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Huang X, Field M, Vinod S, Ball H, Batumalai V, Keall P, Holloway L. Radiotherapy protocol compliance in routine clinical practice for patients with stages I-III non-small-cell lung cancer. J Med Imaging Radiat Oncol 2024. [PMID: 39077798 DOI: 10.1111/1754-9485.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/06/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Despite the availability of radiotherapy treatment protocols for lung cancer, considerable treatment variation occurs in clinical practice. This study assessed compliance with a radiotherapy protocol for the treatment of patients with stages I-III non-small-cell lung cancer (NSCLC) in routine clinical practice and to identify factors that were associated with compliance. METHODS The Cancer Institute New South Wales eviQ treatment protocol for external beam radiotherapy of stages I-III NSCLC was taken as the reference to measure compliance. All inoperable patients with stages I-III NSCLC and documented ECOG performance status treated with radiotherapy between 2007 and 2019 at two radiotherapy facilities were available for analysis. Protocol compliance rates were calculated. Univariate and multivariate logistic regression models with 23 input factors were used to determine factors significantly associated with compliance. Survival analysis was conducted for both compliant and non-compliant treatments. RESULTS Overall, 656 patients met the inclusion criteria. Protocol compliance was 16%. Alternative dose/fractionation was responsible for 49% of non-compliant treatments with 30% receiving an alternative curative fractionation. Five of 23 factors (age at the start of radiotherapy, stage group, ECOG performance status, tumour location and alcoholism history) showed significant associations with protocol compliance on multivariate analysis. There was no significant difference in median survival between patients receiving protocol compliant treatment (15.1 months) and non-compliant treatment (15.6 months). CONCLUSION Adherence to the eviQ curative radiotherapy protocol for stages I-III NSCLC was low. Alternative dose/fractionation schemes were the main reason for non-compliance. Protocol compliance was not associated with outcome.
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Affiliation(s)
- Xiaoshui Huang
- Image X Institute, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Matthew Field
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
- South Western Clinical Campus, School of Medicine, University of NSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
- South Western Clinical Campus, School of Medicine, University of NSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen Ball
- Image X Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vikneswary Batumalai
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
- South Western Clinical Campus, School of Medicine, University of NSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul Keall
- Image X Institute, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Lois Holloway
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
- South Western Clinical Campus, School of Medicine, University of NSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South Western Sydney Local Health District, Sydney, New South Wales, Australia
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2
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Rogers JL, Wall T, Acquaye-Mallory AA, Boris L, Kim Y, Aldape K, Quezado MM, Butman JA, Smirniotopoulos JG, Chaudhry H, Tsien CI, Chittiboina P, Zaghloul K, Aboud O, Avgeropoulos NG, Burton EC, Cachia DM, Dixit KS, Drappatz J, Dunbar EM, Forsyth P, Komlodi-Pasztor E, Mandel J, Ozer BH, Lee EQ, Ranjan S, Lukas RV, Raygada M, Salacz ME, Smith-Cohn MA, Snyder J, Soldatos A, Theeler BJ, Widemann BC, Camphausen KA, Heiss JD, Armstrong TS, Gilbert MR, Penas-Prado M. Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors. J Neurooncol 2024; 167:349-359. [PMID: 38427131 PMCID: PMC11023967 DOI: 10.1007/s11060-024-04613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Multidisciplinary tumor boards (MTBs) integrate clinical, molecular, and radiological information and facilitate coordination of neuro-oncology care. During the COVID-19 pandemic, our MTB transitioned to a virtual and multi-institutional format. We hypothesized that this expansion would allow expert review of challenging neuro-oncology cases and contribute to the care of patients with limited access to specialized centers. METHODS We retrospectively reviewed records from virtual MTBs held between 04/2020-03/2021. Data collected included measures of potential clinical impact, including referrals to observational or therapeutic studies, referrals for specialized neuropathology analysis, and whether molecular findings led to a change in diagnosis and/or guided management suggestions. RESULTS During 25 meetings, 32 presenters discussed 44 cases. Approximately half (n = 20; 48%) involved a rare central nervous system (CNS) tumor. In 21% (n = 9) the diagnosis was changed or refined based on molecular profiling obtained at the NIH and in 36% (n = 15) molecular findings guided management. Clinical trial suggestions were offered to 31% (n = 13), enrollment in the observational NCI Natural History Study to 21% (n = 9), neuropathology review and molecular testing at the NIH to 17% (n = 7), and all received management suggestions. CONCLUSION Virtual multi-institutional MTBs enable remote expert review of CNS tumors. We propose them as a strategy to facilitate expert opinions from specialized centers, especially for rare CNS tumors, helping mitigate geographic barriers to patient care and serving as a pre-screening tool for studies. Advanced molecular testing is key to obtaining a precise diagnosis, discovering potentially actionable targets, and guiding management.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Thomas Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Alvina A Acquaye-Mallory
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Yeonju Kim
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Martha M Quezado
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - John A Butman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - James G Smirniotopoulos
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Huma Chaudhry
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Christina I Tsien
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Proton Therapy Center, Sibley Memorial Hospital, Johns Hopkins Medicine, 5255 Loughboro Rd NW, Washington, DC, 20016, USA
| | - Prashant Chittiboina
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Kareem Zaghloul
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Orwa Aboud
- Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA
| | - Nicholas G Avgeropoulos
- Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA
- Global Medical Affairs, Novocure GmbH, D4 Pk. 6, 6039, Root, Switzerland
| | - Eric C Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - David M Cachia
- Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA
| | - Karan S Dixit
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA
| | - Jan Drappatz
- Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Erin M Dunbar
- Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA
| | - Peter Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Edina Komlodi-Pasztor
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road Washington, Washington DC, 20007, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA
| | - Byram H Ozer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Surabhi Ranjan
- Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US
| | - Rimas V Lukas
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA
| | - Margarita Raygada
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA
| | - Michael E Salacz
- Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA
| | - Matthew A Smith-Cohn
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
- Benefis Sletten Cancer Institute, 1117 29Th St. S, Great Falls, MT, 59405, USA
| | - James Snyder
- Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke,, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Brett J Theeler
- School of Medicine, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Kevin A Camphausen
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - John D Heiss
- Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
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Cordeiro de Lima VC, Gelatti A, Moura JF, Fares AF, de Castro G, Mathias C, Terra RM, Werutsky G, Corassa M, Araújo LHL, Cronenberger E, Fujiki FK, Reichow S, da Silva AVT, Reis TV, Padoan MLA, Pacheco P, Yamamura R, Kawamura C, Mascarenhas E, de Jesus RG, Gössling G, Baldotto C. Health Services Access Inequalities in Brazil Result in Poorer Outcomes for Stage III NSCLC-RELANCE/LACOG 0118. JTO Clin Res Rep 2024; 5:100646. [PMID: 38434771 PMCID: PMC10906523 DOI: 10.1016/j.jtocrr.2024.100646] [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: 07/31/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Stage III NSCLC is a heterogeneous disease, representing approximately one-third of newly diagnosed lung cancers. Brazil lacks detailed information regarding stage distribution, treatment patterns, survival, and prognostic variables in locally advanced NSCLC. Methods RELANCE/LACOG 0118 is an observational, retrospective cohort study assessing sociodemographic and clinical data of patients diagnosed with having stage III NSCLC from January 2015 to June 2019, regardless of treatment received. The study was conducted across 13 cancer centers in Brazil. Disease status and survival data were collected up to June 2021. Descriptive statistics, survival analyses, and a multivariable Cox regression model were performed. p values less than 0.05 were considered significant. Results We recruited 403 patients with stage III NSCLC. Most were male (64.0%), White (31.5%), and smokers or former smokers (86.1%). Most patients had public health insurance (67.5%), had stage IIIA disease (63.2%), and were treated with concurrent chemoradiation (53.1%). The median follow-up time was 33.83 months (95% confidence interval [CI]: 30.43-37.50). Median overall survival (OS) was 27.97 months (95% CI: 21.57-31.73), and median progression-free survival was 11.23 months (95% CI: 10.70-12.77). The type of treatment was independently associated with OS and progression-free survival, whereas the types of health insurance and histology were independent predictors of OS only. Conclusions Brazilian patients with stage III NSCLC with public health insurance are diagnosed later and have poorer OS. Nevertheless, patients with access to adequate treatment have outcomes similar to those reported in the pivotal trials. Health policy should be improved to make lung cancer diagnosis faster and guarantee prompt access to adequate treatment in Brazil.
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Affiliation(s)
| | - Ana Gelatti
- CPO - Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - José F.P. Moura
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Aline F. Fares
- FUNFARME - Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil
| | - Gilberto de Castro
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
- Hospital das Clínicas, Faculdade de Medicina - Universidade de São Paulo (USP), São Paulo, Brazil
| | - Clarissa Mathias
- NOB - Núcleo de Oncologia da Bahia (Oncoclínicas BA), Bahia, Brazil
- Hospital Santa Izabel, Salvador, Brazil
| | - Ricardo M. Terra
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | | | | | | | | | | | - Tércia V. Reis
- NOB - Núcleo de Oncologia da Bahia (Oncoclínicas BA), Bahia, Brazil
| | | | | | - Rosely Yamamura
- BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
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Zhang Y, Li J, Liao M, Yang Y, He G, Zhou Z, Feng G, Gao F, Liu L, Xue X, Liu Z, Wang X, Shi Q, Du X. Cloud platform to improve efficiency and coverage of asynchronous multidisciplinary team meetings for patients with digestive tract cancer. Front Oncol 2024; 13:1301781. [PMID: 38288106 PMCID: PMC10824572 DOI: 10.3389/fonc.2023.1301781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
Background Multidisciplinary team (MDT) meetings are the gold standard of cancer treatment. However, the limited participation of multiple medical experts and the low frequency of MDT meetings reduce the efficiency and coverage rate of MDTs. Herein, we retrospectively report the results of an asynchronous MDT based on a cloud platform (cMDT) to improve the efficiency and coverage rate of MDT meetings for digestive tract cancer. Methods The participants and cMDT processes associated with digestive tract cancer were discussed using a cloud platform. Software programming and cMDT test runs were subsequently conducted to further improve the software and processing. cMDT for digestive tract cancer was officially launched in June 2019. The doctor response duration, cMDT time, MDT coverage rate, National Comprehensive Cancer Network guidelines compliance rate for patients with stage III rectal cancer, and uniformity rate of medical experts' opinions were collected. Results The final cMDT software and processes used were determined. Among the 7462 digestive tract cancer patients, 3143 (control group) were diagnosed between March 2016 and February 2019, and 4319 (cMDT group) were diagnosed between June 2019 and May 2022. The average number of doctors participating in each cMDT was 3.26 ± 0.88. The average doctor response time was 27.21 ± 20.40 hours, and the average duration of cMDT was 7.68 ± 1.47 min. The coverage rates were 47.85% (1504/3143) and 79.99% (3455/4319) in the control and cMDT groups, respectively. The National Comprehensive Cancer Network guidelines compliance rates for stage III rectal cancer patients were 68.42% and 90.55% in the control and cMDT groups, respectively. The uniformity rate of medical experts' opinions was 89.75% (3101/3455), and 8.97% (310/3455) of patients needed online discussion through WeChat; only 1.28% (44/3455) of patients needed face-to-face discussion with the cMDT group members. Conclusion A cMDT can increase the coverage rate of MDTs and the compliance rate with National Comprehensive Cancer Network guidelines for stage III rectal cancer. The uniformity rate of the medical experts' opinions was high in the cMDT group, and it reduced contact between medical experts during the COVID-19 pandemic.
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Affiliation(s)
- Yu Zhang
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Jie Li
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Min Liao
- Information Center, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Yalan Yang
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Gang He
- Information Center, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Zuhong Zhou
- Information Center, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Gang Feng
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Feng Gao
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Lihua Liu
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Xiaojing Xue
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Zhongli Liu
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Xiaoyan Wang
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xaiobo Du
- Department of Oncology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology, Mianyang, China
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Walter J, Moeller C, Resuli B, Kauffmann-Guerrero D, Manapov F, Dinkel J, Neumann J, Kovacs J, Schneider C, Huber RM, Tufman A. Guideline adherence of tumor board recommendations in lung cancer and transfer into clinical practice. J Cancer Res Clin Oncol 2023; 149:11679-11688. [PMID: 37402967 PMCID: PMC10465379 DOI: 10.1007/s00432-023-05025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Evaluating patients and treatment decisions in a multidisciplinary tumor board has led to better quality of care and longer survival in cancer patients. The aim of this study was to evaluate tumor board recommendations for thoracic oncology patients regarding guideline adherence and transferal of recommendations into clinical practice. METHODS We evaluated tumor board recommendations of the thoracic oncology tumor board at Ludwig-Maximilians University (LMU) Hospital Munich between 2014 and 2016. We compared patient characteristics between guideline-adherent and non-guideline-adherent recommendations, as well as between transferred and non-transferred recommendations. We used multivariate logistic regression models to evaluate factors associated with guideline adherence. RESULTS Over 90% of recommendations by the tumor board were either adherent to the guidelines (75.5%) or over fulfilling guidelines (15.6%). Almost 90% of recommendations were transferred to clinical practice. If a recommendation was not according to the guidelines, the reason was mostly associated with the general condition (age, Charlson comorbidity index, ECOG) of the patient or due to the patients' request. Surprisingly, sex also had a significant influence on the guideline adherence of recommendations, with females being more likely to get recommendations not according to the guidelines. CONCLUSION In conclusion, the results of this study are promising, as the guideline adherence of recommendations as well as the transferal of recommendations into clinical practice were high. In the future, a special focus should be put on fragile patients as well as female patients.
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Affiliation(s)
- Julia Walter
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany.
- German Center for Lung Research (DZL), Giessen, Germany.
| | - Caroline Moeller
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Blerina Resuli
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Farkhad Manapov
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiology, Asklepios Clinic Gauting, Gauting, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Julia Kovacs
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schneider
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Rudolf M Huber
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Amanda Tufman
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
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Zhou A, Zhang D, Kang X, Brooks JD. Identification of age- and immune-related gene signatures for clinical outcome prediction in lung adenocarcinoma. Cancer Med 2023; 12:17475-17490. [PMID: 37434467 PMCID: PMC10501266 DOI: 10.1002/cam4.6330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The understanding of the factors causing decreased overall survival (OS) in older patients compared to younger patients in lung adenocarcinoma (LUAD) remains. METHODS Gene expression profiles of LUAD were obtained from publicly available databases by Kaplan-Meier analysis was performed to determine whether age was associated with patient OS. The immune cell composition in the tumor microenvironment (TME) was evaluated using CIBERSORT. The fraction of stromal and immune cells in tumor samples were also using assessed using multiple tools including ESTIMATE, EPIC, and TIMER. Differentially expressed genes (DEGs) from the RNA-Seq data that were associated with age and immune cell composition were identified using the R package DEGseq. A 22-gene signature composed of DEGs associated with age and immune cell composition that predicted OS were constructed using Least Absolute Shrinkage and Selection Operator (LASSO). RESULTS In The Cancer Genome Atlas (TCGA)-LUAD dataset, we found that younger patients (≤70) had a significant better OS compared to older patients (>70). In addition, older patients had significantly higher expression of immune checkpoint proteins including inhibitory T cell receptors and their ligands. Moreover, analyses using multiple bioinformatics tools showed increased immune infiltration, including CD4+ T cells, in older patients compared to younger patients. We identified a panel of genes differentially expressed between patients >70 years compared to those ≤70 years, as well as between patients with high or low immune scores and selected 84 common genes to construct a prognostic gene signature. A risk score calculated based on 22 genes selected by LASSO predicted 1, 3, and 5-year OS, with an area under the curve (AUC) of 0.72, 0.72, 0.69, receptively, in TCGA-LUAD dataset and an independent validation dataset available from the European Genome-phenome Archive (EGA). CONCLUSION Our results demonstrate that age contributes to OS of LUAD patients atleast in part through its association with immune infiltration in the TME.
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Affiliation(s)
- Andrew Zhou
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Dalin Zhang
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Xiaoman Kang
- Department of OncologyStanford University School of MedicineStanfordCaliforniaUSA
| | - James D. Brooks
- Department of UrologyStanford University School of MedicineStanfordCaliforniaUSA
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7
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Dieleman E, van der Woude L, van Os R, van Bockel L, Coremans I, van Es C, De Jaeger K, Knol HP, Kolff W, Koppe F, Pomp J, Reymen B, Schinagl D, Spoelstra F, Tissing-Tan C, van der Voort van Zyp N, van der Wel A, Wijsman R, Dielwart M, Wiegman E, Damhuis R, Belderbos J. The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R): Real-World Data on Stage III Non-Small Cell Lung Cancer Patients Treated With Curative Chemoradiation. Clin Lung Cancer 2023; 24:130-136. [PMID: 36572596 DOI: 10.1016/j.cllc.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chemoradiotherapy (CRT) is the standard of care in inoperable non-small-cell lung cancer (NSCLC) patients, favoring concurrent (cCRT) over sequential CRT (seqCRT), with adjuvant immunotherapy in responders. Elderly and frail NSCLC patients have generally been excluded from trials in the past. In elderly patients however, the higher treatment related morbidity of cCRT, may outweigh the possible lower tumor control of seqCRT. For elderly patients with locally advanced NSCLC real-world data is essential to be able to balance treatment toxicity and treatment outcome. The aim of this study is to analyze acute toxicity and 3-month mortality of curative chemoradiation (CRT) in patients with stage III NSCLC and to analyze whether cCRT for elderly stage III NSCLC patients is safe. METHODS The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) is a national lung cancer audit that started in 2013 for patients treated with curative intent radiotherapy. All Dutch patients treated for stage III NSCLC between 2015 and 2018 with seqCRT or cCRT for (primary or recurrent) stage III lung cancer are included in this population-based study. Information was collected on patient, tumor- and treatment characteristics and the incidence and severity of acute non-hematological toxicity (CTCAE-4 version 4.03) and mortality within 3 months after the end of radiotherapy. To evaluate the association between prognostic factors and outcome (acute toxicity and mortality within 3 months), an univariable and multivariable analysis was performed. The definition of cCRT was:radiotherapy started within 30 days after the start of chemotherapy. RESULTS Out of all 20 Dutch departments of radiation oncology, 19 centers participated in the registry. A total of 2942 NSCLC stage III patients were treated with CRT. Of these 67.2% (n = 1977) were treated with cCRT (median age 66 years) and 32.8% (n = 965) were treated with seqCRT (median age 69 years). Good performance status (WHO 0-1) was scored in 88.6% for patients treated with cCRT and in 71.0% in the patients treated with seqCRT. Acute nonhematological 3-month toxicity (CTCAE grade ≥3 or radiation pneumonitis grade ≥2) was scored in 21.9% of the patients treated with cCRT and in 17.7% of the patients treated with seqCRT. The univariable analysis for acute toxicity showed significantly increased toxicity for cCRT (P = .008), WHO ≥2 (P = .006), and TNM IIIC (P = .031). The multivariable analysis for acute toxicity was significant for cCRT (P = .015), WHO ≥2 (P = .001) and TNM IIIC (P = .016). The univariable analysis for 3-month mortality showed significance for seqCRT (P = .025), WHO ≥2 (P < .001), higher cumulative radiotherapy dose (P < .001), higher gross tumor volume total (P = .020) and male patients (p < .001). None of these variables reached significance in the multivariable analysis for 3-month mortality. CONCLUSION In this national lung cancer audit of inoperable NSCLC patients, 3-month toxicity was significantly higher in patients treated with cCRT (21.9% vs. 17.7% for seqCRT) higher TNM stage IIIC, and poor performance (WHO≥2) patients.The 3-months mortality was not significantly different for tested parameters. Age was not a risk factor for acute toxicity, nor 3 months mortality.
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Affiliation(s)
- Edith Dieleman
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | - Lisa van der Woude
- RadboudUMC, Cardiothoracic surgery, Nijmegen, The Netherlands; Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Rob van Os
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | | | - Ida Coremans
- LUMC, Radiation Oncology, Leiden, The Netherlands
| | | | - Katrien De Jaeger
- Catharina Ziekenhuis, Radiation Oncology, Eindhoven, The Netherlands
| | - Hans Peter Knol
- Noordwest Ziekenhuis groep, Radiation Oncology, Alkmaar, The Netherlands
| | - Willemijn Kolff
- Amsterdam UMC location AMC, Radiation Oncology, Amsterdam, The Netherlands
| | - Frederike Koppe
- Instituut Verbeeten, Radiation Oncology, Tilburg, The Netherlands
| | - Jacqueline Pomp
- Medisch Spectrum Twente, Radiation Oncology, Enschede, The Netherlands
| | - Bart Reymen
- Maastro, Radiation Oncology, Maastricht, The Netherlands
| | | | - Femke Spoelstra
- Amsterdam UMC location VUMC, Radiation Oncology, Amsterdam, The Netherlands
| | | | | | - Antoinet van der Wel
- Radiotherapeutisch Instituut Friesland, Radiation Oncology, Leeuwarden, The Netherlands
| | - Robin Wijsman
- UMCG, Radiation Oncology, Groningen, The Netherlands
| | | | | | - Ronald Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Jose Belderbos
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
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Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13235923. [PMID: 34885034 PMCID: PMC8657053 DOI: 10.3390/cancers13235923] [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] [Received: 09/24/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Various radiotherapy treatment methods are available for patients with stage III non-small-cell lung cancer (NSCLC). A multidisciplinary tumor board review is recommended to determine the best treatment strategy. In fit patients with inoperable tumors, concurrent chemoradiotherapy (cCRT) is preferred over sequential CRT (sCRT), due to better survival. Nonetheless, the use of cCRT in stage III NSCLC varies significantly, with concerns about treatment toxicity being a contributory factor. Many reports describing the relationship between overall survival, toxicity, and dosimetry in patients with locally advanced NSCLC are based on clinical trials, with strict criteria for patient selection, including good performance status, pulmonary function, etc. These trials have not always mandated the use of IMRT/VMAT. We therefore performed an institutional analysis to study the relationship between dosimetric parameters and overall survival and toxicity in patients with stage III NSCLC treated with IMRT/VMAT-based techniques in routine clinical practice. Abstract Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (n = 64) and (2) sCRT/RT (n = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process.
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9
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Ronden MI, Bahce I, Claessens NJ, Barlo N, Dahele MR, Daniels JM, Tissing-Tan C, Hekma E, Hashemi SM, van der Wel A, Spoelstra FO, Verbakel WFR, Tiemessen MA, van Laren M, Becker A, Tarasevych S, Haasbeek CJ, Maassen van den Brink K, Dickhoff C, Senan S. The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis. JTO Clin Res Rep 2021; 2:100195. [PMID: 34590040 PMCID: PMC8474425 DOI: 10.1016/j.jtocrr.2021.100195] [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: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Treatment patterns in stage III NSCLC can vary considerably between countries. The PACIFIC trial reported improvements in progression-free and overall survival with adjuvant durvalumab after concurrent chemoradiotherapy (CCRT). We studied treatment decision-making by three Dutch regional thoracic multidisciplinary tumor boards between 2015 and 2019, to identify changes in practice when adjuvant durvalumab became available. METHODS Details of patients presenting with stage III NSCLC were retrospectively collected. Both CCRT and multimodality schemes incorporating planned surgery were defined as being radical-intent treatment (RIT). RESULTS Of 855 eligible patients, most (95%) were discussed at a thoracic multidisciplinary tumor board, which recommended a RIT in 63% (n = 510). Only 52% (n = 424) of the patients finally received a RIT. Predictors for not recommending RIT were age greater than or equal to 70 years, WHO performance score greater than or equal to 2, Charlson comorbidity index greater than or equal to 2 (excluding age), forced expiratory volume in 1 second less than 80% of predicted value, N3 disease, and period of diagnosis. Between 2015 to 2017 and 2018 to 2019, the proportion of patients undergoing CCRT increased from 34% to 42% (p = 0.02) and use of sequential chemoradiotherapy declined (21%-16%, p = 0.05). Rates of early toxicity and 1-year mortality were comparable for both periods. After 2018, 57% of the patients who underwent CCRT (90 of 159) received adjuvant durvalumab. CONCLUSIONS After publication of the PACIFIC trial, a significant increase was observed in the use of CCRT for patients with stage III NSCLC with rates of early toxicity and mortality being unchanged. Since 2018, 57% of the patients undergoing CCRT went on to receive adjuvant durvalumab. Nevertheless, approximately half of the patients were still considered unfit for a RIT.
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Affiliation(s)
- Merle I. Ronden
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Nicole Barlo
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Max R. Dahele
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Edo Hekma
- Department of Surgery, Rijnstate Ziekenhuis, Arnhem, the Netherlands
| | | | | | | | | | - Marian A. Tiemessen
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Marjolein van Laren
- Department of Pulmonology, Dijklander Ziekenhuis, Hoorn & Purmerend, the Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | | | - Chris Dickhoff
- Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
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Evers J, de Jaeger K, Hendriks LEL, van der Sangen M, Terhaard C, Siesling S, De Ruysscher D, Struikmans H, Aarts MJ. Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008 to 2018: A nationwide population-based study from the Netherlands. Lung Cancer 2021; 155:103-113. [PMID: 33774382 DOI: 10.1016/j.lungcan.2021.03.013] [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: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression. RESULTS In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)). CONCLUSIONS The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
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Affiliation(s)
- Jelle Evers
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Katrien de Jaeger
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
| | - Lizza E L Hendriks
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Pulmonary Diseases, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| | - Maurice van der Sangen
- Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
| | - Chris Terhaard
- Utrecht University Medical Center, Department of Radiation Oncology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands.
| | - Dirk De Ruysscher
- Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO Clinic), Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands.
| | - Henk Struikmans
- Leiden University Medical Centre, Department of Radiation Oncology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Mieke J Aarts
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands.
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