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Fornacon-Wood I, Banfill K, Ahmad S, Britten A, Carson C, Dorey N, Hatton M, Hiley C, Thippu Jayaprakash K, Jegannathen A, Kidd AC, Koh P, Panakis N, Peedell C, Peters A, Pope A, Powell C, Stilwell C, Thomas B, Toy E, Wicks K, Wood V, Yahya S, Price G, Faivre-Finn C. Impact of the COVID-19 Pandemic on Outcomes for Patients with Lung Cancer Receiving Curative-intent Radiotherapy in the UK. Clin Oncol (R Coll Radiol) 2023; 35:e593-e600. [PMID: 37507280 DOI: 10.1016/j.clon.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
AIMS Previous work found that during the first wave of the COVID-19 pandemic, 34% of patients with lung cancer treated with curative-intent radiotherapy in the UK had a change to their centre's usual standard of care treatment (Banfill et al. Clin Oncol 2022;34:19-27). We present the impact of these changes on patient outcomes. MATERIALS AND METHODS The COVID-RT Lung database was a prospective multicentre UK cohort study including patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between April and October 2020. Data were collected on patient demographics, radiotherapy and systemic treatments, toxicity, relapse and death. Multivariable Cox and logistic regression were used to assess the impact of having a change to radiotherapy on survival, distant relapse and grade ≥3 acute toxicity. The impact of omitting chemotherapy on survival and relapse was assessed using multivariable Cox regression. RESULTS Patient and follow-up forms were available for 1280 patients. Seven hundred and sixty-five (59.8%) patients were aged over 70 years and 603 (47.1%) were female. The median follow-up was 213 days (119, 376). Patients with stage I-II non-small cell lung cancer (NSCLC) who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.859) or death (P = 0.884); however, they did have increased odds of grade ≥3 acute toxicity (P = 0.0348). Patients with stage III NSCLC who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.216) or death (P = 0.789); however, they did have increased odds of grade ≥3 acute toxicity (P < 0.001). Patients with stage III NSCLC who had their chemotherapy omitted had no significant increase in distant relapse (P = 0.0827) or death (P = 0.0661). CONCLUSION This study suggests that changes to radiotherapy and chemotherapy made in response to the COVID-19 pandemic did not significantly affect distant relapse or survival. Changes to radiotherapy, namely increased hypofractionation, led to increased odds of grade ≥3 acute toxicity. These results are important, as hypofractionated treatments can help to reduce hospital attendances in the context of potential future emergency situations.
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Affiliation(s)
| | - K Banfill
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - S Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Britten
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Carson
- The Northern Ireland Cancer Centre, Belfast, UK
| | - N Dorey
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - C Hiley
- University College London Hospitals, London, UK
| | - K Thippu Jayaprakash
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Jegannathen
- University Hospitals North Midlands, Stoke on Trent, UK
| | | | - P Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Panakis
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - C Peedell
- The James Cook University Hospital, Middlesborough, UK
| | - A Peters
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Pope
- Clatterbridge Cancer Centre, Liverpool, UK
| | - C Powell
- Velindre Cancer Centre, Cardiff, UK
| | | | - B Thomas
- Swansea Bay University Hospital, Swansea, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - K Wicks
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - V Wood
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - S Yahya
- University Hospitals Birmingham, Birmingham, UK
| | - G Price
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
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Yan M, Tjong M, Chan WC, Darling G, Delibasic V, Davis LE, Doherty M, Hallet J, Kidane B, Mahar A, Mittmann N, Parmar A, Tan V, Tan H, Wright FC, Coburn NG, Louie AV. Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care. J Thorac Dis 2023; 15:494-506. [PMID: 36910044 PMCID: PMC9992624 DOI: 10.21037/jtd-22-919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
Background Patients with metastatic non-small cell lung cancer (NSCLC) experience significant morbidity with dyspnea being a common symptom with a prevalence of 70%. The objective of this study was to determine factors associated with a moderate-to-severe dyspnea score based on the Edmonton Symptom Assessment System (ESAS), as well as resultant patterns of intervention and factors correlated to intervention receipt. Methods Using health services administrative data, we conducted a population-based study of all patients diagnosed with metastatic NSCLC treated from January 2007 to September 2018 in the province of Ontario. The primary outcomes of interest are the prevalence of moderate-to-severe dyspnea scores, and the receipt of dyspnea-directed intervention. Differences in baseline characteristic between moderate-to-severe dyspnea and low dyspnea score cohorts were assessed by comparative statistics. Predictors of intervention receipt for patients with moderate-to-severe dyspnea scores were estimated using multivariable modified Poisson regression. Results The initial study cohort included 13,159 patients diagnosed with metastatic NSCLC and of these, 9,434 (71.7%) reported a moderate-to-severe dyspnea score. Compared to patients who did not report moderate-to-severe dyspnea scores, those who reported a moderate-to-severe dyspnea score were more likely to complete a greater number of ESAS surveys, be male, have a higher Elixhauser comorbidity index (ECI) score, and receive subsequent systemic therapy after diagnosis. Most patients with a moderate-to-severe dyspnea score received intervention (96%), of which the most common were palliative care management (87%), thoracic radiotherapy (56%) and thoracentesis (37%). Multivariable regression identified older patients to be less likely to undergo pleurodesis. Thoracentesis was less common for patients living in rural and non-major urban areas, lower income areas, and earlier year of diagnosis. Receipt of thoracic radiotherapy was less common for older patients, females, those with ECI ≥4, patients living in major urban areas, and those with later year of diagnosis. Finally, palliative care referrals were less frequent for patients with ECI ≥4, age 60-69, residence outside of major urban areas, earlier year of diagnosis, and lower income areas. Conclusions Dyspnea is a prevalent symptom amongst patients with metastatic NSCLC. Subpopulations of patients with moderate-to-severe dyspnea scores were in which inequities may exist in access to care that require further attention and evaluation.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael Tjong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Victoria Delibasic
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Laura E Davis
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mark Doherty
- Department of Oncology, St. Vincent's Hospital Group, Dublin, Ireland.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Biniam Kidane
- Division of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Mittmann
- Canadian Agency for Drugs and Technology in Health, Ottawa, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vivian Tan
- Department of Radiation Oncology, University of Western Ontario, London, Canada
| | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Sengupta B, Oh K, Sponseller P, Zaki P, Eastman B, Dinh TKT, Cardenas CE, Court LE, Parvathaneni U, Ford E. Cobalt compensator-based IMRT device: A treatment planning study of head and neck cases. Phys Med 2023; 106:102526. [PMID: 36621080 PMCID: PMC10468209 DOI: 10.1016/j.ejmp.2023.102526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Our goal is to develop a novel cobalt-compensator-based IMRT device for low- and middle-income countries that is reliable and cost-effective while delivering treatment plans of equal quality to those from linac-MLC devices. The present study examines the quality of treatment plans using this device. METHODS A commercial treatment planning system (TPS; RayStation v.8B) was commissioned for this device using Monte Carlo simulations from the Geant4 toolkit. Patient-specific compensators were created as regions-of-interest. Thirty clinical head & neck cases were planned and compared to clinical plans with a 6MV linac using IMRT. The mock head and neck plan from TG-119 was used for further validation. RESULTS PTV objectives were achieved in all 30 plans with PTV V95% >95 %. OAR sparing was similar to clinical plans. There were 14 cases where OAR dose limits exceeded the recommended QUANTEC limits in the clinical plan in order to achieve target coverage. OAR sparing was better in the cobalt compensator plan in 8 cases and worse in 3 cases, in the latter cases exceeding the clinical plan doses by an average of 8.22 % (0.0 %-13.5 %). Average field-by-field gamma pass-rate were 93.7 % (2 %/2mm). Estimated treatment times using the Co-60 compensator device were 1 min 27 s vs 1 min 2 s for the clinical system. CONCLUSION This system is the first of its kind to allow for IMRT with a Co-60 device. Data here suggests that the delivery meets plan quality criteria while maintaining short treatment times which may offer a sustainable and cost-low option for IMRT on the global scale.
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Affiliation(s)
| | - Kyuhak Oh
- Department of Radiation Oncology, University of Washington, Seattle, USA; M.D. Anderson Cancer Center, Houston, USA
| | | | - Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Boryana Eastman
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Tru-Khang T Dinh
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Carlos E Cardenas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, USA.
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Ghandourh W, Holloway L, Batumalai V, Chlap P, Field M, Jacob S. Optimal and actual rates of Stereotactic Ablative Body Radiotherapy (SABR) utilisation for primary lung cancer in Australia. Clin Transl Radiat Oncol 2022; 34:7-14. [PMID: 35282142 PMCID: PMC8907547 DOI: 10.1016/j.ctro.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Stereotactic Ablative Body Radiotherapy (SABR) plays a major role in the management of early-stage non-small cell lung cancer (NSCLC). An evidence-based model is developed to estimate optimal rates of lung SABR utilisation within the Australian population. Optimal utilisation rates are compared against actual utilisation rates to evaluate service provision.
Background and purpose Radiotherapy utilisation rates considerably vary across different countries and service providers, highlighting the need to establish reliable benchmarks against which utilisation rates can be assessed. Here, optimal utilisation rates of Stereotactic Ablative Body Radiotherapy (SABR) for lung cancer are estimated and compared against actual utilisation rates to identify potential shortfalls in service provision. Materials and Methods An evidence-based optimal utilisation model was constructed after reviewing practice guidelines and identifying indications for lung SABR based on the best available evidence. The proportions of patients likely to develop each indication were obtained, whenever possible, from Australian population-based studies. Sensitivity analysis was performed to account for variations in epidemiological data. Practice pattern studies were reviewed to obtain actual utilisation rates. Results A total of 6% of all lung cancer patients were estimated to optimally require SABR at least once during the course of their illness (95% CI: 4–6%). Optimal utilisation rates were estimated to be 32% for stage I and 10% for stage II NSCLC. Actual utilisation rates for stage I NSCLC varied between 6 and 20%. For patients with inoperable stage I, 27–74% received SABR compared to the estimated optimal rate of 82%. Conclusion The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care. The model can be easily modified to determine optimal utilisation rates in other populations or updated to reflect any changes in practice guidelines or epidemiological data.
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Ghita M, Billiet C, Copot D, Verellen D, Ionescu CM. Model Calibration of Pharmacokinetic-Pharmacodynamic Lung Tumour Dynamics for Anticancer Therapies. J Clin Med 2022; 11:jcm11041006. [PMID: 35207279 PMCID: PMC8879872 DOI: 10.3390/jcm11041006] [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: 11/30/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Individual curves for tumor growth can be expressed as mathematical models. Herein we exploited a pharmacokinetic-pharmacodynamic (PKPD) model to accurately predict the lung growth curves when using data from a clinical study. Our analysis included 19 patients with non-small cell lung cancer treated with specific hypofractionated regimens, defined as stereotactic body radiation therapy (SBRT). The results exhibited the utility of the PKPD model for testing growth hypotheses of the lung tumor against clinical data. The model fitted the observed progression behavior of the lung tumors expressed by measuring the tumor volume of the patients before and after treatment from CT screening. The changes in dynamics were best captured by the parameter identified as the patients’ response to treatment. Median follow-up times for the tumor volume after SBRT were 126 days. These results have proven the use of mathematical modeling in preclinical anticancer investigations as a potential prognostic tool.
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Affiliation(s)
- Maria Ghita
- Research Group of Dynamical Systems and Control, Ghent University, 9052 Ghent, Belgium; (M.G.); (D.C.)
- Faculty of Medicine and Health Sciences, Antwerp University, 2610 Wilrijk, Belgium
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, 9052 Ghent, Belgium
- Cancer Research Institute Ghent, 9052 Ghent, Belgium
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Cancer Network—GZA Hospitals Sint Augustinus, 2610 Wilrijk, Belgium; (C.B.); (D.V.)
- Department of Radiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, 2610 Wilrijk, Belgium
| | - Dana Copot
- Research Group of Dynamical Systems and Control, Ghent University, 9052 Ghent, Belgium; (M.G.); (D.C.)
- Faculty of Medicine and Health Sciences, Antwerp University, 2610 Wilrijk, Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Cancer Network—GZA Hospitals Sint Augustinus, 2610 Wilrijk, Belgium; (C.B.); (D.V.)
- Department of Radiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, 2610 Wilrijk, Belgium
| | - Clara Mihaela Ionescu
- Research Group of Dynamical Systems and Control, Ghent University, 9052 Ghent, Belgium; (M.G.); (D.C.)
- Faculty of Medicine and Health Sciences, Antwerp University, 2610 Wilrijk, Belgium
- Department of Automatic Control, Technical University of Cluj Napoca, 400114 Cluj, Romania
- Correspondence: ; Tel.: +32-9-264-5608
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Diversifying for Growth or Longing for Yesterday. Pract Radiat Oncol 2021; 12:11-12. [PMID: 34857502 DOI: 10.1016/j.prro.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
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