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Xiao H, Han Q, Wei S, Du M, Deng X, Zhang N, Li C, Wang J, Qu A, Jiang P. Setup errors analysis in iterative kV CBCT: A clinical study of cervical cancer treated with Volumetric Modulated Arc Therapy. J Appl Clin Med Phys 2024; 25:e14480. [PMID: 39120606 PMCID: PMC11466492 DOI: 10.1002/acm2.14480] [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: 04/06/2024] [Revised: 06/17/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE This study aims to analyze setup errors in pelvic Volumetric Modulated Arc Therapy (VMAT) for patients with non-surgical primary cervical cancer, utilizing the onboard iterative kV cone beam CT (iCBCT) imaging system on the Varian Halcyon 2.0 ring gantry structure accelerator to enhance radiotherapy precision. METHOD We selected 132 cervical cancer patients who underwent VMAT with daily iCBCT imaging guidance. Before each treatment session, a registration method based on the bony structure was employed to acquire iCBCT images with the corresponding planning CT images. Following verification and adjustment of image registration results along the three axes (but not rotational), setup errors in the lateral (X-axis), longitudinal (Y-axis), and vertical (Z-axis) directions were recorded for each patient. Subsequently, we analyzed 3642 iCBCT image setup errors. RESULTS The mean setup errors for the X, Y, and Z axes were 4.50 ± 3.79 mm, 6.08 ± 6.30 mm, and 1.48 ± 2.23 mm, respectively. Before correction with iCBCT, setup margins based on the Van Herk formula for the X, Y, and Z axes were 6.28, 12.52, and 3.26 mm, respectively. In individuals aged 60 years and older, setup errors in the X and Y axes were significantly larger than those in the younger group (p < 0.05). Additionally, there is no significant linear correlation between setup errors and treatment fraction numbers. CONCLUSION Data analysis underscores the importance of precise Y-axis setup for cervical cancer patients undergoing VMAT. Radiotherapy centers without daily iCBCT should appropriately extend the planning target volume (PTV) along the Y-axis for cervical cancer patients receiving pelvic VMAT. Elderly patients exhibit significantly larger setup errors compared to younger counterparts. In conclusion, iCBCT-guided radiotherapy is recommended for cervical cancer patients undergoing VMAT to improve setup precision.
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Affiliation(s)
- Hui Xiao
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Qiman Han
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Shuhua Wei
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Minghao Du
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Xiuwen Deng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Nan Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, P. R. China
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Ishii R, Ohkoshi A, Katori Y. Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment. Auris Nasus Larynx 2024; 51:647-658. [PMID: 38631257 DOI: 10.1016/j.anl.2024.04.005] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
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Pan K, Wang B, Xu X, Liang J, Tang Y, Ma S, Xia B, Zhu L. Hypofractionated stereotactic radiotherapy for brain metastases in lung cancer patients: dose‒response effect and toxicity. Discov Oncol 2024; 15:318. [PMID: 39078419 PMCID: PMC11289209 DOI: 10.1007/s12672-024-01191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Lung cancer is a common cause of brain metastases, approximately 40% of patients with lung cancer will develop brain metastases at some point during their disease. Hypofractionated stereotactic radiotherapy (HSRT) has been demonstrated to be effective in controlling limited brain metastases. However, there is still no conclusive on the optimal segmentation of HSRT. The aim of our study was to explore the correlation between the HSRT dosage and its treatment effect and toxicity. METHODS A retrospective analysis was conducted on patients with non-small cell lung cancer (NSCLC) brain metastasis at Hangzhou Cancer Hospital from 1 January 2019 to 1 January 2021. The number of brain metastases did not exceed 10 in all patients and the number of fractions of HSRT was 5. The prescription dose ranges from 25 to 40 Gy. The Kaplan-Meier method was used for estimation of the localised intracranial control rate (iLC). Adverse radiation effects (AREs) were evaluated according to CTCAE 5.0. This study was approved by the Institutional Ethics Review Board of the Hangzhou Cancer Hospital (#73/HZCH-2022). RESULTS Forty eligible patients with a total of 70 brain metastases were included in this study. The 1-year iLC was 76% and 89% in the prescribed dose ≤ 30 Gy and > 30 Gy group, respectively (P < 0.05). For patients treated with HSRT combined with targeted therapy, immunotherapy and chemotherapy, the 1-year iLC was 89%, 100%, and 45%, respectively. No significant associations were observed between the number, maximum diameter, location, and type of pathology of brain metastases. The rate of all-grade AREs was 33%. Two patients who received a total dose of 40 Gy developed grade 3 headache, the rest of the AREs were grade 1-2. CONCLUSIONS Increasing the prescription dose of HSRT improves treatment effect but may also exacerbate the side effects. Systemic therapy might impact the iLC rate, and individualized treatment regimens need to be developed.
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Affiliation(s)
- Kaicheng Pan
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Bing Wang
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Xiao Xu
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Jiafeng Liang
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Yi Tang
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Shenglin Ma
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Bing Xia
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China.
| | - Lucheng Zhu
- Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China.
- Department of Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
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Neibart SS, Moningi S, Jethwa KR. Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Cancer. Clin Exp Gastroenterol 2024; 17:213-225. [PMID: 39050120 PMCID: PMC11268661 DOI: 10.2147/ceg.s341189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction For patients with locally advanced pancreatic cancer (LAPC), who are candidates for radiation therapy, dose-escalated radiation therapy (RT) offers unique benefits over traditional radiation techniques. In this review, we present a historical perspective of dose-escalated RT for LAPC. We also outline advances in SBRT delivery, one form of dose escalation and a framework for selecting patients for treatment with SBRT. Results Techniques for delivering SBRT to patients with LAPC have evolved considerably, now allowing for dose-escalation and superior respiratory motion management. At the same time, advancements in systemic therapy, particularly the use of induction multiagent chemotherapy, have called into question which patients would benefit most from radiation therapy. Multidisciplinary assessment of patients with LAPC is critical to guide management and select patients for local therapy. Results from ongoing trials will establish if there is a role of dose-escalated SBRT after induction chemotherapy for carefully selected patients. Conclusion Patients with LAPC have more therapeutic options than ever before. Careful selection for SBRT may enhance patient outcomes, pending the maturation of pivotal clinical trials.
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Affiliation(s)
- Shane S Neibart
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shalini Moningi
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Ahmed I, Krishnamurthy S, Bhise R, Vinchurkar K, Kalloli M. Outcomes with optimal treatment in geriatric head and neck cancers - Tertiary cancer centre experience. J Cancer Res Ther 2024; 20:1384-1389. [PMID: 39412904 DOI: 10.4103/jcrt.jcrt_34_22] [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: 01/06/2022] [Accepted: 01/27/2023] [Indexed: 10/18/2024]
Abstract
AIM Older patients with locally advanced head and neck cancers (LA-HNC) are under-represented in clinical trials and denied standard treatment with concurrent chemo-radiation. Most are treated with radiotherapy (RT) alone. However, with the use of Intensity Modulated Radiation Therapy (IMRT) and good supportive care, even this cohort of patients can be considered for chemo-radiation. METHODS AND MATERIALS 69 patients with age >65 years with LA-HNC treated between April 2015 and December 2019 in our Institute were prospectively evaluated for treatment compliance and outcomes. All patients were planned to receive 70 Gy in 33-35 fractions with IMRT and weekly Cisplatin at a dose of 40 mg/m2 (or Carboplatin-AUC-2). Loco-regional control (LRC), Overall survival (OS), and prognostic factors were evaluated. RESULTS Median age at presentation was 67 years (65-81). 54 were male. 64% had Karnofsky Performance Status of >90. 42% had Oropharyngeal Primary. 17% had co-morbidities, 66% had T3 disease, 77% had Node positive disease, and 54% had Stage III disease. All patients completed 70 Gy and 81% patients received at least 5 (>200 mg/m2) chemotherapy cycles. Acute grade-3 toxicity was seen in 20% of patients and 64% had complete response. With a median follow up of 23.6 months (3-71), OS was 53.5%. Estimated 2-year LRC was 60%; estimated 2- and 5-year OS was 53.5% and 34.3%, respectively. On univariate analysis, age <70 years, Cisplatin use, limited nodal disease, Stage III, and complete response to treatment showed good OS (p < 0.05). CONCLUSION Definitive chemo-IMRT approach in older patients with LA-HNC is well tolerated with good clinical outcomes. Hence, older age should not be a barrier for standard treatment.
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Affiliation(s)
- Imtiaz Ahmed
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Sapna Krishnamurthy
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Rohan Bhise
- Department of Medical Oncology, KLES Belgaum Cancer Hospital and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Kumar Vinchurkar
- Department of Surgical Oncology, KLES Belgaum Cancer Hospital and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Mahesh Kalloli
- Department of Surgical Oncology, KLES Belgaum Cancer Hospital and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
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Monfardini S, Perrone F, Balducci L. Pitfalls in Oncogeriatrics. Cancers (Basel) 2023; 15:cancers15112910. [PMID: 37296871 DOI: 10.3390/cancers15112910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
An oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly. Despite major shortcomings, professionals interested in geriatric oncology have taken a number of important initiatives to highlight the benefits of this particular activity, including the organization of an international society (Société Internationale de Oncogeriatrie, or SIOG). In spite of these efforts, the authors believe that the management of cancer in the older population is still encountering several important and generalized pitfalls. The main obstacle is the grossly inadequate number of geriatricians and clinical oncologists necessary to an integrated care of the ever-expanding aging population, but other hurdles have been reported. Additionally, the prejudice of ageism can lead to missing potential resources for the development of a generalized oncogeriatric approach.
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Affiliation(s)
- Silvio Monfardini
- History of European Oncology Program, European School of Oncology, 20121 Milan, Italy
| | - Francesco Perrone
- Director Clinical Trial Unit, National Cancer Institute, IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Lodovico Balducci
- Oncology and Medicine, University of South Florida College of Medicine and Division of Geriatric Oncology, Senior Adult Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33620, USA
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Cao BY, Wang QQ, Zhang LT, Wu CC, Tong F, Yang W, Wang J. Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma. World J Gastrointest Oncol 2023; 15:155-170. [PMID: 36684051 PMCID: PMC9850762 DOI: 10.4251/wjgo.v15.i1.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/27/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Older patients represent a unique subgroup of the cancer patient population, for which the role of cancer therapy requires special consideration. However, the outcomes of radiation therapy (RT) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) are not well-defined in the literature.
AIM To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.
METHODS Data from patients with PDAC aged ≥ 65 years between 2004 and 2018 were collected from the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression analysis was performed to determine factors associated with RT administration. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using the Kaplan–Meier method with the log-rank test. Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS. Propensity score matching (PSM) was applied to balance the baseline characteristics between the RT and non-RT groups. Subgroup analyses were performed based on clinical characteristics.
RESULTS A total of 12245 patients met the inclusion criteria, of whom 2551 (20.8%) were treated with RT and 9694 (79.2%) were not. The odds of receiving RT increased with younger age, diagnosis in an earlier period, primary site in the head, localized disease, greater tumor size, and receiving chemotherapy (all P < 0.05). Before PSM, the RT group had better outcomes than did the non-RT group [median OS, 14.0 vs 6.0 mo; hazard ratio (HR) for OS: 0.862, 95% confidence interval (CI): 0.819–0.908, P < 0.001; and HR for CSS: 0.867, 95%CI: 0.823–0.914, P < 0.001]. After PSM, the survival benefit associated with RT remained comparable (median OS: 14.0 vs 11.0 mo; HR for OS: 0.818, 95%CI: 0.768–0.872, P < 0.001; and HR for CSS: 0.816, 95%CI: 0.765–0.871, P < 0.001). Subgroup analysis revealed that the survival benefits (OS and CSS) of RT were more significant in patients aged 65 to 80 years, in regional and distant stages, with no surgery, and receiving chemotherapy.
CONCLUSION RT improved the outcome of elderly patients with PDAC, particularly those aged 65 to 80 years, in regional and distant stages, with no surgery, and who received chemotherapy. Further prospective studies are warranted to validate our results.
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Affiliation(s)
- Bi-Yang Cao
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Beijing 100853, China
| | - Qian-Qian Wang
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Le-Tian Zhang
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Beijing 100853, China
| | - Chen-Chen Wu
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
- Medical School of Chinese PLA, Beijing 100853, China
| | - Fang Tong
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wei Yang
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Wang
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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Bryant JM, Palm RF, Herrera R, Rubens M, Hoffe SE, Kim DW, Kaiser A, Ucar A, Fleming J, De Zarraga F, Hodul P, Aparo S, Asbun H, Malafa M, Jimenez R, Denbo J, Frakes JM, Chuong MD. Multi-Institutional Outcomes of Patients Aged 75 years and Older With Pancreatic Ductal Adenocarcinoma Treated With 5-Fraction Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy (A-SMART). Cancer Control 2023; 30:10732748221150228. [PMID: 36598464 PMCID: PMC9982388 DOI: 10.1177/10732748221150228] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Treatment options for pancreatic ductal adenocarcinoma (PDAC) are commonly limited for patients with advanced age due to medical comorbidities and/or poor performance status. These patients may not be candidates for more aggressive chemotherapy regimens and/or surgical resection leaving few, if any, other effective treatments. Ablative stereotactic MRI-guided adaptive radiation therapy (A-SMART) is both efficacious and safe for PDAC and can achieve excellent long-term local control, however, the appropriateness of A-SMART for elderly patients with inoperable PDAC is not well understood. METHODS A retrospective analysis was performed of inoperable non-metastatic PDAC patients aged 75 years or older treated on the MRIdian Linac at 2 institutions. Clinical outcomes of interest included overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional (LRC). Toxicity was graded according to Common Terminology Criteria for Adverse Events (CTCAE, v5). RESULTS A total of 49 patients were evaluated with a median age of 81 years (range, 75-91) and a median follow-up of 14 months from diagnosis. PDAC was classified as locally advanced (46.9%), borderline resectable (36.7%), or medically inoperable (16.3%). Neoadjuvant chemotherapy was delivered to 84% of patients and all received A-SMART to a median 50 Gy (range, 40-50 Gy) in 5 fractions. 1 Year LRC, PFS, and OS were 88.9%, 53.8%, and 78.9%, respectively. Nine patients (18%) had resection after A-SMART and benefited from PFS improvement (26 vs 6 months, P = .01). ECOG PS <2 was the only predictor of improved OS on multivariate analysis. Acute and late grade 3 + toxicity rates were 8.2% and 4.1%, respectively. CONCLUSIONS A-SMART is associated with encouraging LRC and OS in elderly patients with initially inoperable PDAC. This novel non-invasive treatment strategy appears to be well-tolerated in patients with advanced age and should be considered in this population that has limited treatment options.
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Affiliation(s)
- JM Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA,JM Bryant, Department of Radiation Oncology, Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
| | - Russell F Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Roberto Herrera
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Miami, FL, USA,Muni Rubens, Office of Clinical Research, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Dae Won Kim
- Department of Medical Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Antonio Ucar
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Jason Fleming
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | | | - Pamela Hodul
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Santiago Aparo
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Horacio Asbun
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Mokenge Malafa
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Ramon Jimenez
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Jason Denbo
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA
| | - Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
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Mackenzie P, Vajdic C, Delaney G, Comans T, Morris L, Agar M, Gabriel G, Barton M. Radiotherapy utilisation rates for patients with cancer as a function of age: A systematic review. J Geriatr Oncol 2022; 14:101387. [PMID: 36272958 DOI: 10.1016/j.jgo.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION There is an increasing incidence of cancer in older people, but limited data on radiotherapy uptake, and in particular, radiotherapy utilisation (RTU) rates. The RTU rate for older adults with cancer may be lower than recommended due to lower tolerance for radiotherapy as well as additional comorbidities, reduced life expectancy and travel for treatment. Radiotherapy use must be aligned with best available, age-specific evidence to ensure older adults with cancer receive optimal benefit without harms. MATERIALS AND METHODS A systematic review was conducted to synthesise the published data on the actual RTU rate for patients with cancer as a function of age. MEDLINE and EMBASE were systematically searched to identify relevant population-based and hospital-based cohort studies on radiotherapy utilisation for all age groups, published in English, from 1 January 1990 to 1 July 2020. We focused on the following common cancers in older adults for which radiotherapy is recommended: breast, prostate, lung, rectal cancer, glioblastoma multiforme (GBM), and cervical cancer. Age-specific radiotherapy utilisation data were extracted and analysed as a narrative synthesis. RESULTS From 2606 studies screened, 75 cohort and population-based studies were identified with age-specific radiotherapy utilisation data. The total number of patients in the 75 studies was 4,792,138. The RTU rate decreased with increasing age for all tumour sites analysed, except for patients receiving curative radiotherapy as definitive treatment for prostate or cervical cancer. This reduction with increasing age was demonstrated in both palliative and curative settings. DISCUSSION There is a global reduction in radiotherapy utilisation with increasing age for most tumour sites. The reduction in delivery of radiotherapy warrants further examination and evidence-based guidelines specific to this population.
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Loap P, Kirova Y. [The place of radiotherapy]. SOINS. GERONTOLOGIE 2022; 27:18-20. [PMID: 36280367 DOI: 10.1016/j.sger.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Radiation therapy (RT) is a key component of the management of elderly breast cancer patients. However, level I evidence in elderly patients is limited. Patient selection should include comorbidities and geriatric assessment. Advances in radiation planning and delivery are improving target coverage, reducing toxicity, and expanding treatment eligibility. Some alternative techniques, such as treatment in the lateral or prone position, may reduce the risk of toxicity. Shorter cycles of hypofractionated whole breast RT are safe and effective. In some cases, partial breast irradiation may be an option.
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Affiliation(s)
- Pierre Loap
- Institut Curie, 26 rue d'Ulm, 75005 Paris, France
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11
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Sawaki M, Shimomura A, Shien T, Iwata H. Management of breast cancer in older patients. Jpn J Clin Oncol 2022; 52:682-689. [DOI: 10.1093/jjco/hyac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient’s life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient’s goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.
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Affiliation(s)
- Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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12
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Ishii R, Ohkoshi A, Kiyota N, Matsuura K, Yasuda K, Imamura Y, Saito Y, Homma A. Management of elderly patients with head and neck cancer. Jpn J Clin Oncol 2022; 52:313-321. [PMID: 35165732 DOI: 10.1093/jjco/hyac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
There are no established guidelines for managing older patients with head and neck cancer. Most clinical trials that define current standard therapy included few elderly patients. On the other hand, there is great variability in patients' comorbidities, physical functions, cognitive function, familial and financial background and values. The key point appears to be appropriate geriatric assessment, clarifying the patients' outcomes and a multidisciplinary team approach, including the treatment decision-making policy. Although these processes should be scientific in nature, the evidence for the treatment of elderly head and neck patients is very limited. This review summarizes the evidence available regarding the management of geriatric assessment, each treatment modality and the multidisciplinary team approach for older patients with head and neck cancers.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Yuki Saito
- Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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13
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Multimodality Treatment with Radiotherapy and Immunotherapy in Older Adults: Rationale, Evolving Data, and Current Recommendations. Semin Radiat Oncol 2022; 32:142-154. [DOI: 10.1016/j.semradonc.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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14
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Bhattacharyya T, Shinoto M, Takiyama H, Nitta Y, Koto M, Imai R, Ikawa H, Nomoto A, Tsuji H, Yamada S. Long-term outcomes of octogenarian pancreatic cancer patients treated with carbon ion radiotherapy. Pancreatology 2022; 22:381-386. [PMID: 35317974 DOI: 10.1016/j.pan.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cancer is a disease of the elderly; patients >65 years are 60% of the cases. Due to multiple comorbidities, treating these patients is challenging. We report the efficacy and safety of carbon ion radiotherapy (C-ion RT) in octogenarians. METHODS We retrospectively analyzed the cases of 46 pancreatic cancer patients aged ≥80 years (median 83, range 80-97) treated with definitive C-ion RT in 2007-2018 at our institute. RESULTS Twenty-five patients (54%) had resectable or borderline-resectable disease; none underwent surgery (because of medical reasons, e.g., age, multiple comorbidities). C-ion RT was delivered with a median dose of 55.2 Gy (RBE) in 12 fractions. The survivors' median follow-up period was 43 (range 19-76) months. The entire cohort's median overall survival (OS) was 15 (95%CI: 14-22) months with a 3-year OS of 20% (95%CI: 11%-35%). On both univariate and multivariate analyses, baseline CA19-9 remained the significant independent OS prognostic factor (p = 0.032). The 3-year local control rate for all patients was 34% (95%CI: 19%-53%). Local failure (n = 25, 54%) was as common as distant relapse (n = 26, 57%); 33% of the patients experienced both local and systemic failure. About 15% underwent re-C-ion RT for infield recurrence; they achieved a median 22-month OS. No patients exhibited grade ≥3 severe acute or late toxicities (including those who received re-C-ion RT). CONCLUSIONS C-ion RT in octogenarians with pancreatic cancer showed promising outcomes with acceptable acute and late toxicities and can be considered a reasonable alternative to radical surgery.
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Affiliation(s)
- Tapesh Bhattacharyya
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan; Department of Radiation Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, 700 160, West Bengal, India.
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Yuki Nitta
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Reiko Imai
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Akihiro Nomoto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
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15
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Piras A, Boldrini L, Menna S, Venuti V, Pernice G, Franzese C, Angileri T, Daidone A. Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician. Front Oncol 2021; 11:761393. [PMID: 34868976 PMCID: PMC8633531 DOI: 10.3389/fonc.2021.761393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Radiotherapy (RT) in the head and neck (H&N) site are undoubtedly the most challenging treatments for patients. Older and frail patients are not always able to tolerate it, and there are still no clear guidelines on the type of treatments to be preferred for them. The recommendations for Risk-Adapted H&N Cancer Radiation Therapy during the coronavirus disease 2019 (COVID-19) pandemic provided by the ASTRO-ESTRO consensus statement achieved a strong agreement about hypofractionated RT (HFRT). A systematic literature review was conducted in order to evaluate the feasibility and safety of HFRT for older patients affected by H&N malignancies. Materials and Methods A systematic database search was performed on PubMed and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Original studies, case series, and case reports describing the use of HFRT (with at least 2.2 Gy fractions) in patients with mean age ≥65 years were included. The analysis was based on the type of study, number of patients, mean age, tumor site, histology, performance status (PS), RT details, concomitant chemotherapy (CT), and described clinical outcomes. All the reported doses have been calculated in equivalent dose in 2 Gy fractions (EQD2) and biologically effective dose (BED) using α/β = 10 Gy or α/β = 12 Gy. Results We selected 17 papers that met the inclusion criteria and divided them in 4 categories: 6 articles analyze HFRT performed twice daily in repeated cycles, 3 once a day in repeated cycles, 4 in alternative days, and the last 4 in consecutive days. Conclusion HFRT seems to be a good treatment with an acceptable prolonged disease control. In older patients fit for radical treatments, a 55 Gy in 20 fractions regimen can be proposed as a valid alternative to the standard fractionated RT, but there are a multitude of hypofractionated regimens, ranging from single fraction, quad shot, and 1-, 2-, 3-, 4-, and 5-week schedules that all may be appropriate. The correct regimen for a patient depends on many factors, and it represents the result of a more specific and complex decision.
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Affiliation(s)
- Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica-Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Sebastiano Menna
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica-Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | | | - Ciro Franzese
- Radiotherapy Department, Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Biomedical Science Department, Humanitas University, Milan, Italy
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16
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International efforts in geriatric radiation oncology. J Geriatr Oncol 2021; 13:356-362. [PMID: 34782281 DOI: 10.1016/j.jgo.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Geriatric assessment (GA) has been recommended to form part of treatment decision making for older adults with cancer. However despite consensus guidelines from various organizations, GA does not appear to be a part of routine practice in radiation oncology. The aim of the current study was to explore the implementation of GA in radiation oncology. MATERIALS AND METHODS This anonymous international survey investigated current use of GA in patients presenting for radiation therapy aged 65 years and over, in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines. The survey was designed, using Qualitrics™, an online survey tool. It was distributed via SIOG, social media and radiation oncology professional organizations. Survey responses were analyzed using simple descriptive statistics. An additional analysis by creating a dichotomous variable based on awareness of major clinical practice guidelines and current use of GA. RESULTS Among 158 respondents, there was relatively low awareness of GA guidelines and low uptake of validated tools and processes. A minority of participants, only 16%, stated that they had a specialized geriatric oncology program in their institution. Approximately a third (34%) of respondents were unaware of any GA clinical practice guidelines. With regard to what way participants assess older patients differently to younger patients, 16% reported formally using specific validated tools, whereas 73% reported an informal assessment based on their own judgment, with 5% reporting no difference between younger and older patients. Regarding the use of validated screening tools for geriatric impairments, over half reported using none (57%). Regarding GA implementation, the main barriers highlighted included a lack of clinical/support staff, a lack of training, knowledge, understanding or experience about GA and a lack of time. DISCUSSION Relatively low awareness of guidelines and low uptake of formal GA tools and processes were found. The integration of GA principles into radiation oncology appears to be ad hoc and very much in its infancy. There is a clear need for increased interdisciplinary education and collaboration between the disciplines of radiation oncology and geriatric medicine.
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17
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Desai P, Aggarwal A. Breast Cancer in Women Over 65 years- a Review of Screening and Treatment Options. Clin Geriatr Med 2021; 37:611-623. [PMID: 34600726 DOI: 10.1016/j.cger.2021.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Breast cancer is becoming increasingly prevalent in the women greater than 65 years of age. Most tumors are hormone receptor-positive in this group. Breast cancer screening recommendations for older women should be tailored based on life expectancy. Early stage breast cancer should be treated with conservative surgery followed by adjuvant endocrine therapy in HR+ patients. Primary endocrine therapy is a low-risk option for those with limited life expectancy. Adjuvant radiation therapy can be avoided in early stage, low-risk cancers. Evaluation should include comprehensive geriatric assessment. Treatment with less cytotoxic chemotherapy, HER-2 targeted therapies, and other biomarker-driven, molecularly targeted therapies should be sought whenever possible.
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Affiliation(s)
- Parth Desai
- Hematology/Oncology Division, Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA
| | - Anita Aggarwal
- Hematology/Oncology Division, Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA.
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18
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Zhang R, Guo Y, Yan Y, Liu Y, Zhu Y, Kang J, Li F, Sun X, Xing L, Xu Y. A Propensity-Matched Analysis of Survival of Clinically Diagnosed Early-Stage Lung Cancer and Biopsy-Proven Early-Stage Non-Small Cell Lung Cancer Following Stereotactic Ablative Radiotherapy. Front Oncol 2021; 11:720847. [PMID: 34504798 PMCID: PMC8421845 DOI: 10.3389/fonc.2021.720847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) has been increasingly regarded as a reasonable option for early-stage lung cancer patients without pretreatment pathologic results, but the efficacy and safety in a Chinese population remains unclear. The aim of this study was to compare survival outcomes and toxicities between patients with clinically diagnosed early-stage lung cancer or biopsy-proven early-stage non-small cell lung cancer and to demonstrate the rationality of this treatment. Material and Methods From May 2012 to December 2018, 56 patients with clinically diagnosed early-stage lung cancer and 60 patients with early-stage biopsy-proven were selected into non-pathological group and pathological group, respectively. Propensity score matching (PSM) was performed to reduce patient selection bias. Survival analysis with log-rank test was used to assess the differences of treatment outcomes, which included local control (LC), progression-free survival (PFS), and overall survival (OS). Results The median age was 76 (range 47–93) years, and the median follow-up time was 58.3 (range 4.3–95.1) months in the cohort without pathologic results. The median age was 74 (range 57–88) years, and the median follow-up time was 56.3 (range 2.6–94) months in the cohort with pathologic results. 45 matched-pair were analyzed. The 5-year LC, PFS, and OS rates in matched-pair patients with or without pathologic biopsy were 85.5% and 89.8%, 40.6% and 70.9%, and 63.2% and 76.1%, respectively. On Kaplan-Meier survival analysis after PSM analysis, there was no significant difference between patients with pathologic results versus patients with no pathologic results in terms of LC (P= 0.498) and OS (P=0.141). Of the matched-pair patients treated with SBRT, only 1 patient experienced grade 3 or above radiation pneumonitis. Conclusion For early-stage lung cancer patients with medically inoperable or not suitable for invasive diagnosis, SBRT may be a good local treatment.
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Affiliation(s)
- Ran Zhang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Yanling Guo
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Yujie Yan
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.,Tongji University, Shanghai, China
| | - Yuanjun Liu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Yaoyao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jingjing Kang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fangjuan Li
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaojiang Sun
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yaping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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19
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Zhu X, Cao Y, Lu M, Zhao X, Jiang L, Ye Y, Ju X, Zhang H. Stereotactic body radiation therapy with sequential S-1 for patients with locally advanced pancreatic cancer and poor performance status: An open-label, single-arm, phase 2 trial. Radiother Oncol 2021; 162:178-184. [PMID: 34274393 DOI: 10.1016/j.radonc.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The optimal treatment for a particularly neglected group of patients with locally advanced pancreatic cancer (LAPC) and poor performance status, who are usually excluded from most clinical trials, is required. Therefore, we aim to investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) with sequential S-1 for those patients. METHODS Eligible patients had histologically and radiographically confirmed LAPC and ECOG performance status of 2 or more points determined by two independent physicians. Radiation doses ranged from 35-40 Gy/5f. S-1 was taken orally, twice daily, at a dose of 80 mg/m2 for 28 days, followed by a 14-day interval, which repeated for 6 cycles and was initiated one month after SBRT. The primary endpoint was 1-year overall survival (OS). The secondary endpoints were OS, progression free survival (PFS), treatment-related toxicity and quality of life. The study was registered at ClinicalTrials.gov: NCT02704143. RESULTS Sixty-three patients were enrolled. At the time of data cut-off, all patients died. No patients were lost to follow-up. Median follow-up was 15.8 months (95%CI 12.9-18.7 months). One-year OS was noted in 46 of 63 patients (73.0%, 95%CI 67.4%-78.6%). The median OS and PFS was 14.4 (95%CI 13.2-15.6 months) and 10.1 months (95%CI 9.7-10.5 months) respectively. Eighteen patients (28.6%) had grade 3 toxicity. According to Quality of Life Questionnaire-Core 30, significant improvements of abdominal pain were found, and patients with poorer baseline global health status had greater improvement of health status and pain relief after treatment. CONCLUSIONS SBRT with sequential S-1 shows promising efficacy and acceptable toxicity in poor performance status patients with LAPC.
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Affiliation(s)
- Xiaofei Zhu
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Yangsen Cao
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Mingzhi Lu
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Xianzhi Zhao
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Lingong Jiang
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Yusheng Ye
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Xiaoping Ju
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China
| | - Huojun Zhang
- Department of Radiation Oncology, Changhai Hospital affiliated to Naval Medical University, China.
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20
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Chapman AE, Elias R, Plotkin E, Lowenstein LM, Swartz K. Models of Care in Geriatric Oncology. J Clin Oncol 2021; 39:2195-2204. [PMID: 34043453 PMCID: PMC10476747 DOI: 10.1200/jco.21.00118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - Rawad Elias
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, CT
| | - Elana Plotkin
- Provider Education, Association of Community Cancer Centers, Rockville, MD
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kristine Swartz
- Division of Geriatrics and Palliative Care, Department of Family and Community Medicine, Sidney Kimmel Medical College/Jefferson Health, Philadelphia, PA
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21
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Andruska N, Stowe HB, Crockett C, Liu W, Palma D, Faivre-Finn C, Badiyan SN. Stereotactic Radiation for Lung Cancer: A Practical Approach to Challenging Scenarios. J Thorac Oncol 2021; 16:1075-1085. [PMID: 33901637 DOI: 10.1016/j.jtho.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is an effective and well-tolerated treatment for medically inoperable patients with early stage NSCLC. SBRT is a noninvasive treatment involving the delivery of ablative radiation doses with high precision in the course of a few treatments. Relative to conventionally fractionated radiation, SBRT achieves superior local control and survival. SBRT use has increased dramatically in the past 15 years and is currently considered the standard of care in cases of inoperable early stage NSCLC. It is being increasingly applied to more complex patient populations at higher risk of treatment-related toxicity. In these more complex patients, there is an increasing need to balance patient and treatment factors in selecting the optimal patients for SBRT. Here, we review several challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Cathryn Crockett
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wei Liu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri.
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22
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He C, Li L, Wang L, Meng W, Hao Y, Zhu G. Exosome-mediated cellular crosstalk within the tumor microenvironment upon irradiation. Cancer Biol Med 2021; 18:21-33. [PMID: 33628582 PMCID: PMC7877182 DOI: 10.20892/j.issn.2095-3941.2020.0150] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy is one of the most effective treatment methods for various solid tumors. Bidirectional signal transduction between cancer cells and stromal cells within the irradiated microenvironment is important in cancer development and treatment responsiveness. Exosomes, initially considered as “garbage bins” for unwanted from cells, are now understood to perform a variety of functions in interactions within the tumor microenvironment. Exosome-mediated regulation processes are rebuilt under the irradiation stimuli, because the exosome production, uptake, and contents are markedly modified by irradiation. In turn, irradiation-modified exosomes may modulate the cell response to irradiation through feedback regulation. Here, we review current knowledge and discuss the roles of exosome-mediated interactions between cells under radiotherapy conditions.
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Affiliation(s)
- Chuanshi He
- Department of Stomatology, Sichuan Cancer Hospital, Sichuan Key Laboratory of Radiation Oncology, School of Medicine, University of Electronic Science and Technology of China
| | - Ling Li
- Department of Stomatology, Sichuan Cancer Hospital, Sichuan Key Laboratory of Radiation Oncology, School of Medicine, University of Electronic Science and Technology of China
| | - Linlin Wang
- Department of Stomatology, Sichuan Cancer Hospital, Sichuan Key Laboratory of Radiation Oncology, School of Medicine, University of Electronic Science and Technology of China
| | - Wanrong Meng
- Department of Stomatology, Sichuan Cancer Hospital, Sichuan Key Laboratory of Radiation Oncology, School of Medicine, University of Electronic Science and Technology of China
| | - Yaying Hao
- Department of Stomatology, Sichuan Cancer Hospital, Sichuan Key Laboratory of Radiation Oncology, School of Medicine, University of Electronic Science and Technology of China
| | - Guiquan Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Thiruthaneeswaran N, Tharmalingam H, Hoskin PJ. Practical brachytherapy solutions to an age-old quandary. Tech Innov Patient Support Radiat Oncol 2020; 16:39-47. [PMID: 33385072 PMCID: PMC7769855 DOI: 10.1016/j.tipsro.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
Age should not be a limiting factor for brachytherapy in patients with localised cancer or for palliation in metastatic disease. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. Treatment decisions should factor in patient preferences, the relative merits of different therapeutic approaches and maintaining minimal impact on quality of life.
Cancer is predominantly a disease of the elderly and as population life expectancy increases, so will the incidence of malignant disease. Elderly patients often have other comorbidities and social complexities, increasing the support required to safely deliver all treatment modalities. Brachytherapy is a relatively simple technique by which radiation therapy can be delivered. It offers dosimetric advantages through a highly conformal dose distribution thereby limiting radiation exposure to normal tissues reducing toxicity. Requiring fewer hospital visits, it also offers practical and logistical advantages to the elderly population and in many cases can be performed without the need for general anaesthesia. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. In the palliative setting, brachytherapy often offers an excellent means for achieving either local tumour and/or symptom control and should be actively considered in the therapeutic armamentarium of the oncologist in this context.
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Affiliation(s)
- N Thiruthaneeswaran
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - P J Hoskin
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Mount Vernon Cancer Centre, Northwood, UK
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24
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The role of the radiation oncologist in quality and patient safety: A proposal of indicators and metrics. Crit Rev Oncol Hematol 2020; 154:103045. [DOI: 10.1016/j.critrevonc.2020.103045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
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McWilliams L. An Overview of Treating People with Comorbid Dementia: Implications for Cancer Care. Clin Oncol (R Coll Radiol) 2020; 32:562-568. [PMID: 32718761 DOI: 10.1016/j.clon.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 01/26/2023]
Abstract
With increasing prevalence of both cancer and dementia in the UK, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual, it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other comorbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared with people who have cancer alone or other comorbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this group.
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Affiliation(s)
- L McWilliams
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
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Desideri I, Salvestrini V, Livi L. Recent advances in de-intensification of radiotherapy in elderly cancer patients. F1000Res 2020; 9. [PMID: 32518630 PMCID: PMC7255897 DOI: 10.12688/f1000research.21151.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer in the elderly remains an evolving issue and a health challenge. Several improvements in the radiotherapy field allow the delivery of higher doses/fractions with a safe toxicity profile, permitting the reduction of radiation treatment protocols in the elderly. Regarding breast, prostate, and lung cancer, the under-representation of older patients in clinical trials limits the extension of treatment recommendations to elderly patients in routine clinical practice. Among the feasible alternatives to standard whole breast radiotherapy (WBRT) in older patients are shorter courses using higher hypofractionation (HF) and accelerated partial breast irradiation (APBI). The boost continues to be used in women at high risk of local recurrence but is less widely accepted for women at lower risk and patients over 70 years of age. Regarding prostate cancer, there are no published studies with a focus on the elderly. Current management decisions are based on life expectancy and geriatric assessment. Regimens of HF and ultra-HF protocols are feasible strategies for older patients. Several prospective non-randomized studies have documented the safe delivery of ultra-HF for patients with localized prostate cancer, and multiple phase III trials and meta-analyses have confirmed that the HF regimen should be offered with similar acute toxicity regardless of patient age and comorbidity. A recent pooled analysis from two randomized trials comparing surgery to stereotactic body radiation therapy (SBRT) in older adult patients with early stage non-small cell lung cancer did show comparable outcomes between surgery and SBRT. Elderly cancer patients are significantly under-represented in all clinical trials. Thus, the inclusion of older patients in clinical studies should be strongly encouraged to strengthen the evidence base for this age group. We suggest that the creation of oncogeriatric coordination units may promote individualized care protocols, avoid overtreatment with aggressive and unrecommended therapies, and support de-escalating treatment in elderly cancer patients.
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Affiliation(s)
- Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences Biochemistry, Radiotherapy Unit, University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences Biochemistry, Radiotherapy Unit, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Biochemistry, Radiotherapy Unit, University of Florence, Florence, Italy
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Shu Z, Dong B, Shi L, Shen W, Hang Q, Wang J, Chen Y. Stereotactic body radiotherapy for elderly patients (≥ 75 years) with early-stage non-small cell lung cancer. J Cancer Res Clin Oncol 2020; 146:1263-1271. [PMID: 32095885 DOI: 10.1007/s00432-020-03154-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/11/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is the primary treatment method for early-stage non-small cell lung cancer (NSCLC) considered inoperable due to medical comorbidities. However, the application of SBRT in patients aged ≥ 75 years has not been adequately studied. This retrospective study aimed to investigate the effectiveness and safety of SBRT in early-stage NSCLC patients aged ≥ 75 years, and the impact of treatment on nutritional status and self-care ability. METHODS Histopathologically confirmed early-stage (T1-3N0M0) NSCLC patients aged ≥ 75 years treated with SBRT between 2013 and 2018 at our center were identified from the electronic database. Treatment efficacy, treatment toxicities, impact of treatment on nutritional status, and self-care ability were retrospectively analyzed. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Event (CTCAE) (Common 2010) version 4.0. Nutritional status was assessed by Nutritional Risk Screening 2002 criteria, and self-care ability by Barthel index and fall risk index. RESULTS A total of 68 patients were enrolled. Median follow-up duration was 46.3 (3.9-80.1) months. The 1-, 3-, and 5-year overall survival rates were 92.6%, 77.2%, and 59.1%, respectively, and the 1-year, 3-year and 5-year local control rates were 95.6%, 88.9% and 85.6%, respectively. Grade 1-2 and grade 3 radiation pneumonitis occurred in 60/68 (96.8%) and 1/68 (1.5%) patients, respectively. Fall risk at 3 months after treatment was not significantly different from that before treatment (P = 0.22). Barthel index increased significantly after treatment (P < 0.001). CONCLUSIONS SBRT appears to be effective and safe for NSCLC patients aged ≥ 75 years, with no adverse impact on nutritional status and self-care ability.
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Affiliation(s)
- Zekai Shu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Baiqiang Dong
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, 215123, China
| | - Lei Shi
- Hangzhou YITU Healthcare Technology Co., Ltd, Hangzhou, 310012, China
| | - Wei Shen
- Hangzhou YITU Healthcare Technology Co., Ltd, Hangzhou, 310012, China
| | - Qingqing Hang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jin Wang
- Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, Hangzhou, 310011, China.
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, 310011, China.
| | - Yuanyuan Chen
- Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, Hangzhou, 310011, China.
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, 310011, China.
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La Rocca E, Meneghini E, Dispinzieri M, Fiorentino A, Bonfantini F, Di Cosimo S, Gennaro M, Cosentino V, Sant M, Pignoli E, Valdagni R, Lozza L, De Santis MC. Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study. Breast J 2019; 26:188-196. [DOI: 10.1111/tbj.13489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Eliana La Rocca
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
- Department of Oncology and Hemato‐oncology Università degli Studi di Milano Milan Italy
| | - Elisabetta Meneghini
- Analytical Epidemiology and Health Impact Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Michela Dispinzieri
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
| | - Alba Fiorentino
- Radiation Oncology General Regional Hospital “F. Miulli” Acqua viva delle Fonti Italy
| | | | - Serena Di Cosimo
- Department of Applied Research and Technological Development (DRAST) Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | | | - Vito Cosentino
- Medical Physics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Emanuele Pignoli
- Medical Physics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato‐oncology Università degli Studi di Milano Milan Italy
- Radiation Oncology 1 and Prostate Cancer Program Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Laura Lozza
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
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Hata M. Radiation therapy for elderly patients with uterine cervical cancer: feasibility of curative treatment. Int J Gynecol Cancer 2019; 29:622-629. [PMID: 30630886 DOI: 10.1136/ijgc-2018-000077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
As the average lifespan lengthens worldwide, and the older adult population increases, the number of elderly patients with uterine cervical cancer is increasing. Because intensive and invasive treatments, including surgery, are frequently unacceptable in elderly patients, cancer treatments for these patients must be carefully considered. Elderly patients have undergone radiation therapy as less-invasive curative treatment, and it has been shown to be safe and effective for local control of cervical cancer in this population, even among patients aged ≥80 years treated with curative radiation doses. Although concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer, it is unclear whether the addition of chemotherapy to radiation therapy prolongs survival in elderly patients. Elderly patients treated with curative radiation therapy for cervical cancer might develop more therapy-related gastrointestinal and hematological toxicities and insufficiency fractures compared with younger patients. However, advanced techniques of radiation therapy (eg, intensity-modulated radiation therapy and volumetric modulated arc therapy with photons, charged-particle radiation therapy with protons and carbon ions in external-beam radiation therapy, and image-guided adaptive brachytherapy) can minimize radiation-induced toxicities and thus make curative treatment safer and more effective for elderly patients with uterine cervical cancer.
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Affiliation(s)
- Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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SIOG guidelines- essential for good clinical practice in geriatric oncology. J Geriatr Oncol 2019; 10:196-198. [PMID: 30630747 DOI: 10.1016/j.jgo.2018.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022]
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Lancia A, Ingrosso G, Carosi A, Bottero M, Cancelli A, Turturici I, Ponti E, Santoni R. Oligometastatic cancer in elderly patients: the "blitzkrieg" radiotherapy approach : SBRT in oligometastatic elderly patients. Aging Clin Exp Res 2019; 31:109-114. [PMID: 29594874 DOI: 10.1007/s40520-018-0937-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
Abstract
AIMS To retrospectively evaluate the outcome of stereotactic body radiation therapy (SBRT) in the treatment of elderly patients affected by isolated body metastasis from different primitive tumors. METHODS 70 patients with isolated body metastasis were treated. Median age at diagnosis was 75 years (IQR 69-80). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). The primary endpoints were Local Control (LC) and Toxicity. Secondary endpoints were Overall Survival (OS) and Disease-Specific Survival (DSS). Response to radiotherapy was assessed according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We performed survival analysis with the Kaplan-Meier method. The correlation between time actuarial incidence and clinical parameters was studied. RESULTS Median follow-up was 26.5 months. 44 patients (62.8%) were alive at the time of analysis, while 22 (31.4%) died because of the disease. Local control at 2 and 3 years was 87%. The 2-year OS and DSS were 84 and 71%, respectively, while the 3-year values were 57 and 62%. PFS at 2 and 3 years was 41 and 25%, respectively. On univariate analysis, KPS ≥ 90 is statistically correlated with improved OS and DSS (p < 0.05). Acute toxicity of grade ≥ 2 occurred in 4 (5.7%) patients, while late toxicity ≥ 2 was recorded in 6 (8.6%) patients. CONCLUSIONS Ablative Radiotherapy represents a safe, effective, and minimally invasive treatment modality for elderly oligometastatic patients who are judged unfit for systemic therapy.
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Cao KI, Salviat F, Laki F, Falcou MC, Carton M, Poortmans P, Fourquet A, Kirova YM. Outcomes of postoperative radiation therapy for breast cancer in older women according to age and comorbidity status: An observational retrospective study in 752 patients. J Geriatr Oncol 2018. [DOI: 10.1016/j.jgo.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients. Strahlenther Onkol 2018; 194:894-903. [DOI: 10.1007/s00066-018-1318-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
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Abstract
There is increasing awareness of the special needs for care of the elderly cancer patient. Newer precise conformal radiotherapy techniques allow the safe delivery of higher doses of radiotherapy to the target tumor while reducing the dose to surrounding critical organs. This has led to a shortening of radiotherapy protocols for both curative and palliative indications. We review these novel techniques and protocols and the published clinical studies that include elderly patients treated with these techniques. Despite the fact that the elderly are a growing significant proportion of cancer patients, and the need for radiotherapy in the elderly is expected to rise with increasing life expectancy, they are underrepresented in most clinical studies of radiotherapy, and there are few studies specifically investigating radiotherapy in the elderly. The treatment of early-stage primary lung cancer with stereotactic body radiotherapy is a prime example how new highly conformal techniques and shortened treatment protocols are changing the approach to radiotherapy in the elderly. With improved imaging and radiotherapy treatment precision, it is expected that such techniques will become increasingly used in other cancer sites. It is important for radiation oncologists to be aware of the special needs of the elderly cancer patient and in particular to assess these patients based on functional status and not only chronological age. In addition, geriatric oncologists should be aware of modern radiotherapy techniques that can be particularly appropriate for the elderly patient.
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Specht L, Aleman B, Eich H, Illidge T, Kirova Y, Mikhaeel N, Ricardi U, Yahalom J. Recommendations for the clinical management of the elderly patient with malignant lymphoma. Ann Oncol 2018; 29:1069-1070. [DOI: 10.1093/annonc/mdy029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Movsas B. Radiation Therapy in Elderly Persons: An Old Issue With New Approaches. Int J Radiat Oncol Biol Phys 2018; 98:715-717. [PMID: 28602405 DOI: 10.1016/j.ijrobp.2016.11.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
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Loh KP, Soto-Perez-de-Celis E, Hsu T, de Glas NA, Battisti NML, Baldini C, Rodrigues M, Lichtman SM, Wildiers H. What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper. J Oncol Pract 2018; 14:85-94. [PMID: 29436306 PMCID: PMC5812308 DOI: 10.1200/jop.2017.026435] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.
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Affiliation(s)
- Kah Poh Loh
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Enrique Soto-Perez-de-Celis
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Tina Hsu
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Nienke A. de Glas
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Nicolò Matteo Luca Battisti
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Capucine Baldini
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Manuel Rodrigues
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Stuart M. Lichtman
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- University of Rochester School of Medicine and Dentistry, Rochester, NY; City of Hope National Medical Center, Duarte, CA; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada; Leiden University Medical Center, Leiden, the Netherlands; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Gustave Roussy, Villejuif; Institut Curie, PSL Research University, Paris, France; Memorial Sloan Kettering Cancer Center, New York, NY; and University Hospitals Leuven, Leuven, Belgium
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Lancellotta V, Kovács G, Tagliaferri L, Perrucci E, Colloca G, Valentini V, Aristei C. Age Is Not a Limiting Factor in Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2178469. [PMID: 29581964 PMCID: PMC5822774 DOI: 10.1155/2018/2178469] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/04/2017] [Accepted: 12/25/2017] [Indexed: 01/23/2023]
Abstract
This review examines the role of interventional radiotherapy (IRT otherwise known as brachytherapy) in cancer treatment for elderly patients. Despite their advanced age and associated comorbidities, elderly patients should receive definitive cancer therapies, including surgery and radiotherapy (RT). In fact, RT becomes first-line option for patients who are not eligible for surgery (due to comorbidities, anticoagulant drugs, and risk of disfigurement) or those who refuse it. It emerged from this review of the literature as effective, simple, safe, and comfortable and was associated with good local control, low toxicity rates, and excellent cosmesis and provided a cost benefit. IRT may be used as sole treatment for small cancers or as a useful adjunct to surgery or external beam radiotherapy (EBRT) in more advanced (or lymph node positive) cases, especially when the aim is local control with adequate preservation of normal tissue function. As palliative treatment, IRT preserves quality of life and/or improves survival. It is to be hoped that this review will serve as a helpful guide for members of multidisciplinary teams that are involved in treating elderly patients with cancer.
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Affiliation(s)
- Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH-CL, Lübeck, Germany
| | - Luca Tagliaferri
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giuseppe Colloca
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Gruppo Italiano di Oncologia Geriatrica (GIOGER), Roma, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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Managing an Older Adult with Cancer: Considerations for Radiation Oncologists. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1695101. [PMID: 29387715 PMCID: PMC5745659 DOI: 10.1155/2017/1695101] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 02/07/2023]
Abstract
Older adults with cancer present a unique set of management complexities for oncologists and radiation oncologists. Prognosis and resilience to cancer treatments are notably dependent on the presence or risk of "geriatric syndromes," in addition to cancer stage and histology. Recognition, proper evaluation, and management of these conditions in conjunction with management of the cancer itself are critical and can be accomplished by utilization of various geriatric assessment tools. Here we review principles of the geriatric assessment, common geriatric syndromes, and application of these concepts to multidisciplinary oncologic treatment. Older patients may experience toxicities related to treatments that impact treatment effectiveness, quality of life, treatment-related mortality, and treatment compliance. Treatment-related burdens from radiotherapy are increasingly important considerations and include procedural demands, travel, costs, and temporary or permanent loss of functional independence. An overall approach to delivering radiotherapy to an older cancer patient requires a comprehensive assessment of both physical and nonphysical factors that may impact treatment outcome. Patient and family-centered communication is also an important part of developing a shared understanding of illness and reasonable expectations of treatment.
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40
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Rosati LM, Herman JM. Role of Stereotactic Body Radiotherapy in the Treatment of Elderly and Poor Performance Status Patients With Pancreatic Cancer. J Oncol Pract 2017; 13:157-166. [PMID: 28282277 DOI: 10.1200/jop.2016.020628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Literature on the management of nonmetastatic pancreatic ductal adenocarcinoma in patients who are elderly or have poor performance status is sparse. The median survival of this unique cohort of patients is < 6 months, and most patients are only offered single-agent gemcitabine or supportive care. Recently, adding nanoparticle albumin-bound paclitaxel to gemcitabine was shown to improve survival of patients with metastatic disease with Eastern Cooperative Group performance status of 2. Although standard chemoradiotherapy provides long-term locoregional control in locally advanced pancreatic cancer, it is difficult for this group of patients to tolerate 6 weeks of therapy. Stereotactic body radiotherapy (SBRT) can be delivered in only 3 to 5 days, does not require concurrent chemotherapy, and has limited toxicity, and tumor control rates appear to be equivalent to or better than those achieved with standard chemoradiotherapy. Additionally, SBRT has been shown to improve cancer-related pain and patient-reported quality of life. Given the favorable toxicity profile, SBRT seems like an obvious choice for patients who are elderly, have multiple comorbidities, or have poor performance status. Herein, we review the literature on SBRT in this unique patient population and discuss future directions.
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Affiliation(s)
- Lauren M Rosati
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph M Herman
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of Texas MD Anderson Cancer Center, Houston, TX
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Runzer-Colmenares FM, Urrunaga-Pastor D, Aguirre LG, Reategui-Rivera CM, Parodi JF, Taype-Rondan A. Fragilidad y vulnerabilidad como predictores de radiotoxicidad en adultos mayores: un estudio longitudinal en Perú. Med Clin (Barc) 2017; 149:325-330. [DOI: 10.1016/j.medcli.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
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42
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Zhu X, Li F, Ju X, Cao F, Cao Y, Fang F, Qing S, Shen Y, Jia Z, Zhang H. Prognostic role of stereotactic body radiation therapy for elderly patients with advanced and medically inoperable pancreatic cancer. Cancer Med 2017; 6:2263-2270. [PMID: 28834410 PMCID: PMC5633558 DOI: 10.1002/cam4.1164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/26/2017] [Accepted: 07/25/2017] [Indexed: 12/28/2022] Open
Abstract
The role of stereotactic body radiation therapy for the elderly with advanced or medically inoperable pancreatic cancer was still debated. Therefore, we evaluated the value of stereotactic body radiation therapy and its association with survival of those patients. A total of 417 elderly patients were retrospectively reviewed from 2012 to 2015. Overall survival (OS), progression‐free survival (PFS), local recurrence‐free survival (LRFS), distant metastasis‐free survival (DMFS), and toxicities were analyzed. Prescription doses ranged from 30–46.8 Gy in 5–8 fractions. Median age was 73 years old. Median OS, PFS, LRFS, and DMFS were 10, 8, 10, and 9.5 months, respectively. One‐year OS, PFS, LRFS, and DMFS rate were 35.5%, 18.2%, 26.6%, and 27.1%, respectively. Tumor stage and tumor response at 6 months and CA19‐9 levels normalization at 3 months after treatment were independent predictors of OS, PFS, LRFS, and DMFS. Patients with early‐stage cancer, better tumor response, and normalization of CA19‐9 levels had significantly longer OS, PFS, LRFS, and DMFS. Patients with the prodrug of 5‐FU and radiotherapy had longer survival than those with gemcitabine‐based chemotherapy and radiotherapy. Patients who received BED10 ≥ 60 Gy achieved better tumor response compared with those who received BED10 < 60 Gy. Two patients had grade 4 intestinal strictures. No grade 3 or higher hematologic toxicities occurred. Stereotactic body radiation therapy is safe and effective for elderly patients with advanced or medically inoperable pancreatic cancer. Early efficacy could be predictive of prognosis. Higher doses may be associated with efficacy but need further investigation.
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Affiliation(s)
- Xiaofei Zhu
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Fuqi Li
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Xiaoping Ju
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Fei Cao
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yangsen Cao
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Fang Fang
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Shuiwang Qing
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yuxin Shen
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zhen Jia
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Huojun Zhang
- Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
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Hehemann MC, Baldea KG, Quek ML. Prostate Cancer in the Elderly Male: Diagnostic and Management Considerations. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0213-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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44
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Extermann M. Cancer in the Elderly: Moving the Needle Toward Evidence-Based Personalized Oncology. Int J Radiat Oncol Biol Phys 2017; 98:718-720. [PMID: 28602406 DOI: 10.1016/j.ijrobp.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022]
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Morris L, Thiruthaneeswaran N, Lehman M, Hasselburg G, Turner S. Are Future Radiation Oncologists Equipped With the Knowledge to Manage Elderly Patients With Cancer? Int J Radiat Oncol Biol Phys 2017; 98:743-747. [DOI: 10.1016/j.ijrobp.2017.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/21/2016] [Accepted: 01/01/2017] [Indexed: 01/07/2023]
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46
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47
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Exploring the Impact of Human Papillomavirus Status, Comorbidity, Polypharmacy, and Treatment Intensity on Outcome of Elderly Oropharyngeal Cancer Patients Treated With Radiation Therapy With or Without Chemotherapy. Int J Radiat Oncol Biol Phys 2017; 98:858-867. [DOI: 10.1016/j.ijrobp.2016.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 11/23/2022]
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48
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“But We Are Already Geriatric Oncologists”—Why Older Patients Need a Special Approach (A View from a United Kingdom Cancer Center). Int J Radiat Oncol Biol Phys 2017; 98:964-965. [DOI: 10.1016/j.ijrobp.2016.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022]
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Spiegelberg D, Dascalu A, Mortensen AC, Abramenkovs A, Kuku G, Nestor M, Stenerlöw B. The novel HSP90 inhibitor AT13387 potentiates radiation effects in squamous cell carcinoma and adenocarcinoma cells. Oncotarget 2016; 6:35652-66. [PMID: 26452257 PMCID: PMC4742132 DOI: 10.18632/oncotarget.5363] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022] Open
Abstract
Overexpression of heat shock protein 90 (HSP90) is associated with increased tumor cell survival and radioresistance. In this study we explored the efficacy of the novel HSP90 inhibitor AT13387 and examined its radiosensitizing effects in combination with gamma-radiation in 2D and 3D structures as well as mice-xenografts. AT13387 induced effective cytotoxic activity and radiosensitized cancer cells in monolayer and tumor spheroid models, where low drug doses triggered significant synergistic effects on cell survival together with radiation. Furthermore, AT13387 treatment resulted in G2/M-phase arrest and significantly reduced the migration capacity. The expression of selected client proteins involved in DNA repair, cell-signaling and cell growth was downregulated in vitro, though the expression of most investigated proteins recurred after 8–24 h. These results were confirmed in vivo where AT13387 treated tumors displayed effective downregulation of HSP90 and its oncogenic client proteins. In conclusion, our results demonstrate that AT13387 is a potent new cancer drug and effective radiosensitizer in vitro with an excellent in vivo efficacy. AT13387 treatment has the potential to improve external beam therapy and radionuclide therapy outcomes and restore treatment efficacy in cancers that are resistant to initial therapeutic regimes.
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Affiliation(s)
- Diana Spiegelberg
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Adrian Dascalu
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anja C Mortensen
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Andris Abramenkovs
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Gamze Kuku
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Marika Nestor
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Unit of Otolaryngology and Head and Neck Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bo Stenerlöw
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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50
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Brown ML, Glanzmann C, Huber G, Bredell M, Rordorf T, Studer G. IMRT/VMAT for malignancies in the head-and-neck region : Outcome in patients aged 80. Strahlenther Onkol 2016; 192:526-36. [PMID: 27306747 PMCID: PMC4956718 DOI: 10.1007/s00066-016-0986-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/21/2016] [Indexed: 11/24/2022]
Abstract
Objective Elderly patients with malignant head-and-neck tumors (HNT) often pose a therapeutic challenge. They frequently have significant comorbidities which may influence their ability to tolerate tumor-specific therapies. Our aim was to investigate the outcome of patients aged 80+ years undergoing curative intent intensity- or volume-modulated radiation therapy (IMRT/VMAT). Methods We retrospectively reviewed our HNT patients aged 80+ treated with curative IMRT/VMAT from December 2003 to November 2015. Overall survival (OS), disease-free survival (DFS), local control (LC), and treatment tolerance were assessed. Outcome results were compared with that of a younger HNT patient cohort from our hospital. Results A total of 140 consecutive patients were included (65 postoperative, 75 definitive). Mean/median age at treatment start was 84.8/84.1 years (range 80–96 years). Mean/median follow-up time was 25/16 months (range 2–92 months). Of the 140 patients, 80 were alive with no evidence of disease when last seen, 28 had died due to the cancer, 12 remained alive with disease, the remaining 20 died intercurrently. Systemic concomitant therapy was administered in 7 %. Late grade 3–4 toxicity was observed in 2 %. All patients completed treatment. Hospitalization and feeding tube rates were 26 % and 11 %, respectively. The 2‑/3-year LC, DFS, and OS rates for the entire cohort were 81/80 %, 69/63 %, and 68/66 %, respectively. Squamous cell carcinoma (SCC) patients showed an inferior 3-year OS rate as compared to non-SCC patients (62 % vs 77 %, p = 0.0002), while LC and DFS did not differ. Patients undergoing postoperative radiation attained a higher OS compared to the definitively irradiated subgroup with 74 vs. 60 % at 3 years (p = 0.01); however, DFS rates were similar for both groups (68 vs. 61 %, p = 0.15). Corresponding rates for >1400 HNT patients <80 years treated during the same time interval were 81/80 %, 69/67 %, and 77/72 %, respectively. Conclusions Treatment tolerance in our patients aged 80+ was high. These results suggest that elderly HNT patients should not be denied potentially curative treatment strategies.
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Affiliation(s)
- Michelle L Brown
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, Head Neck Cancer Center, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marius Bredell
- Department of Craniomaxillofacial and Oral Surgery, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Tamara Rordorf
- Department of Medical Oncology, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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