the papers, while reirradiation was not considered in any of the studies. Competing risks analysis was not performed in any of the studies. In the analysis of clinical data, competing risks analysis showed that relapse of pain predominated as the cause of the end of response. Median DOR was correctly estimated to be 4.1 months in Analyses A and B, but was overestimated to be 8.1 months in Analysis C. CONCLUSIONS Death and reirradiation should be treated as the events of interest that mark the end of response (as in Analyses A and B) to avoid overestimation of treatment efficacy and an invalid assumption of independent censoring. ADVANCES IN KNOWLEDGE The definition of end of response remains inconclusive in the assessment of DOR. We recommend competing risks analysis (Analysis A), by which we can estimate cumulative incidence of each event type and evaluate the necessity of reirradiation.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal
Hospital, Arao, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume
University, Fukuoka, Japan
| | - Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo
Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital, Tokyo, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University
School of Medicine, Kanagawa, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University
Hospital, Kumamoto, Japan
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AKIN M, DUZOVA M. Single fraction image guided radiation therapy for management of bone metastases during the COVID-19 pandemic. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1112225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Radiation therapy (RT) plays a major role in management of bone metastases, however, various dose-fractionation schemes are utilized taking into account patient, tumor, and treatment characteristics. The aim of this study was to assess Image Guided Single Fraction Radiation Therapy (IG-SFRT) for management of painful bone metastases during the COVID-19 pandemic.
Material and Method: Patients receiving IG-SFRT for painful bone metastases were assessed for age, gender, primary cancer diagnosis, location of metastases, performance status, analgesic intake, pain relief, and overall treatment efficacy in this study.
Results: Out of the total 65 patients treated with IG-SFRT during the course of COVID-19 pandemic at our department, 54 patients were evaluable for overall treatment efficacy analysis. Based on the international consensus on palliative RT endpoints, rates of complete response (CR), partial response (PR), pain progression (PP), and indeterminate response (IR) were 16.67%, 59.26%, 9.26%, 14.81%, respectively corresponding to an overall response rate of 75.93%. IG-SFRT was well tolerated by all patients without toxicity.
Conclusion: For patients with bone metastases, pain palliation is a critical aspect of management. In view of the high rate of overall treatment efficacy achieved with IG-SFRT in our study, we suggest routine utilization of this image guided radiotherapeutic approach for management of painful bone metastases which additionally allows for minimization of treatment visits thereby improving patient and treatment facility convenience under the special circumstances of the recent COVID-19 pandemic.
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An automated treatment planning framework for spinal radiotherapy and vertebral level second check. Int J Radiat Oncol Biol Phys 2022; 114:516-528. [PMID: 35787928 DOI: 10.1016/j.ijrobp.2022.06.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Complicating factors such as time pressures, anatomic variants in the spine, and similarities in adjacent vertebrae are associated with wrong level treatments of the spine. The purpose of this work is to mitigate such challenges by fully automating the treatment planning process for diagnostic and simulation CT scans. METHODS AND MATERIALS Vertebral bodies are labeled on CT scans of any length using two intendent deep learning models-mirroring two different experts labeling the spine. Then, a U-Net++ architecture was trained, validated, and tested to contour each vertebra (n = 220 CTs). Features from the CT and auto-contours were input into a random forest classifier to predict whether vertebrae were correctly labeled. This classifier was trained using auto-contours from CBCT, PET-CT, simulation CT, and diagnostic CT images (n = 56 CTs, 751 contours). Auto-plans were generated via scripting. Each model was combined into a framework to make a fully-automated clinical tool. A retrospective planning study was conducted where 3 radiation oncologists scored auto-plan quality on an unseen patient cohort (n = 60) on a 5-point scale. CTs varied in scan length, presence of surgical implants, imaging protocol, and metastatic burden. RESULTS The results showed that the uniquely designed convolutional-neural-networks (CNNs) accurately labeled and segmented vertebral bodies C1-L5 regardless of imaging protocol or metastatic burden. Mean Dice-Similarity Coefficient was 85.0% (cervical), 90.3% (thoracic), and 93.7% (lumbar). The random forest classifier predicted mislabeling across various CT scan types with AUC = 0.82. All contouring and labeling errors within treatment regions (11/11), including errors from patient plans with atypical anatomy (e.g. T13, L6) were detected. Radiation oncologists scored 98% of simulation CT- and 92% of diagnostic CT-based plans as clinically acceptable or needing minor edits for patients with typical anatomy. On average, end-to-end treatment planning time of the clinical tool was less than 8 minutes. CONCLUSIONS This novel method to automatically verify, contour, and plan palliative spine treatments is efficient and effective across various CT scan types. Furthermore, it is the first to create a clinical tool that can automatically verify vertebral level in CT images.
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Ahmed S, M.Kamal S, Salah T, Fawzy Sedik M, Youssief AA. Concurrent capecitabine with external beam radiotherapy versus radiotherapy alone in painful bone metastasis of breast cancer origin. J Bone Oncol 2021; 31:100395. [PMID: 34712554 PMCID: PMC8529095 DOI: 10.1016/j.jbo.2021.100395] [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: 07/01/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In breast cancer, painful bone metastases are common. Local radiotherapy is the standard treatment of painful bone metastases. Pain control and overall response rateswere low in radiotherapy alone.The objectives of this study were to compare the safety and efficacy of external beam radiotherapy with concurrent capecitabine vs. external beam radiotherapy alone in pain control of painful bone metastases in breast cancer patients. MATERIALS AND METHODS Eighty-four patients with painful bone metastases from breast cancer participated in this prospective study. We randomized the patients into two groups: group A treated with radiotherapy 30 Gy in 10 fractions and group B treated with capecitabine 825 mg/m2 every 12 hrs. concurrently with the same radiotherapy dose. RESULTS There was no statistically significant difference between the two groups regarding early treatment toxicity. Most of the toxicity was gastrointestinal (diarrhea and nausea) and mild (grade I or II). The median pain score decreased from week one, and there was a marked response at week4. The difference in median pain score between both groups was statistically significant with p-value = 0.045. The median analgesic score in both groups was statistically significant with a p-value = 0.032 at week 12. A complete response to pain at week 4 was 19% and 42.9% in groups A and B, respectively. CONCLUSION Concurrent chemoradiation in painful bone metastases from breast cancer origin was tolerable and safe; it had a higher overall response rate and pain palliation than radiotherapy alone.
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Affiliation(s)
- Shimaa Ahmed
- Radiation Oncology, and Nuclear Medicine, Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Shereen M.Kamal
- Anesthesia, Intensive Care Unit and Pain Management Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Tareq Salah
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Mayada Fawzy Sedik
- Medical Oncology and Hematological Malignancies Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ayatallah A. Youssief
- Radiation Oncology, and Nuclear Medicine, Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Yamaguchi K, Saito T, Toya R, Tomitaka E, Matsuyama T, Fukugawa Y, Watakabe T, Otsuka H, Oya N. Palliative radiotherapy for painful lymph node metastases. Radiat Oncol 2021; 16:178. [PMID: 34530897 PMCID: PMC8447670 DOI: 10.1186/s13014-021-01900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence concerning radiotherapy for painful lymph node metastases (PLM). We evaluated the effectiveness of radiotherapy for PLM using the International Consensus Endpoint in a subgroup analysis of a prospective observational study. METHODS In the primary study, 302 patients received radiotherapy for painful tumors. Among them, those treated with palliative radiotherapy for PLM were analyzed in the present study. We used the Brief Pain Inventory short form to evaluate the intensity of pain and the pain interference in patient's life. We collected the Brief Pain Inventory and analgesic data at baseline and at 1, 2, and 3 months after the start of radiotherapy. Pain response was assessed using the International Consensus Endpoint. Patients were diagnosed with a predominance of other pain (POP) if non-index pain of a malignant or unknown origin was present and had a greater 'worst pain' score than the index pain. RESULTS Radiotherapy for PLM was performed on 25 patients. In total, 15 (60%) patients experienced a pain response. The pain response rates for evaluable patients were 66%, 67%, and 57% at 1-, 2-, and 3-month follow-ups, respectively. At baseline and at 1, 2, and 3 months, the median index pain scores were 7, 2, 0, and 0.5, respectively. At 1 month, all pain interference scores were significantly reduced from baseline. Four (16%) patients experienced POP within three months. CONCLUSION Radiotherapy for PLM improved pain intensity and pain interference. Palliative radiotherapy may be a viable treatment option for PLM.
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Affiliation(s)
- Kohsei Yamaguchi
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. .,Department of Radiation Oncology, Arao Municipal Hospital, Arao, Japan. .,Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan.
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Arao, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshiyuki Fukugawa
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
| | - Hirohito Otsuka
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Mushonga M, Nyakabau AM, Ndlovu N, Iyer HS, Bellon JR, Kanda C, Ndarukwa-Jambwa S, Chipidza F, Makunike-Mutasa R, Muchuweti D, Muguti EG, Cluff Elmore SN. Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe. JCO Glob Oncol 2021; 7:1212-1219. [PMID: 34343013 PMCID: PMC8457791 DOI: 10.1200/go.20.00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In sub-Saharan Africa, radiotherapy (RT) utilization and delivery patterns have not been extensively studied in patients with metastatic breast cancer. METHODS A retrospective cohort study of female patients with metastatic breast cancer seen at Parirenyatwa Radiotherapy Centre in Zimbabwe from 2014 to 2018 was conducted. Demographics, pathology, staging, and treatment data were abstracted through chart review. Fisher's exact test and chi-squared test of independence were used to compare proportions, and independent two-sample t-tests were used to compare means. RESULTS Of 351 patients with breast cancer, 152 (43%) had metastatic disease, median age 51 years (interquartile range: 43-61 years). Of those with metastatic disease, 30 patients (20%) received radiation to various metastatic sites: 16 spine; three nonspine bone metastases; six whole brain; and five chest wall or supraclavicular. Patients who received radiation were younger (46 v 52 years; P = .019), but did not differ significantly by performance status than those who did not. The most common dose prescription was 30 Gy in 10 fractions (33%). Five (17%) patients had treatment interruption and two (7%) had treatment noncompletion. Province of origin and clinical tumor stage were significant predictors of RT receipt (P = .002; and P = .018, respectively). CONCLUSION A minority of patients with metastatic breast cancer received RT (20%), and these were likely to be younger, with advanced tumor stage, and resided in provinces where RT is available. Conventional courses were generally prescribed. There is a need to strongly consider palliative RT as an option for patients with metastatic breast cancer and use of hypofractionated courses (e.g. 8 Gy in one fraction) may support this goal.
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Affiliation(s)
| | - Anna Mary Nyakabau
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Cancerserve Trust, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hari Subramaniam Iyer
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | | | - Caroline Kanda
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Sandra Ndarukwa-Jambwa
- Sally Mugabe Central Hospital, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Fallon Chipidza
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Radiation Oncology Program, Boston, MA
| | - Rudo Makunike-Mutasa
- Department of Pathology, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - David Muchuweti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Edwin G Muguti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
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