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Swaminath A, Cheung P, Glicksman RM, Donovan EK, Niglas M, Vesprini D, Kapoor A, Erler D, Chu W. Patient-reported Quality of Life following Stereotactic Body Radiation Therapy for Primary Kidney Cancer - Results from a Prospective Cohort Study. Clin Oncol (R Coll Radiol) 2021; 33:468-475. [PMID: 33775496 DOI: 10.1016/j.clon.2021.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 01/31/2023]
Abstract
AIMS We report on the first prospective series of patient-reported quality of life (QoL) following stereotactic body radiation therapy (SBRT) for primary kidney cancer. MATERIALS AND METHODS Patients were treated on a multi-institutional prospective cohort study with 30-42 Gy SBRT in three or five fractions. QoL assessments were carried out using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-15 Palliative (EORTC-QLQ-C15-PAL), the Functional Assessment of Cancer Therapy-Kidney Symptom Index-19 (FACT FKSI-19) and the EuroQol-5D-3L tools at baseline, 1 week, and 1, 3 and 6 months post-treatment. QoL over time was analysed using linear mixed modelling, pairwise and anchor-based analyses. RESULTS Twenty-eight patients were included. No significant reduction in any QoL metric was observed on repeated measures. However, a trend to reduced EORTC global QoL and fatigue was observed at 1 week, with improvement over time in other symptom scores such as pain, appetite and nausea. On pairwise analysis, there were statistically significant reductions in global QoL at 1 week (with subsequent recovery) and dyspnoea at 6 months post-SBRT. Trends to improved pain, appetite and nausea were observed following SBRT. Less than half of patients reported stable or better EORTC global QoL at 1 week. For all other QoL and symptom scales, most patients had reported stable or better scores at all times, with a slight proportional improvement in emotional functioning, nausea, fatigue, pain and appetite, and a slight worsening of physical functioning and dyspnoea over time. CONCLUSIONS SBRT results in well-preserved QoL in the weeks to months following treatment for primary kidney cancer.
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Affiliation(s)
- A Swaminath
- Juravinski Cancer Centre, McMaster University, Department of Oncology, Hamilton, Ontario, Canada.
| | - P Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - R M Glicksman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - E K Donovan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - M Niglas
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - D Vesprini
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - A Kapoor
- St. Joseph's Healthcare, McMaster University, Institute of Urology, Hamilton, Ontario, Canada
| | - D Erler
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - W Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
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Chalkidou A, Macmillan T, Grzeda MT, Peacock J, Summers J, Eddy S, Coker B, Patrick H, Powell H, Berry L, Webster G, Ostler P, Dickinson PD, Hatton MQ, Henry A, Keevil S, Hawkins MA, Slevin N, van As N. Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: a prospective, registry-based, single-arm, observational, evaluation study. Lancet Oncol 2021; 22:98-106. [PMID: 33387498 DOI: 10.1016/s1470-2045(20)30537-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is increasingly being used to treat oligometastatic cancers, but high-level evidence to provide a basis for policy making is scarce. Additional evidence from a real-world setting is required. We present the results of a national study of patients with extracranial oligometastases undergoing SABR, representing the largest dataset, to our knowledge, on outcomes in this population so far. METHODS In 2015, National Health Service (NHS) England launched a Commissioning through Evaluation scheme that funded a prospective, registry-based, single-arm, observational, evaluation study of patients with solid cancer and extracranial oligometastases treated with SABR. Prescribed doses ranged from 24-60 Gy administered in three to eight fractions. The study was done at 17 NHS radiotherapy centres in England. Patients were eligible for the scheme if aged 18 years or older with confirmed primary carcinoma (excluding haematological malignancies), one to three extracranial metastatic lesions, a disease-free interval from primary tumour development to metastases of longer than 6 months (with the exception of synchronous colorectal liver metastases), a WHO performance status of 2 or lower, and a life expectancy of at least 6 months. The primary outcome was overall survival at 1 year and 2 years from the start of SABR treatment. The study is now completed. FINDINGS Between June 15, 2015, and Jan 30, 2019, 1422 patients were recruited from 17 hospitals in England. The median age of the patients was 69 years (IQR 62-76), and the most common primary tumour was prostate cancer (406 [28·6%] patients). Median follow-up was 13 months (IQR 6-23). Overall survival was 92·3% (95% CI 90·5-93·9) at 1 year and 79·2% (76·0-82·1) at 2 years. The most common grade 3 adverse event was fatigue (28 [2·0%] of 1422 patients) and the most common serious (grade 4) event was increased liver enzymes (nine [0·6%]). Notreatment-related deaths were reported. INTERPRETATION In patients with extracranial oligometastatic cancer, use of SABR was associated with high overall survival and low toxicity. 'The study findings complement existing evidence from a randomised, phase 2 trial, and represent high-level, real-world evidence supporting the use of SABR in this patient cohort, with a phase 3 randomised, controlled trial to confirm these findings underway. Based on the selection criteria in this study, SABR was commissioned by NHS England in March, 2020, as a treatment option for patients with oligometastatic disease. FUNDING NHS England Commissioning through Evaluation scheme.
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Affiliation(s)
- Anastasia Chalkidou
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Thomas Macmillan
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mariusz T Grzeda
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Janet Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Jennifer Summers
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Saskia Eddy
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Bola Coker
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Hannah Patrick
- National Institute for Health and Care Excellence, Manchester, UK
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, UK
| | - Lee Berry
- National Institute for Health and Care Excellence, Manchester, UK
| | - Gareth Webster
- Department of Medical Physics, Worcestershire Acute Hospitals National Health Service (NHS) Trust, Worcester, UK
| | | | - Peter D Dickinson
- Clinical Oncology Department, St James's University Hospital and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Q Hatton
- Clinical Oncology Department, Weston Park Hospital, Sheffield, UK
| | - Ann Henry
- Clinical Oncology Department, St James's University Hospital and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen Keevil
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Maria A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Nick Slevin
- The Christie NHS Foundation Trust, Manchester, UK
| | - Nicholas van As
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
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Quality of life changes after stereotactic ablative radiotherapy for liver metastases: A prospective cohort analysis. Radiother Oncol 2018; 129:435-440. [PMID: 30274721 DOI: 10.1016/j.radonc.2018.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/28/2018] [Accepted: 09/15/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To report the changes in quality of life (QoL) after stereotactic ablative radiotherapy (SABR) in patients with liver metastases (LM). MATERIALS AND METHODS A prospective cohort study was undertaken to measure the acute changes in QoL after SABR. Patients with 1-3 treated LM were eligible. Doses of 30-60 Gy in 3-5 fractions were delivered. Prospective QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires, Core 15 for Palliative Care (EORTC QLQ-C15-PAL) and liver metastases (LM21), at baseline, 1st week and last day of treatment, then 1, 6 and 12 weeks after SABR. The functional living index-emesis (FLIE) was collected at baseline, 1st week, last day and 1 week after treatment. Univariable and multivariable linear mixed modeling were performed as appropriate to assess changes in QoL over time. RESULTS Sixty patients were included. The most common primary cancer was colorectal (42%). The global health score measured by QLQ-C15-PAL was significantly worse at treatment completion (p = 0.001), 1 week (p = 0.003) and 6 weeks (p = 0.002) after SABR but recovered by 12 weeks (p = 0.124). Nausea and constipation were worse at treatment completion (p < 0.05) but recovered 1 week after while fatigue recovered 6 weeks post-SABR. The majority of patients reported stable QoL at 12 weeks for all domains in the C15-PAL and LM21 questionnaires. CONCLUSION SABR offers a non-invasive mean of ablating LM with minimal impact on acute QoL.
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