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Alapati R, Wagoner SF, Lawrence A, Bon Nieves A, Desai A, Shnayder Y, Hamill C, Kakarala K, Neupane P, Gan G, Sykes KJ, Bur AM. Impact of Adjuvant Radiotherapy Setting on Quality-of-Life in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024; 134:3645-3655. [PMID: 38436503 DOI: 10.1002/lary.31382] [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: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine differences in post-treatment QoL across treatment settings in patients receiving adjuvant radiation therapy for head and neck squamous cell carcinoma (HNSCC). METHODS This was a prospective observational cohort study of patients with HNSCC initially evaluated in a head and neck surgical oncologic and reconstructive clinic at an academic medical center (AMC). Participants were enrolled prior to treatment in a prospective registry collecting demographic, social, and clinical data. Physical and social-emotional QoL (phys-QoL and soc-QoL, respectively) was measured using the University of Washington-QoL questionnaire at pre-treatment and post-treatment visits. RESULTS A cohort of 177 patients, primarily male and White with an average age of 61.2 ± 11.2 years, met inclusion criteria. Most patients presented with oral cavity tumors (n = 132, 74.6%), had non-HPV-mediated disease (n = 97, 61.8%), and were classified as Stage IVa (n = 72, 42.8%). After controlling for covariates, patients treated at community medical centers (CMCs) reported a 7.15-point lower phys-QoL compared with those treated at AMCs (95% CI: -13.96 to -0.35, p = 0.040) up to 12 months post-treatment. Additionally, patients who were treated at CMCs had a 5.77-point (-11.86-0.31, p = 0.063) lower soc-QoL score compared with those treated at an AMC, which was not statistically significant. CONCLUSION This study revealed that HNSCC patients treated with radiation at AMCs reported significantly greater phys-QoL in their first-year post-treatment compared to those treated at CMCs, but soc-QoL did not differ significantly. Further observational studies are needed to explore potential factors, including treatment planning and cancer resource engagement, behind disparities between AMCs and CMCs. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3645-3655, 2024.
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Affiliation(s)
- Rahul Alapati
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Sarah F Wagoner
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Amelia Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Antonio Bon Nieves
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Atharva Desai
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Chelsea Hamill
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Gregory Gan
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Baylor Scott & White, Health and Wellness Center, Dallas, Texas, U.S.A
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
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Carver A, Scaggion A, Jurado-Bruggeman D, Blanck O, Dalqvist E, Romana Giglioli F, Jenko A, Karlsson K, Staykova V, Swinnnen A, Warren S, Mancosu P, Jornet N. Treatment planning and delivery practice of lung SBRT: Results of the 2022 ESTRO physics survey. Radiother Oncol 2024; 196:110318. [PMID: 38702015 DOI: 10.1016/j.radonc.2024.110318] [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: 11/20/2023] [Revised: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE The use of Stereotactic Body Radiation Therapy (SBRT) in lung cancer is increasing. However, there is no consensus on the most appropriate treatment planning and delivery practice for lung SBRT. To gauge the range of practice, quantify its variability and identify where consensus might be achieved, ESTRO surveyed the medical physics community. MATERIALS AND METHODS An online survey was distributed to ESTRO's physicist membership in 2022, covering experience, dose and fractionation, target delineation, dose calculation and planning practice, imaging protocols, and quality assurance. RESULTS Two-hundred and forty-four unique answers were collected after data cleaning. Most respondents were from Europe the majority of which had more than 5 years' experience in SBRT. The large majority of respondents deliver lung SBRT with the VMAT technique on C-arm Linear Accelerators (Linacs) employing daily pre-treatment CBCT imaging. A broad spectrum of fractionation schemes were reported, alongside an equally wide range of dose prescription protocols. A clear preference was noted for prescribing to 95% or greater of the PTV. Several issues emerged regarding the dose calculation algorithm: 22% did not state it while 24% neglected to specify the conditions under which the dose was calculated. Contouring was usually performed on Maximum or Average Intensity Projection images while dose was mainly computed on the latter. No clear indications emerged for plan homogeneity, complexity, and conformity assessment. Approximately 40% of the responders participated in inter-centre credentialing of SBRT in the last five years. Substantial differences emerged between high and low experience centres, with the latter employing less accurate algorithms and older equipment. CONCLUSION The survey revealed an evident heterogeneity in numerous aspects of the clinical implementation of lung SBRT treatments. International guidelines and codes of practice might promote harmonisation.
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Affiliation(s)
- Antony Carver
- University Hospitals Birmingham NHS Foundation Trust, Department of Medical Physics, Birmingham, United Kingdom
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Diego Jurado-Bruggeman
- Institut Català d'Oncologia, Medical Physics and Radiation Protection Department, Girona, Spain
| | - Oliver Blanck
- University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Emmy Dalqvist
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | | | - Aljasa Jenko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
| | - Kristin Karlsson
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | - Vanya Staykova
- Guy's and St Thomas' NHS Foundation Trust, Radiotherapy Physics, London, United Kingdom
| | - Ans Swinnnen
- GROW School for Oncology, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Samantha Warren
- Northern Centre for Cancer Care, Freeman Hospital, Department of Medical Physics, Newcastle Upon Tyne, United Kingdom
| | - Pietro Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Department of Radiotherapy and Radiosurgery, Rozzano-Milan, Italy.
| | - Nuria Jornet
- Hospital de la Santa Creu i Sant Pau, Servei de Radiofísica i Radioprotecció, Barcelona, Spain
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Cantù G. Nasopharyngeal carcinoma. A "different" head and neck tumour. Part B: treatment, prognostic factors, and outcomes. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:155-169. [PMID: 37204840 DOI: 10.14639/0392-100x-n2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/08/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Giulio Cantù
- Former Director of Otorhinolaryngology and Cranio-Maxillo-Facial Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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4
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Contrera KJ, Tam S, Pytynia K, Diaz EM, Hessel AC, Goepfert RP, Lango M, Su SY, Myers JN, Weber RS, Eguia A, Pisters PWT, Adair DK, Nair AS, Rosenthal DI, Mayo L, Chronowski GM, Zafereo ME, Shah SJ. Impact of Cancer Care Regionalization on Patient Volume. Ann Surg Oncol 2023; 30:2331-2338. [PMID: 36581726 DOI: 10.1245/s10434-022-13029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). METHODS This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. RESULTS The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). CONCLUSIONS The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
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Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kristen Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arturo Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | | | - Deborah K Adair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajith S Nair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yang PC, Chen WM, Chen M, Shia BC, Wu SY, Chiang CW. Survival effect of pretreatment FDG-PET-CT on nasopharyngeal cancer. J Formos Med Assoc 2023; 122:36-46. [PMID: 35999158 DOI: 10.1016/j.jfma.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/16/2022] [Accepted: 07/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND/PURPOSE Accurate staging is the first step for optimal treatment selection in patients with nasopharyngeal carcinoma (NPC). In this propensity-score-matched, population-based cohort study, we investigated the survival effects of pretreatment 8-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG-PET-CT) on patients with NPC. METHODS We included patients with stage I-IVA NPC receiving radiotherapy or concurrent chemoradiotherapy and categorized them into two 1:1 propensity score-matched groups according to whether or not they underwent pretreatment 18FDG-PET-CT and compared their outcomes. RESULTS Of the 10,756 patients, propensity score matching yielded 4366 patients in each group. According to multivariable Cox regression analyses, the most prominent correlation between pretreatment 18FDG-PET-CT and all-cause death was observed in patients with stage II NPC (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.60-0.90; P = .0433), followed by patients with stage III NPC (aHR, 0.81; 95% CI, 0.69-0.94; P = .0071) and patients with stage IVA NPC (aHR, 0.88; 95% CI, 0.79-0.97; P = .0091). This association was not significant in patients with stage I NPC (aHR, 1.20; 95% CI, 0.75-1.93; P = .4426). CONCLUSION Pretreatment 18FDG-PET-CT is associated with longer survival in patients with clinical stage II-IVA NPC but not in stage I NPC.
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Affiliation(s)
- Pei-Chen Yang
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
| | - Ching-Wen Chiang
- Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
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Development and Clinical Implementation of an Automated Virtual Integrative Planner for Radiation Therapy of Head and Neck Cancer. Adv Radiat Oncol 2022; 8:101029. [PMID: 36578278 PMCID: PMC9791598 DOI: 10.1016/j.adro.2022.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/10/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Head and neck (HN) radiation (RT) treatment planning is complex and resource intensive. Deviations and inconsistent plan quality significantly affect clinical outcomes. We sought to develop a novel automated virtual integrative (AVI) knowledge-based planning application to reduce planning time, increase consistency, and improve baseline quality. Methods and Materials An in-house write-enabled script was developed from a library of 668 previously treated HN RT plans. Prospective hazard analysis was performed, and mitigation strategies were implemented before clinical release. The AVI-planner software was retrospectively validated in a cohort of 52 recent HN cases. A physician panel evaluated planning limitations during initial deployment, and feedback was enacted via software refinements. A final second set of plans was generated and evaluated. Kolmogorov-Smirnov test in addition to generalized evaluation metric and weighted experience score were used to compare normal tissue sparing between final AVI planner versus respective clinically treated and historically accepted plans. A t test was used to compare the interactive time, complexity, and monitor units for AVI planner versus manual optimization. Results Initially, 86% of plans were acceptable to treat, with 10% minor and 4% major revisions or rejection recommended. Variability was noted in plan quality among HN subsites, with high initial quality for oropharynx and oral cavity plans. Plans needing revisions were comprised of sinonasal, nasopharynx, P-16 negative squamous cell carcinoma unknown primary, or cutaneous primary sites. Normal tissue sparing varied within subsites, but AVI planner significantly lowered mean larynx dose (median, 18.5 vs 19.7 Gy; P < .01) compared with clinical plans. AVI planner significantly reduced interactive optimization time (mean, 2 vs 85 minutes; P < .01). Conclusions AVI planner reliably generated clinically acceptable RT plans for oral cavity, salivary, oropharynx, larynx, and hypopharynx cancers. Physician-driven iterative learning processes resulted in favorable evolution in HN RT plan quality with significant time savings and improved consistency using AVI planner.
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Baba MH, Singh BK, Wani SUQ. Skin Sparing in Intensity-Modulated Radiation Therapy of Nasopharyngeal Carcinoma. J Med Phys 2022; 47:243-249. [PMID: 36684702 PMCID: PMC9847000 DOI: 10.4103/jmp.jmp_27_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Purpose Radiation therapy of nasopharyngeal carcinomas (NPCs) involves high doses to the target structures which are superficial to the skin surfaces. As a result, the skin toxicities involved are higher and sometimes worsens to such an extent that radiotherapy needs to be interrupted unplanned. This leads to a break in radiation therapy which overall affects the local control and cure rates. The aim of this study is to decrease the skin dose by contouring skin as an organ at risk (OAR) to include in inverse planning calculation. Materials and Methods Seventy-three cases of nasopharyngeal cancers were planned for 60 Gy to intermediate-risk planning target volume (PTVIntermediate) and 70 Gy to high risk (PTVHigh), by three different modes of Intensity-modulated radiation therapy (IMRT)- namely conventional sequential intensity-modulated radiation therapy (S-IMRT PH-I and PH-II), Skin Spared sequential intensity-modulated radiation therapy (SS-IMRT PH-I and PH-II), and Skin Spared simultaneously instantaneous boost intensity-modulated radiation therapy (SS-SIB IMRT). The plans were compared by dose volume histograms and dose statistics to the PTV as well as to the OAR's. For PTV, mean dose (Dmean), maximum dose (Dmax), and minimum dose (Dmin) were compared to check the homogeneity index (HI) while sparing the skin. For other OAR's Dmean, Dmax and dose to to 1 cubic cm was used for comparison. The skin doses to various volumes from volume to receive 5 Gy (V5) to volume to receive 70 Gy (V70) were evaluated and compared between the three techniques. Statistical analysis was done using one away ANOVA on the data editor SPSS Version 26.0 (SPSS Inc., Chicago, Illinois, USA) to evaluate the results. Continuous variables were expressed as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages. Survival analysis was done by Kaplan-Meier Estimator. Results When the skin was considered as an OAR, the skin volume to receive 5, 10, 15, 20, 30, 40, 50, 60, 70 Gy was reduced by 6.5%, 6.5%, 6%, 11.5%, 7%, 6%, 6%, 5%, 2%, respectively, by SS-IMRT PH-I and II and 2%, 4.05%, 4%, 7%, 5%, 3%, 6%, 5%, 1%, respectively, by SS-SIB IMRT when both the SS techniques were compared with S-IMRT PH-I and II. Volume of skin to receive 20 Gy showed maximum reduction in SS-IMRT PH-I and II. A one-way ANOVA was carried out to find the differences in the skin doses between the three techniques. The skin dose in the two SS techniques, i.e., SS-IMRT PH-I and PH-II and SS-SIB IMRT was found significantly lower than that of IMRT plans without skin as an OAR, i.e., S-IMRT PH-I and PH-II (P = 0.000). The PTV doses were well within the 95%-107% of the prescribed dose (HI) and there were no significant differences in the means of the prescribed dose between the simple and skin spared IMRT techniques. The other OARs doses were also evaluated and there were no significant differences between the means of the doses among the techniques. Conclusions SS IMRT for NPC has demonstrated reduction in skin dose while using skin as an OAR in the optimization. Moreover, decreased skin dose can decrease the skin related toxicities provided there is no compromise on Target dose coverage and OAR dose. We recommend that skin should be contoured as an OAR for NPC, provided PTV is minimally 3-5 mm beneath skin surface, in order to have a better disease control with lesser toxicities and less unplanned treatment interruptions.
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Affiliation(s)
- Misba Hamid Baba
- Department of Physics, Institute of Applied Sciences and Humanities, GLA University, Mathura, Uttar Pradesh, India
- Department of Radiological Physics and Bio-Engineering, Srinagar, Jammu and Kashmir, India
| | - Benoy K Singh
- Department of Physics, Institute of Applied Sciences and Humanities, GLA University, Mathura, Uttar Pradesh, India
| | - Shaq ul Qamar Wani
- Department of Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Goshtasbi K, Abiri A, Lehrich BM, Haidar YM, Tjoa T, Kuan EC. The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma. Head Neck 2021; 43:2755-2763. [PMID: 33998094 DOI: 10.1002/hed.26739] [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: 01/03/2021] [Revised: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluates the influence of facility case-volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS). METHODS The 2004-2015 National Cancer Database was queried for patients with NPC receiving definitive treatment. RESULTS A total of 8260 patients (5-year OS: 63.4%) were included. The 1114 unique facilities were categorized into 854 low-volume (treating 1-8 patients), 200 intermediate-volume (treating 9-23 patients), and 60 high-volume (treating 24-187 patients) facilities. Kaplan-Meier log-rank analysis demonstrated significantly improved OS with high-volume facilities (p < 0.001). On cox proportional-hazard multivariate regression after adjusting for age, sex, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high-volume facilities were associated with lower mortality risk than low-volume (HR = 0.865, p = 0.019) and intermediate-volume facilities (HR = 0.916, p = 0.004). Propensity score matching analysis confirmed this association (p < 0.001). CONCLUSION Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high-volume medical centers.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yarah M Haidar
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
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9
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Chen SH, Huang WT, Kao WC, Hsiao SY, Pan HY, Fang CW, Shiue YL, Chou CL, Li CF. O6-methylguanine-DNA methyltransferase modulates cisplatin-induced DNA double-strand breaks by targeting the homologous recombination pathway in nasopharyngeal carcinoma. J Biomed Sci 2021; 28:2. [PMID: 33397362 PMCID: PMC7780675 DOI: 10.1186/s12929-020-00699-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background The homologous recombination (HR) pathway is involved in DNA damage response (DDR), which is crucial to cancer cell survival after treatment with DNA damage agents. O6-methylguanine DNA methyltransferase (MGMT) is associated with cisplatin (CDDP) resistance in cancer cells; however, the underlying mechanisms remain unclear. Here, we explored the interactions between MGMT and the HR pathway in CDDP-activated DDR and their clinical implications in nasopharyngeal carcinoma (NPC). Methods Human NPC cells were assessed using loss-of-function approaches in vitro. The expression correlations between MGMT and major proteins of the HR pathway were analyzed through Western blotting, quantitative real-time PCR, and bioinformatic analysis by using a public database. The physical interactions between MGMT and HR proteins were studied using co-immunoprecipitation and immunofluorescence analyses. Cell comet tails and γ-H2AX expression levels were examined to evaluate double-strand break (DSB) formation. Established immunofluorescence and reporter analyses were conducted to measure HR activity. Xenograft and cell viability studies were used to assess the therapeutic potential of MGMT inhibition in combination with CDDP and poly(ADP-ribose) polymerase (PARP) inhibitor, respectively. Results Among major proteins of the HR pathway, MGMT suppression inhibited CDDP-induced RAD51 expression. Bioinformatic analyses showed a positive correlation between MGMT and RAD51 expression in patients with NPC. Moreover, MGMT physically interacted with BRCA1 and regulated CDDP-induced BRCA1 phosphorylation (ser 988). In functional assays, MGMT inhibition increased CDDP-induced DSB formation through attenuation of HR activity. NPC xenograft studies demonstrated that MGMT inhibition combined with CDDP treatment reduced tumor size and downregulated RAD51 expression and BRCA1 phosphorylation. Furthermore, MGMT suppression increased PARP inhibitor–induced cell death and DSB formation in NPC cells. Conclusion MGMT is crucial in the activation of the HR pathway and regulates DDR in NPC cells treated with CDDP and PARP inhibitor. Thus, MGMT is a promising therapeutic target for cancer treatments involving HR-associated DDR.
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Affiliation(s)
- Shang-Hung Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Wan-Chen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Sheng-Yen Hsiao
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Pan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Chin-Wen Fang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chia-Lin Chou
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Division of Colon and Rectal Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan, 71004, Taiwan.
| | - Chien-Feng Li
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan. .,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan. .,Institute of Precision Medicine, National Sun Yat-sen University, No.70, Lien-hai Rd., Kaohsiung, 80424, Taiwan.
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10
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Lai TY, Yeh CM, Hu YW, Liu CJ. Hospital volume and physician volume in association with survival in patients with nasopharyngeal cancer after radiation therapy. Radiother Oncol 2020; 151:190-199. [DOI: 10.1016/j.radonc.2020.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023]
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11
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Luo SD, Chen WC, Wu CN, Yang YH, Li SH, Fang FM, Huang TL, Wang YM, Chiu TJ, Wu SC. Low-Dose Aspirin Use Significantly Improves the Survival of Late-stage NPC: A Propensity Score-Matched Cohort Study in Taiwan. Cancers (Basel) 2020; 12:cancers12061551. [PMID: 32545461 PMCID: PMC7352863 DOI: 10.3390/cancers12061551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Aspirin use has been associated with improved survival rates in various cancers. However, it remains unclear if aspirin confers a survival benefit on patients with nasopharyngeal carcinoma (NPC). The aim of this study was to assess the associations between aspirin use and survival in different stages of NPC. Methods: This is a 10-year retrospective cohort study of NPC patients. A total of 565 NPC patients were recruited after we performed a 1:4 propensity score match between aspirin users and non-users. Cox regression models with adjusted covariates were employed to evaluate factors that influence the survival rate of NPC patients. Results: The Kaplan-Meier analysis revealed that the overall survival (p < 0.0001) and disease-specific survival (p < 0.0001) rates of 180-day aspirin users increased. Increased survival rates were also observed in 180-day aspirin users with Stages III and IV, T, N1 and 2, and N3 categories. Cox regression models indicated that factors, including aspirin use (univariate: HR = 0.28, 95% CI = 0.14-0.55, p < 0.001; multivariate: HR = 0.23, 95% CI = 0.12-0.46, p < 0.001), were independent prognostic factors for survival. Conclusions: Aspirin use for more than 180 days is associated with an increased survival rate and is a positive independent prognostic factor in NPC.
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Affiliation(s)
- Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-D.L.); (W.-C.C.); (C.-N.W.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-D.L.); (W.-C.C.); (C.-N.W.)
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-D.L.); (W.-C.C.); (C.-N.W.)
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-H.L.); (T.-L.H.)
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (F.-M.F.); (Y.-M.W.)
| | - Tai-Lin Huang
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-H.L.); (T.-L.H.)
| | - Yu-Ming Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (F.-M.F.); (Y.-M.W.)
| | - Tai-Jan Chiu
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-H.L.); (T.-L.H.)
- Correspondence: (T.-J.C.); (S.-C.W.); Tel.: +886-7-317-123 (ext. 3267) (T.-J.C.); +886-7-731-7123 (ext. 2533) (S.-C.W.)
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Correspondence: (T.-J.C.); (S.-C.W.); Tel.: +886-7-317-123 (ext. 3267) (T.-J.C.); +886-7-731-7123 (ext. 2533) (S.-C.W.)
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12
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Zhang J, Peng Y, Ding S, Zhu J, Liu Y, Chen M, Sun W, Zhou L, Deng X. Comparison of Different Combinations of Irradiation Mode and Jaw Width in Helical Tomotherapy for Nasopharyngeal Carcinoma. Front Oncol 2020; 10:598. [PMID: 32391275 PMCID: PMC7190867 DOI: 10.3389/fonc.2020.00598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose: To aid in the selection of a suitable combination of irradiation mode and jaw width in helical tomotherapy (HT) for the treatment of nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients with NPC who underwent radiotherapy were retrospectively selected. Four plans using a jaw width of 2.5 or 5-cm in dynamic jaw (DJ) or fix jaw (FJ) modes for irradiation were designed (2.5DJ, 2.5FJ, 5.0DJ, and 5.0FJ). The dose parameters of planning target volume (PTV) and organs at risk (OARs) of the plans were compared and analyzed, as well as the beam on time (BOT) and monitor unit (MU). The plans in each group were ranked by scoring the doses received by the OARs and the superity was assessed in combination with the planned BOT and MU. Results: The prescribed dose coverage of PTV met the clinical requirements for all plans in the four groups. The groups using a 2.5-cm jaw width or a DJ mode provided better protection to most OARs, particularly for those at the longitudinal edges of the PTV (P < 0.05). The 2.5DJ group had the best ranking for OAR-dose, followed by the 2.5FJ and 5.0DJ groups with a same score. The BOT and MU of the groups using a 5.0-cm jaw width reduced nearly 45% comparing to those of the 2.5-cm jaw groups. Conclusion: 2.5DJ has the best dose distribution, while 5.0DJ has satisfactory dose distribution and less BOT and MU that related to the leakage dose. Both 2.5DJ or 5DJ were recommended for HT treatment plan for NPC based on the center workload.
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Affiliation(s)
- Jun Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yinglin Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Shouliang Ding
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jinhan Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yimei Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Meining Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wenzhao Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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13
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Wheatley-Price P, Jonker H, Al-Baimani K, Mhang T, Nicholas G, Goss G, Laurie SA. Analyzing the effect of physician assignment in the survival of patients with advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2020; 27:34-38. [PMID: 32218658 DOI: 10.3747/co.27.5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Non-small-cell lung cancer (nsclc) is the most common cause of cancer deaths worldwide, with a 5-year survival of 17%. The low survival rate observed in patients with nsclc is primarily attributable to advanced stage of disease at diagnosis, with more than 50% of cases being stage iv at presentation. For patients with advanced disease, palliative systemic therapy can improve overall survival (os); however, a recent review at our institution of more than 500 consecutive cases of advanced nsclc demonstrated that only 55% of the patients received palliative systemic therapy. What is unknown to date is whether that observed low rate of systemic therapy in our previous study is uniform across oncologists. Methods With ethics approval, we performed a retrospective analysis of newly diagnosed patients with stage iv nsclc seen as outpatients at our institution between 2009 and 2012 by 4 different oncologists. Demographics, treatment, and survival data were collected and compared for the 4 oncologists. Results The 4 oncologists saw 528 patients overall, with D seeing 115; L, 158; R, 137; and M, 118. Significant variation was observed in the proportion receiving 1 line or more of chemotherapy: D, 60%; L, 65%; R, 43%; and M, 52%. Physician assignment was not associated with a difference in median os, with D's cohort having a median os of 6.8 months; L, 8.4 months; R, 7.0 months; and M, 7.0 months. Conclusions Practice size and proportion of patients treated varied between oncologists, but those differences did not translate into significantly different survival outcomes for patients.
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Affiliation(s)
- P Wheatley-Price
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa.,The Ottawa Hospital, Ottawa
| | - H Jonker
- McMaster University, Hamilton, ON
| | - K Al-Baimani
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | | | - G Nicholas
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa.,The Ottawa Hospital, Ottawa
| | - G Goss
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa.,The Ottawa Hospital, Ottawa
| | - S A Laurie
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa.,The Ottawa Hospital, Ottawa
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14
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Bollig CA, Zitsch RP. Impact of treating facilities’ type and volume in patients with major salivary gland cancer. Laryngoscope 2019; 129:2321-2327. [DOI: 10.1002/lary.27844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri U.S.A
| | - Robert P. Zitsch
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri U.S.A
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15
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Naghavi AO, Echevarria MI, Strom TJ, Abuodeh YA, Venkat PS, Ahmed KA, Demetriou S, Frakes JM, Kim Y, Kish JA, Russell JS, Otto KJ, Chung CH, Harrison LB, Trotti A, Caudell JJ. Patient choice for high-volume center radiation impacts head and neck cancer outcome. Cancer Med 2018; 7:4964-4979. [PMID: 30175512 PMCID: PMC6198196 DOI: 10.1002/cam4.1756] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background Studies suggest treatment outcomes may vary between high (HVC)‐ and low‐volume centers (LVC). Radiation therapy (RT) for head and neck cancer (HNC) requires weeks of treatment, the inconvenience of which may influence a patient's choice for treatment location. We hypothesized that receipt of RT for HNC at a HVC would influence outcomes compared to patients evaluated at a HVC, but who chose to receive RT at a LVC. Methods From 1998 to 2011, 1930 HNC patients were evaluated at a HVC and then treated with RT at either a HVC or LVC. Time‐to‐event outcomes and treatment factors were compared. Results Median follow‐up was 34 months. RT was delivered at a HVC for 1368 (71%) patients and at a LVC in 562 (29%). Patients were more likely to choose HVC‐RT if they resided in the HVC's county or required definitive RT (all P < 0.001). HVC‐RT was associated with a significant improvement in 3‐year LRC (84% vs 68%), DFS (68% vs 48%), and OS (72% vs 57%) (all P < 0.001). On multivariate analysis (MVA), HVC‐RT independently predicted for improved LRC, DFS, and OS (all P < 0.05). Conclusions In patients evaluated at a HVC, the choice of RT location was primarily influenced by their residing distance from the HVC. HVC‐RT was associated with improvements in LRC, DFS, and OS in HNC. As treatment planning and delivery are technically demanding in HNC, the choice to undergo treatment at a HVC may result in more optimal delivered dose, RT duration, and outcome.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Puja S Venkat
- Department of Radiation Oncology, UCLA Health, Los Angeles, California
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Stephanie Demetriou
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie A Kish
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffery S Russell
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H Chung
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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16
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Ha B, Cho KH, Moon SH, Lee CG, Keum KC, Kim YS, Wu HG, Kim JH, Ahn YC, Oh D, Noh JM, Lee JH, Kim SH, Kim WT, Oh YT, Kang MK, Kim JH, Kim JY, Cho MJ, Kay CS, Choi JH. The Effect of Hospital Case Volume on Clinical Outcomes in Patients with Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Analysis (KROG-1106). Cancer Res Treat 2018; 51:12-23. [PMID: 29397658 PMCID: PMC6333987 DOI: 10.4143/crt.2017.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/04/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). Materials and Methods Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). Results At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). Conclusion A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
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Affiliation(s)
- Boram Ha
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang-Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Won Taek Kim
- Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon-June Cho
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chul Seoung Kay
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea
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17
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Philips R, Martin D, Eskander A, Schord J, Brown N, Zhao S, Brock G, Kumar B, Carrau R, Ozer E, Agrawal A, Kang SY, Rocco JW, Schuller D, Ali S, Blakaj D, Bhatt A, Grecula J, Teknos T, Diavolitsis V, Old M. Effect of adjuvant radiotherapy treatment center volume on overall survival. Oral Oncol 2018; 78:46-51. [PMID: 29496057 DOI: 10.1016/j.oraloncology.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES to examine the impact of radiotherapy center volume on overall survival in patients with oral cavity and oropharyngeal squamous cell carcinoma getting adjuvant radiation therapy after receiving surgery at a high-volume center. MATERIALS AND METHODS a retrospective study was conducted on patients with oral cavity squamous cell carcinoma or oropharyngeal squamous cell carcinoma treated surgically at a tertiary institution from 2000 to 2012 who received adjuvant radiotherapy. The outcome variable was overall survival and the independent variable was location of adjuvant radiation therapy: high-volume center (HVC) versus low-volume center (LVC). Cox proportional hazards models were used to assess associations between predictors of death. Variables that were found to be significant at the α = 0.10 were included in a multivariable model. RESULTS 336 patients met inclusion criteria. One-hundred thirty-nine patients received adjuvant radiation therapy at HVC and 197 patients received adjuvant radiation therapy at LVC. A univariate Cox proportional hazards model identified the variables location, age, marital status, subsite, T stage, extracapsular extension, and smoking status to include in a multivariable model. Age, subsite, T stage, and extracapsular extension were independent predictors of overall survival (p < .05). Location (p = .55), marital status (p = .29), and smoking status (p = .22) were not statistically significant predictors of survival. CONCLUSION After surgery at a HVC, the volume of adjuvant radiation therapy center was not significantly associated with overall survival. Significant predictors of survival included age, subsite, T stage, and extracapsular extension.
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Affiliation(s)
- Ramez Philips
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Daniel Martin
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Jeffrey Schord
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Nicole Brown
- Department of Biomedical Informatics Center for Biostatistics at the Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics Center for Biostatistics at the Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Guy Brock
- Department of Biomedical Informatics Center for Biostatistics at the Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Bhavna Kumar
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - David Schuller
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Syed Ali
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Aashish Bhatt
- Department of Radiation Oncology at the James Cancer Hospital, Columbus, OH 43210, USA
| | - John Grecula
- Department of Radiation Oncology at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Theodoros Teknos
- Department of Otolaryngology-Head and Neck Surgery at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Virginia Diavolitsis
- Department of Radiation Oncology at the James Cancer Hospital, Columbus, OH 43210, USA
| | - Matthew Old
- Department of Radiation Oncology at the James Cancer Hospital, Columbus, OH 43210, USA.
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18
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Huang CI, Chen LF, Chang SL, Wu HC, Ting WC, Yang CC. Accuracy of a Staging System for Prognosis of 5-Year Survival of Patients With Nasopharyngeal Carcinoma Who Underwent Chemoradiotherapy. JAMA Otolaryngol Head Neck Surg 2017; 143:1086-1091. [PMID: 28975193 DOI: 10.1001/jamaoto.2017.1562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Concurrent chemoradiotherapy delivers a high level of tumor control and survival benefits for patients with nasopharyngeal carcinoma (NPC). However, many uncertainties still exist regarding the outcomes of chemoradiotherapy, making a more precise survival prognostic system necessary. Objective To introduce a new staging system that combines tumor and clinical characteristics to improve the accuracy of prognosis for patients with NPC. Design, Setting, and Participants This cohort study enrolled 207 patients with newly diagnosed NPC who underwent concurrent chemoradiotherapy between January 1, 2007, and December 31, 2014, at Chi-Mei Medical Center in Tainan, Taiwan. Data on these patients were collected from the cancer registry database of the Chi-Mei Medical Center. Patients who had a history of cancer or were unable to complete a full course of radiotherapy were excluded. Follow-up was completed on September 30, 2016, and the data analysis was performed from January 1, 2017, to February 28, 2017. Main Outcomes and Measures The risk factors associated with 5-year disease-specific survival were incorporated into the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer TNM staging system to construct a new prognostic staging system. The χ2 test for linear trend, the Akaike information criterion, and the C statistic were used to evaluate the monotonicity and discriminatory ability of the new prognostic staging system and the AJCC TNM staging system. Results Of the 207 patients enrolled in the study, 157 (75.8%) were men, and the mean (SD) age was 48 (11) years. Multivariate analysis identified advanced clinical T stage (adjusted hazard ratio [aHR], 3.20; 95% CI, 1.58-6.48), poor performance status (aHR, 2.62; 95% CI, 1.30-5.28), and cumulative cisplatin dose lower than 100 mg/m2 (aHR, 2.28; 95% CI, 1.10-4.74) as independent prognostic factors. The β coefficients from the Cox proportional hazards regression model were used to develop an integer-based, weighted point system; advanced clinical T stage, poor performance, and cumulative cisplatin dose lower than 100 mg/m2 were each assigned a score of 1. The sum of these risk scores was stratified into new stage I (score of 0), new stage II (score of 1), new stage III (score of 2), and new stage IV (score of 3). Compared with the AJCC TNM staging system, the new prognostic staging category had better monotonicity with a higher χ2 value (17.8 vs 25.6) for linear trend, better discriminatory ability with a smaller Akaike information criterion (367 vs 360), and a greater C statistic (0.702 vs 0.740) for 5-year disease-specific survival. Conclusions and Relevance The new prognostic staging system has a better accuracy of prognosis of survival than the routinely used AJCC TNM staging system and thus is more useful in identifying high-risk patients for more intense treatment and care.
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Affiliation(s)
- Chung-I Huang
- Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Li-Fu Chen
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lun Chang
- Department of Otolaryngology-Head and Neck Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Chang Wu
- Department of Hematology and Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wei-Chen Ting
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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Abstract
OBJECTIVE To describe the change in colposcopy volume in light of recent guideline shifts, which target higher-risk women while limiting unnecessary procedures in low-risk women. METHODS After institutional review board approval, colposcopy clinic visits at a large-volume referral center from January 2010 to December 2015 were reviewed. All women diagnosed with abnormal cervical cytology who were referred and subsequently underwent colposcopic evaluation were included. Mean monthly and annual clinic volumes were calculated. Return visit proportions were compared using chi-square test. Negative binomial regression analysis was used to examine trends. RESULTS There were a total of 8722 colposcopy clinic visits between January 2010 and December 2015. Approximately 7395 visits (85%) were new patient visits, and 1327 visits (15%) were return visits. The percentage of return visits declined dramatically during the study period from 22.9% (2011) of total visits to 9.0% in 2015 (P < 0.001). Annual clinic volume ranged from 903 to 1884 with a mean monthly volume of 121.13 visits (SD, 42.1). Annual volume was highest in 2011 (n = 1884) and has since demonstrated a steady decline. In 2015, average monthly volume (75.3 visits) dropped to nearly one third of its peak 218 visits per month in July 2010. CONCLUSIONS In a large referral clinic that adheres to guideline-based screening and management recommendations, monthly colposcopy volume has declined dramatically with a reduction by two thirds compared with peak volume in 2010.
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Validity of the age-adjusted charlson comorbidity index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: a 5-year nationwide cohort study. PLoS One 2015; 10:e0117323. [PMID: 25617629 PMCID: PMC4305297 DOI: 10.1371/journal.pone.0117323] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/22/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To characterize the impact of comorbidity on survival outcomes for patients with nasopharyngeal carcinoma (NPC) post radiotherapy (RT). Methods A total of 4095 patients with NPC treated by RT or RT plus chemotherapy (CT) in the period from 2007 to 2011 were included through Taiwan’s National Health Insurance Research Database. Information on comorbidity present prior to the NPC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI), Age-Adjusted Charlson Comorbidity Index (ACCI) and a revised head and neck comorbidity index (HN-CCI). The prevalence of comorbidity and the influence on survival were calculated and analyzed. Results Most of the patients (75%) were male (age 51±13 years) and 2470 of them (60%) had at least one comorbid condition. The most common comorbid condition was diabetes mellitus. According to these three different comorbidity index (CCI, ACCI and HN-CCI), higher scores were associated with worse overall survival (P< 0.001). The Receiver Operating Characteristic (ROC) curve was used to assess the discriminating ability of CCI, AACI and HN-CCI scores and it demonstrated the predictive ability for mortality with the ACCI (0.693, 95% CI 0.670–0.715) was superior to that of the CCI (0.619, 95% CI 0.593–0.644) and HN-CCI (0.545, 95%CI 0.519–0.570). Conclusion Comorbidities greatly influenced the clinical presentations, therapeutic interventions, and outcomes of patients with NPC post RT. Higher comorbidity index scores accurately was associated with worse survival. The ACCI seems to be a more appropriate prognostic indicator and should be considered in further clinical studies.
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Yeh C, Tung C, Lee C, Lin M, Chao T. Measurement-based Monte Carlo simulation of high definition dose evaluation for nasopharyngeal cancer patients treated by using intensity modulated radiation therapy. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Lee MS, Tsai SJ, Lee CC, Su YC, Chiou WY, Lin HY, Hung SK. Higher caseload improves cervical cancer survival in patients treated with brachytherapy. Radiat Oncol 2014; 9:234. [PMID: 25344121 PMCID: PMC4218989 DOI: 10.1186/s13014-014-0234-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
Objectives Increased caseload has been associated with better patient outcomes in many areas of health care, including high-risk surgery and cancer treatment. However, such a positive volume vs. outcome relationship has not yet been validated for cervical cancer brachytherapy. The purpose of this study was to examine the relationship between physician caseload and survival rates in cervical cancer treated with brachytherapy using population-based data. Methods Between 2005 and 2010, a total of 818 patients were identified using the Taiwan National Health Insurance Research Database. Multivariate analysis using a Cox proportional hazards model and propensity scores was used to assess the relationship between 5-year survival rates and physician caseloads. Results As the caseload of individual physicians increased, unadjusted 5-year survival rates increased (P = 0.005). Using a Cox proportional hazard model, patients treated by high-volume physicians had better survival rates (P = 0.03), after adjusting for comorbidities, hospital type, and treatment modality. When analyzed by propensity score, the adjusted 5-year survival rate differed significantly between patients treated by high/medium-volume physicians vs. patients treated by low/medium-volume physicians (60% vs. 54%, respectively; P = 0.04). Conclusions Provider caseload affected survival rates in cervical cancer patients treated with brachytherapy. Both Cox proportional hazard model analysis and propensity scores showed association between high/medium volume physicians and improved survival.
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Affiliation(s)
- Moon-Sing Lee
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, 2, Ming Sheng Road, Dalin, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Shiang-Jiun Tsai
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, 2, Ming Sheng Road, Dalin, Chiayi, Taiwan.
| | - Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Yu-Chieh Su
- Department of Hematology Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, 2, Ming Sheng Road, Dalin, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Hon-Yi Lin
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, 2, Ming Sheng Road, Dalin, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Shih-Kai Hung
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, 2, Ming Sheng Road, Dalin, Chiayi, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Eskander A, Merdad M, Irish JC, Hall SF, Groome PA, Freeman JL, Urbach DR, Goldstein DP. Volume-outcome associations in head and neck cancer treatment: a systematic review and meta-analysis. Head Neck 2014; 36:1820-34. [PMID: 24123512 DOI: 10.1002/hed.23498] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high- and low-volume centers have demonstrated mixed results. METHODS We conducted a systematic review using MEDLINE and EMBASE including all studies examining a volume-outcome relationship in the treatment of patients with head and neck cancer with meta-analysis for long-term survival results. RESULTS Seventeen studies were identified. Meta-analysis was performed for studies that assessed long-term survival. High-volume hospitals (5 studies; hazard ratio [HR], 0.886; 95% confidence interval [CI], 0.820-0.956) and high-volume surgeons (2 studies; HR, 0.767; 95% CI, 0.641-0.919) have better overall survival than low-volume hospitals and surgeons, respectively. CONCLUSION Volume-outcome associations exist for head and neck oncologic procedures, although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care, which may explain this relationship.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Impact of young age on the prognosis for oral cancer: a population-based study in Taiwan. PLoS One 2013; 8:e75855. [PMID: 24086646 PMCID: PMC3784390 DOI: 10.1371/journal.pone.0075855] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022] Open
Abstract
Background Oral cancer leads to a considerable use of health care resources. Wide resection of the tumor and reconstruction with a pedicle flap/ free flap is widely used. This study was conducted to investigate if young age at the time of diagnosis of oral cancer requiring this treatment confers a worse prognosis. Methods A total of 2339 patients who underwent resections for oral cancer from 2004 to 2005 were identified from The Taiwan National Health Insurance Research Database. Survival analysis, Cox proportional regression model, propensity scores, and sensitivity test were used to evaluate the association between 5-year survival rates and age. Results In the Cox proportional regression model, the older age group (>65 years) had the worst survival rate (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.45-2.22; P<0.001). When analyzed using the propensity scores, the adjusted 5-year survival rates were also poorer for oral cancer patients with older age (>65 years), compared to those with younger age (<45 years) (P<0.001). In sensitivity test, the adjusted hazard ratio remained no statistically elevated in the younger age group (<45 years). Conclusions For those oral cancer patients who underwent wide excision and reconstruction, young age did not confer a worse prognosis using a Cox proportional regression model, propensity scores or sensitivity test. Young oral cancer patients may be treated using general guidelines and do not require more aggressive treatment.
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Chang TS, Chang CM, Hsu TW, Lin YS, Lai NS, Su YC, Huang KY, Lin HL, Lee CC. The combined effect of individual and neighborhood socioeconomic status on nasopharyngeal cancer survival. PLoS One 2013; 8:e73889. [PMID: 24069242 PMCID: PMC3771923 DOI: 10.1371/journal.pone.0073889] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022] Open
Abstract
Background The relationship between individual and neighborhood socioeconomic status (SES) and mortality rates in patients with nasopharyngeal carcinoma (NPC) is unknown. This population-based study aimed to examine the association between SES and survival of patients with NPC in Taiwan. Materials and Methods A population-based follow-up study was conducted of 4691 patients diagnosed with NPC between 2002 and 2006. Each patient was traced to death or for 5 years. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding factors and risk factors. Results In NPC patients below the age of 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), NPC patients with low individual SES residing in disadvantaged neighborhoods were found to have a 2-fold higher risk of mortality than patients with high individual SES residing in advantaged neighborhoods. We found no significant difference in mortality rates between different SES groups in NPC patients aged 65 and above. Conclusions Our findings indicate that NPC patients with low individual SES who live in disadvantaged neighborhoods have the higher risk of mortality than their more privileged counterparts. Public health strategies and welfare policies would be well advised to try to offset the inequalities in health care and pay more attention to addressing the needs of this vulnerable group.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Ming Chang
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Ta-Wen Hsu
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ning-Sheng Lai
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yu-Chieh Su
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Kuang-Yung Huang
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Division of Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Hung-Lung Lin
- Department of Research, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- * E-mail:
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Chien CC, Sun YM, Wang JJ, Chu CC, Lu CL, Wang SF, Hwang JC, Wang HY, Kan WC, Lu YH, Chen HA, Chio CC, Lin KC, Wu CC. Increased risk of mortality among haemodialysis patients with or without prior stroke: a nationwide population-based study in Taiwan. Indian J Med Res 2013; 138:232-8. [PMID: 24056600 PMCID: PMC3788209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND & OBJECTIVES Patients with prior stroke (PS) undergoing chronic dialysis are at a high risk of mortality. However, little is known about the cumulative risk and survival rate of dialysis patients with long-term follow up. The aim of this study was to assess risks for mortality between patients with and without PS undergoing chronic haemodialysis (HD). METHODS The Taiwan National Health Insurance Research Database (NHRI-NHIRD-99182) was used and all adult patients (≥18 yr) with end stage renal disease (ESRD) who started maintenance HD between January 1, 1999, and December 31, 1999, were selected. The patients were followed from the first reported date of HD to the date of death, end of dialysis or December 31, 2008. A Cox's proportional hazard model was applied to identify the risk factors for all-cause mortality. RESULTS Among 5672 HD patients, 650 patients (11.5%) had PS. A higher proportion of stroke history at baseline was found in men (52.8%) and those aged ≥ 55 yr (80.9%). After adjusting for age, sex and other covariates, the patients with PS were found to have a 36 per cent increased risk of mortality compared to those without PS (HR 1.36, 95% CI: 1.22-1.52). The cumulative survival rates among HD patients without PS were 96.0 per cent at the first year, 68.4 per cent at the fifth year, and 46.7 per cent at the ninth year, and 92.9, 47.3 and 23.6 per cent, respectively, in those with PS (log-rank: P<0.001). INTERPRETATION & CONCLUSIONS Our findings showed that PS was an important predictor for all-cause mortality and poor outcome in patients undergoing chronic HD.
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Affiliation(s)
- Chih-Chiang Chien
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yih-Min Sun
- Department of Occupational Safety & Health, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Li Lu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jyh-Chang Hwang
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsien-Yi Wang
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wei-Chih Kan
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan,Medical Laboratory Science & Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yi-Hua Lu
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-An Chen
- Department of Rheumatology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurological Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kao-Chang Lin
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan,Institution of Biotechnology, Southern Taiwan University, Tainan, Taiwan
| | - Chiou-Chuen Wu
- Institution of Healthcare, Chung Hwa University of Medical Technology, Tainan, Taiwan, Taiwan,Reprint requests: Dr Chiou-Chuen Wu, Chung Hwa College of Medical Technology, Two 187 lanes, No. 12 of right way in the Rende, District of Tainan, Taiwan e-mail:
Dr Kao-Chang Lin, Department of Neurology, Chi Mei Medical Center, No. 901, Jong-Hwa Rd, Yung Kung City, Tainan, Taiwan e-mail:
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Caseload and outcome after brachytherapy. Clin Oncol (R Coll Radiol) 2013; 25:519-21. [PMID: 23830972 DOI: 10.1016/j.clon.2013.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 11/23/2022]
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Tsai MJ, Huang JY, Wei PJ, Wang CY, Yang CJ, Wang TH, Hwang JJ. Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident. Kaohsiung J Med Sci 2012; 29:43-9. [PMID: 23257256 DOI: 10.1016/j.kjms.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/02/2012] [Indexed: 11/20/2022] Open
Abstract
Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU), the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1). Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1) and those with two senior residents (p > 0.2). Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.
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Affiliation(s)
- Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chang CM, Huang KY, Hsu TW, Su YC, Yang WZ, Chen TC, Chou P, Lee CC. Multivariate analyses to assess the effects of surgeon and hospital volume on cancer survival rates: a nationwide population-based study in Taiwan. PLoS One 2012; 7:e40590. [PMID: 22815771 PMCID: PMC3398946 DOI: 10.1371/journal.pone.0040590] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/10/2012] [Indexed: 01/01/2023] Open
Abstract
Background Positive results between caseloads and outcomes have been validated in several procedures and cancer treatments. However, there is limited information available on the combined effects of surgeon and hospital caseloads. We used nationwide population-based data to explore the association between surgeon and hospital caseloads and survival rates for major cancers. Methodology A total of 11677 patients with incident cancer diagnosed in 2002 were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity scores were used to assess the relationship between 5-year survival rates and different caseload combinations. Results Based on the Cox proportional hazard model, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer survival rates, and hazard ratios ranged from 1.3 in head and neck cancer to 1.8 in lung cancer after adjusting for patients’ demographic variables, co-morbidities, and treatment modality. When analyzed using the propensity scores, the adjusted 5-year survival rates were poorer for patients treated by low-volume surgeons in low-volume hospitals, compared to those treated by high-volume surgeons in high-volume hospitals (P<0.005). Conclusions After adjusting for differences in the case mix, cancer patients treated by low-volume surgeons in low-volume hospitals had poorer 5-year survival rates. Payers may implement quality care improvement in low-volume surgeons.
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Affiliation(s)
- Chun-Ming Chang
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Kuang-Yung Huang
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Ta-Wen Hsu
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yu-Chieh Su
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Wei-Zhen Yang
- Department of Medical Research, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Ting-Chang Chen
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- * E-mail:
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