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Pankratova M, Miranda IP, Thonig D, Pereiro M, Sjöqvist E, Delin A, Scheid P, Eriksson O, Bergman A. Coupled atomistic spin-lattice simulations of ultrafast demagnetization in 3d ferromagnets. Sci Rep 2024; 14:8138. [PMID: 38584162 PMCID: PMC10999457 DOI: 10.1038/s41598-024-58662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
Despite decades of research, the role of the lattice and its coupling to the magnetisation during ultrafast demagnetisation processes is still not fully understood. Here we report on studies of both explicit and implicit lattice effects on laser induced ultrafast demagnetisation of bcc Fe and fcc Co. We do this using atomistic spin- and lattice dynamics simulations following a heat-conserving three-temperature model. We show that this type of Langevin-based simulation is able to reproduce observed trends of the ultrafast magnetization dynamics of fcc Co and bcc Fe. The parameters used in our models are all obtained from electronic structure theory, with the exception of the lattice dynamics damping term, where a range of parameters were investigated. It was found that while the explicit spin-lattice coupling in the studied systems does not impact the demagnetisation process notably, the lattice damping has a large influence on the details of the magnetization dynamics. The dynamics of Fe and Co following the absorption of a femtosecond laser pulse are compared with previous results for Ni and similarities and differences in the materials' behavior are analysed. For all elements investigated so far with this model, we obtain a linear relationship between the value of the maximally demagnetized state and the fluence of the laser pulse , which is in agreement with experiments. Moreover, we demonstrate that the demagnetization amplitude is largest for Ni and smallest for Co. This holds over a wide range of the reported electron-phonon couplings, and this demagnetization trend is in agreement with recent experiments.
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Affiliation(s)
- M Pankratova
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden.
| | - I P Miranda
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden.
| | - D Thonig
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden
- School of Science and Technology, Örebro University, 701 82, Örebro, Sweden
| | - M Pereiro
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden
| | - E Sjöqvist
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden
| | - A Delin
- Department of Applied Physics, School of Engineering Sciences, KTH Royal Institute of Technology, AlbaNova University Center, 10691, Stockholm, Sweden
- Swedish e-Science Research Center (SeRC), KTH Royal Institute of Technology, 10044, Stockholm, Sweden
- Wallenberg Initiative Materials Science for Sustainability (WISE), KTH Royal Institute of Technology, 10044, Stockholm, Sweden
| | - P Scheid
- LPCT, CNRS, UMR 7019, BP 70239, Université de Lorraine, 54506, Vandoeuvre-lés-Nancy Cedex, France
- IJL, CNRS, UMR 7198, BP 70239, Université de Lorraine, 54000, Nancy Cedex, France
| | - O Eriksson
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden
- Wallenberg Initiative Materials Science for Sustainability, Uppsala University, 75121, Uppsala, Sweden
| | - A Bergman
- Department of Physics and Astronomy, Uppsala University, Box 516, 75120, Uppsala, Sweden
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2
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Baker S, Lechner L, Liu M, Chang JS, Cruz-Lim EM, Mou B, Jiang W, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Arbour G, Yu I, Tyldesley S, Olson RA. Upfront Versus Delayed Systemic Therapy in Patients With Oligometastatic Cancer Treated With SABR in the Phase 2 SABR-5 Trial. Int J Radiat Oncol Biol Phys 2024; 118:1497-1506. [PMID: 38220069 DOI: 10.1016/j.ijrobp.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The optimal sequencing of local and systemic therapy for oligometastatic cancer has not been established. This study retrospectively compared progression-free survival (PFS), overall survival (OS), and SABR-related toxicity between upfront versus delay of systemic treatment until progression in patients in the SABR-5 trial. METHODS AND MATERIALS The single-arm phase 2 SABR-5 trial accrued patients with up to 5 oligometastases across SABR-5 between November 2016 and July 2020. Patients received SABR to all lesions. Two cohorts were retrospectively identified: those receiving upfront systemic treatment along with SABR and those for whom systemic treatment was delayed until disease progression. Patients treated for oligoprogression were excluded. Propensity score analysis with overlap weighting balanced baseline characteristics of cohorts. Bootstrap sampling and Cox regression models estimated the association of delayed systemic treatment with PFS, OS, and grade ≥2 toxicity. RESULTS A total of 319 patients with oligometastases underwent treatment on SABR-5, including 121 (38%) and 198 (62%) who received upfront and delayed systemic treatment, respectively. In the weighted sample, prostate cancer was the most common primary tumor histology (48%) followed by colorectal (18%), breast (13%), and lung (4%). Most patients (93%) were treated for 1 to 2 metastases. The median follow-up time was 34 months (IQR, 24-45). Delayed systemic treatment was associated with shorter PFS (hazard ratio [HR], 1.56; 95% CI, 1.15-2.13; P = .005) but similar OS (HR, 0.90; 95% CI, 0.51-1.59; P = .65) compared with upfront systemic treatment. Risk of grade 2 or higher SABR-related toxicity was reduced with delayed systemic treatment (odds ratio, 0.35; 95% CI, 0.15-0.70; P < .001). CONCLUSIONS Delayed systemic treatment is associated with shorter PFS without reduction in OS and with reduced SABR-related toxicity and may be a favorable option for select patients seeking to avoid initial systemic treatment. Efforts should continue to accrue patients to histology-specific trials examining a delayed systemic treatment approach.
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Affiliation(s)
- Sarah Baker
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada.
| | | | - Mitchell Liu
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Jee Suk Chang
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ella Mae Cruz-Lim
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Ben Mou
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Will Jiang
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Alanah Bergman
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Devin Schellenberg
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Abraham Alexander
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Tanya Berrang
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Andrew Bang
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Nick Chng
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Quinn Matthews
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Hannah Carolan
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Fred Hsu
- University of British Columbia; BC Cancer-Abbotsford, Department of Radiation Oncology, Abbotsford, BC, Canada
| | - Stacey Miller
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Siavash Atrchian
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Elisa Chan
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Clement Ho
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Islam Mohamed
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Angela Lin
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Vicky Huang
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Ante Mestrovic
- BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Derek Hyde
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Chad Lund
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Howard Pai
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Boris Valev
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Shilo Lefresne
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | | | - Irene Yu
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Scott Tyldesley
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Rob A Olson
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
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3
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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4
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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5
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Olson R, Abraham H, Leclerc C, Benny A, Baker S, Matthews Q, Chng N, Bergman A, Mou B, Dunne EM, Schellenberg D, Jiang W, Chan E, Atrchian S, Lefresne S, Carolan H, Valev B, Tyldesley S, Bang A, Berrang T, Clark H, Hsu F, Louie AV, Warner A, Palma DA, Howell D, Barry A, Dawson L, Grendarova P, Walker D, Sinha R, Tsai J, Bahig H, Thibault I, Koul R, Senthi S, Phillips I, Grose D, Kelly P, Armstrong J, McDermott R, Johnstone C, Vasan S, Aherne N, Harrow S, Liu M. Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET. BMC Cancer 2024; 24:171. [PMID: 38310262 PMCID: PMC10838428 DOI: 10.1186/s12885-024-11905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada.
- University of Northern British Columbia, Prince George, Canada.
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada.
- Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada.
| | - Hadassah Abraham
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Curtis Leclerc
- University of British Columbia, Vancouver, Canada
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | | | - Sarah Baker
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Nick Chng
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Alanah Bergman
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Emma M Dunne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Will Jiang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Elisa Chan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Shilo Lefresne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Hannah Carolan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Boris Valev
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | | | - Andrew Bang
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Tanya Berrang
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | - Haley Clark
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Fred Hsu
- BC Cancer- Abbotsford, Abbotsford, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Laura Dawson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Debra Walker
- Patient partner, BC Cancer-Prince George, Prince George, BC, Canada
| | - Rishi Sinha
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jillian Tsai
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Rashmi Koul
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Iain Phillips
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Paul Kelly
- Bon Secours Radiotherapy Cork (In Partnership with UPMC Hillman Cancer Centre), Cork, Ireland
| | | | | | - Candice Johnstone
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Srini Vasan
- Precision Cancer Center, Ashland, Kentucky, United States of America
| | - Noel Aherne
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
| | - Stephen Harrow
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Mitchell Liu
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
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Rostamzadeh M, Thomas S, Camborde M, Karan T, Liu M, Ma R, Mestrovic A, Gill B, Tai I, Bergman A. Markerless dynamic tumor tracking (MDTT) radiotherapy using diaphragm as a surrogate for liver targets. J Appl Clin Med Phys 2024; 25:e14161. [PMID: 37789572 PMCID: PMC10860457 DOI: 10.1002/acm2.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE To assess the feasibility of using the diaphragm as a surrogate for liver targets during MDTT. METHODS Diaphragm as surrogate for markers: a dome-shaped phantom with implanted markers was fabricated and underwent dual-orthogonal fluoroscopy sequences on the Vero4DRT linac. Ten patients participated in an IRB-approved, feasibility study to assess the MDTT workflow. All images were analyzed using an in-house program to back-project the diaphragm/markers position to the isocenter plane. ExacTrac imager log files were analyzed. Diaphragm as tracking structure for MDTT: The phantom "diaphragm" was contoured as a markerless tracking structure (MTS) and exported to Vero4DRT/ExacTrac. A single field plan was delivered to the phantom film plane under static and MDTT conditions. In the patient study, the diaphragm tracking structure was contoured on CT breath-hold-exhale datasets. The MDTT workflow was applied until just prior to MV beam-on. RESULTS Diaphragm as surrogate for markers: phantom data confirmed the in-house 3D back-projection program was functioning as intended. In patients, the diaphragm/marker relative positions had a mean ± RMS difference of 0.70 ± 0.89, 1.08 ± 1.26, and 0.96 ± 1.06 mm in ML, SI, and AP directions. Diaphragm as tracking structure for MDTT: Building a respiratory-correlation model using the diaphragm as surrogate for the implanted markers was successful in phantom/patients. During the tracking verification imaging step, the phantom mean ± SD difference between the image-detected and predicted "diaphragm" position was 0.52 ± 0.18 mm. The 2D film gamma (2%/2 mm) comparison (static to MDTT deliveries) was 98.2%. In patients, the mean difference between the image-detected and predicted diaphragm position was 2.02 ± 0.92 mm. The planning target margin contribution from MDTT diaphragm tracking is 2.2, 5.0, and 4.7 mm in the ML, SI, and AP directions. CONCLUSION In phantom/patients, the diaphragm motion correlated well with markers' motion and could be used as a surrogate. MDTT workflows using the diaphragm as the MTS is feasible using the Vero4DRT linac and could replace the need for implanted markers for liver radiotherapy.
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Affiliation(s)
- Maryam Rostamzadeh
- Department of Physics and AstronomyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Steven Thomas
- Medical Physics DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | | | - Tania Karan
- Medical Physics DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Mitchell Liu
- Radiation Oncology DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Roy Ma
- Radiation Oncology DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Ante Mestrovic
- Medical Physics DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Bradford Gill
- Medical Physics DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Isaac Tai
- Radiation Therapy DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
| | - Alanah Bergman
- Medical Physics DepartmentBC Cancer‐VancouverVancouverBritish ColumbiaCanada
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7
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Camborde ML, Karan T, Horwood R, Mestrovic A, Bergman A. Evaluation of Patient-Specific Quality Control (QC) for Markerless Dynamic Tumor Tracking (MDTT) Deliveries. Int J Radiat Oncol Biol Phys 2023; 117:e647. [PMID: 37785925 DOI: 10.1016/j.ijrobp.2023.06.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report on the patient-specific QC for MDTT for liver and lung tumors treated using the dome-of-liver/diaphragm as a surrogate for the target position and compare to the QC of conventional fiducial-based tracking. MATERIALS/METHODS Vero4DRT is a linear accelerator that has a gimbal-mounted waveguide and collimation system allowing the radiation beam to perform dynamic tumor tracking based on a patient's respiratory motion. A correlation model is built between an external IR marker placed on the chest and an internal structure, which may be implanted fiducial surrogates or in the case of MDTT, an anatomic landmark. During treatment an orthogonal kV image pair is taken every second. The auto detected internal structure position versus the predicted position is recorded in treatment log files. Five IMRT tracking plans were delivered to two commercial motion phantoms with in-house additions for patient-specific tracking QC. For point dose measurements, a 0.6cc farmer chamber was placed inside the dynamic tracking phantom which contains fiducials for fiducial-based tracking delivery and an anatomic landmark for MDTT. For 2D dose distribution measurements, a radiographic film insert for the Quasar Respiratory Motion Phantom was constructed. The phantom contains both fiducials and has a liver-dome shape at one end to facilitate MDTT. Both motion platforms were interfaced with software that enabled patient-specific respiratory motion traces acquired during a 4DCT scan. Each plan was delivered three times on each phantom: 1) in static mode, 2) during fiducial-based tracking, and 3) during MDTT. Chamber measurements taken during static and tracked delivery were compared to the average chamber dose from the treatment planning software (TPS). Film distributions measured during tracked deliveries were compared to the static film distribution using gamma analysis with FILMQA PRO software. Finally, dynamic tracking treatment statistics, extracted from log files, were compared between fiducial and markerless tracking deliveries. RESULTS All chamber measurements resulted in dose differences <2.5% compared with the TPS. Dose differences between fiducial-based and MDTT were 0.26% on average (range 0.03-0.62%). For film dose map analysis, gamma pass rates were >95% for all plans for all tracking methods. The average gamma pass rate for 3%/3mm was 99.4% (fiducial-based) vs 98.4% (markerless). For 2%/2mm, the average gamma pass rate was 96.4% (fiducial-based tracking) vs 95.6% (MDTT). Dynamic treatment statistics from logs files reported an average 3D absolute deviation from predicted position of 0.52mm (±0.24) for fiducial tracking and 1.19mm (±0.50) for MDTT. CONCLUSION Both fiducial-based and MDTT plans meet passing criteria for patient-specific QC. 3D absolute deviation of detected versus predicted position are larger for MDTT compared to fiducial tracking, however no significant impact on dose delivery was measured.
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Affiliation(s)
| | - T Karan
- BC Cancer, Vancouver, BC, Canada
| | | | | | - A Bergman
- BC Cancer Vancouver, Vancouver, BC, Canada
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8
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander AS, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson RA. Prospective Longitudinal Assessment of Quality of Life after Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-Based SABR-5 Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e224-e225. [PMID: 37784911 DOI: 10.1016/j.ijrobp.2023.06.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS/METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to 5 sites of oligometastases, conducted in 6 regional cancer centers in British Columbia from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30, and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal, and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and baseline score of individual patients. Mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with "stable," "improved," or "worsened" QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI Functional Interference Score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least 1 follow-up assessment were analyzed (n = 135). On equivalence testing, patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% CI [1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% CI [1.15 to 2.21]; FACIT-AD TOI mean difference: -8.76, 90% CI [-11.29 to -6.24]; POSI mean difference: -4.61, 90% CI [-6.09 to -3.14]). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). The majority of patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening, and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSION SABR in the oligometastatic setting can lead to transient decreases in QoL. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterize patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Kelowna, Kelowna, BC, Canada
| | - B Mou
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Kelowna, Kelowna, BC, Canada
| | - S Baker
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - G Arbour
- University of British Columbia, Vancouver, BC, Canada
| | - K Stefanyk
- University of British Columbia, Vancouver, BC, Canada
| | - W Jiang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - M Liu
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - A Bergman
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - A S Alexander
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Victoria, Victoria, BC, Canada
| | - T Berrang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Victoria, Victoria, BC, Canada
| | - A Bang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, BC, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, BC, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - R A Olson
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Prince George, Prince George, BC, Canada
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McDermott RL, Dunne EM, Zhao Y, Bergman A, Liu MC, Schellenberg D, Ma RM. Stereotactic Ablative Radiation Therapy for Colorectal Liver Metastases. Clin Colorectal Cancer 2023; 22:120-128. [PMID: 36526537 DOI: 10.1016/j.clcc.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Stereotactic Ablative Radiation Therapy (SABR) is a therapeutic option for patients with inoperable oligometastatic colorectal carcinoma (CRC). Given the scarcity of prospective data on outcomes of SABR for metastatic CRC, this study aims to review SABR outcomes and determine predictive factors of local control (LC) and survival in patients with liver metastases from CRC. MATERIALS AND METHODS A retrospective review of SABR for CRC liver metastases between 2011 and 2019 was undertaken. Endpoints included LC, overall survival (OS), progression-free survival (PFS) and time to restarting systemic therapy. Univariate (UVA) and multivariable analyses (MVA) were performed to identify predictive factors. RESULTS Forty-eight patients were identified. The total number of tumors treated was 58. Median follow-up was 26.6 months. LC at 1, 2 and 3 years was 92.7%, 80.0%, and 61.2% respectively. Median time to local failure was 40.0 months (95% CI 31.8-76.1 months). Median OS was 31.9 months (95% CI 20.6-40.0 months). OS at 1, 2, and 3 years was 79.2%, 61.7%, and 44.9% respectively. Thirty-three patients (69%) restarted systemic therapy after completion of SABR. Median time to restarting chemotherapy was 11.0 months (95% CI 7.1-17.6 months). Systemic therapy free survival at 1, 2, and 3 years was 45.7%, 29.6%, and 22.6% respectively. On MVA, inferior LC was influenced by GTV volume ≥40 cm3 (HR: 3.805, 95% CI 1.376-10.521, P = .01) and PTV D100% BED <100 Gy10 (HR 2.971, 95% CI 1.110-7.953; P = .03). Inferior OS was associated with PTV volume ≥200 cm3 (HR 5.679, 95% CI 2.339-13.755; P < .001). CONCLUSION SABR is an effective therapeutic option for selected patients with CRC liver metastases providing acceptable LC within the first 2 years. In many cases, it provides meaningful chemotherapy-free intervals. Higher biological effective doses are required to enhance LC.
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Affiliation(s)
- Ronan L McDermott
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Centre, Vancouver, British Columbia, Canada.
| | - Emma M Dunne
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Yizhou Zhao
- Department of Radiation Oncology, British Columbia Cancer Agency - Surrey Centre, Surrey, British Columbia, Canada
| | - Alanah Bergman
- Department of Medical Physics, British Columbia Cancer Agency - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Mitchell Cc Liu
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, British Columbia Cancer Agency - Surrey Centre, Surrey, British Columbia, Canada
| | - Roy Mk Ma
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Centre, Vancouver, British Columbia, Canada
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Eufemon Cereno R, Mou B, Baker S, Chng N, Arbour G, Bergman A, Liu M, Schellenberg D, Matthews Q, Huang V, Mestrovic A, Hyde D, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Jiang W, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson RA. Should organs at risk (OARs) be prioritized over target volume coverage in stereotactic ablative radiotherapy (SABR) for oligometastases? a secondary analysis of the population-based phase II SABR-5 trial. Radiother Oncol 2023; 182:109576. [PMID: 36822355 DOI: 10.1016/j.radonc.2023.109576] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/26/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic ablative radiotherapy (SABR) for oligometastases may improve survival, however concerns about safety remain. To mitigate risk of toxicity, target coverage was sacrificed to prioritize organs-at-risk (OARs) during SABR planning in the population-based SABR-5 trial. This study evaluated the effect of this practice on dosimetry, local recurrence (LR), and progression-free survival (PFS). METHODS This single-arm phase II trial included patients with up to 5 oligometastases between November 2016 and July 2020. Theprotocol-specified planning objective was to cover 95 % of the planning target volume (PTV) with 100 % of the prescribed dose, however PTV coverage was reduced as needed to meet OAR constraints. This trade-off was measured using the coverage compromise index (CCI), computed as minimum dose received by the hottest 99 % of the PTV (D99) divided by the prescription dose. Under-coverage was defined as CCI < 0.90. The potential association between CCI and outcomes was evaluated. RESULTS 549 lesions from 381 patients were assessed. Mean CCI was 0.88 (95 % confidence interval [CI], 0.86-0.89), and 196 (36 %) lesions were under-covered. The highest mean CCI (0.95; 95 %CI, 0.93-0.97) was in non-spine bone lesions (n = 116), while the lowest mean CCI (0.71; 95 % CI, 0.69-0.73) was in spine lesions (n = 104). On multivariable analysis, under-coverage did not predict for worse LR (HR 0.48, p = 0.37) or PFS (HR 1.24, p = 0.38). Largest lesion diameter, colorectal and 'other' (non-prostate, breast, or lung) primary predicted for worse LR. Largest lesion diameter, synchronous tumor treatment, short disease free interval, state of oligoprogression, initiation or change in systemic treatment, and a high PTV Dmax were significantly associated with PFS. CONCLUSION PTV under-coverage was not associated with worse LR or PFS in this large, population-based phase II trial. Combined with low toxicity rates, this study supports the practice of prioritizing OAR constraints during oligometastatic SABR planning.
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Affiliation(s)
- Reno Eufemon Cereno
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Benjamin Mou
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Sarah Baker
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Gregory Arbour
- University of British Columbia, British Columbia, Canada
| | - Alanah Bergman
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Mitchell Liu
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Devin Schellenberg
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Quinn Matthews
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Ante Mestrovic
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Derek Hyde
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Abraham Alexander
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Hannah Carolan
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Fred Hsu
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Abbotsford, British Columbia, Canada
| | - Stacy Miller
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada
| | - Siavash Atrchian
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Elisa Chan
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Clement Ho
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Islam Mohamed
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Angela Lin
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Tanya Berrang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Andrew Bang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Will Jiang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada
| | - Chad Lund
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Howard Pai
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Boris Valev
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Shilo Lefresne
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Robert A Olson
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada.
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Van Oirschot M, Bergman A, Verbakel WFAR, Ward L, Gagne I, Huang V, Chng N, Houston P, Symes K, Thomas CG, Basran P, Bowes D, Harrow S, Olson R, Senan S, Warner A, Palma DA, Gaede S. Determining Planning Priorities for SABR for Oligometastatic Disease: A Secondary Analysis of the SABR-COMET Phase II Randomized Trial. Int J Radiat Oncol Biol Phys 2022; 114:1016-1021. [PMID: 35031340 DOI: 10.1016/j.ijrobp.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE SABR may improve survival in patients with oligometastases, but for some lesions, safe delivery of SABR may require a reduction in delivered dose or target coverage. This study assessed the association between target coverage compromise and oncologic and survival outcomes. METHODS AND MATERIALS Patients with a controlled primary malignancy and 1 to 5 oligometastases were randomized (1:2) between standard of care (SOC) treatment and SOC plus SABR. In patients receiving SABR, the target dose coverage was reduced to meet organ at risk (OAR) constraints, if necessary. The D99 value (minimum dose received by the hottest 99% of the planning target volume [PTV]) was used as a measure of PTV coverage for each treatment plan, and the relationship between the coverage compromise index (CCI, defined as D99/prescription dose) and patient outcomes was assessed. RESULTS Sixty-two patients in the SABR arm had dosimetric information available and a total of 109 lesions were evaluated. The mean CCI per lesion was 0.96 (95% CI, 0.56-1.61). Of the 109 lesions evaluated, 29.4% (n = 32) required coverage compromise (CCI <0.9). Adrenal metastases required coverage compromise in 100% of analyzed lesions (n = 7). CCI was not significantly associated with lesional control, adverse events, overall survival (OS), or progression-free survival (PFS). CONCLUSIONS Target compromise was required in a substantial minority of cases, but PTV coverage was not associated with OS, progression-free survival, or lesional control. This suggests that OAR constraints used for SABR treatments in the oligometastatic setting should continue to be prioritized during planning.
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Affiliation(s)
| | - Alanah Bergman
- British Columbia Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Wilko F A R Verbakel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lucy Ward
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Isabelle Gagne
- British Columbia Cancer, Victoria Centre, Victoria, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey Centre, Surrey, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Peter Houston
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Kerry Symes
- British Columbia Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | | | | | - David Bowes
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Stephen Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Robert Olson
- British Columbia Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Suresh Senan
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrew Warner
- London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- London Health Sciences Centre, London, Ontario, Canada.
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12
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Olson R, Jiang W, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Chng N, Matthews Q, Baker S, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresene S, Tyldesley S. Treatment With Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases in Patients With Cancer: Primary Toxic Effect Results of the Nonrandomized Phase 2 SABR-5 Clinical Trial. JAMA Oncol 2022; 8:1644-1650. [PMID: 36173619 PMCID: PMC9523552 DOI: 10.1001/jamaoncol.2022.4394] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022]
Abstract
Importance After the publication of the landmark SABR-COMET trial, concerns arose regarding high-grade toxic effects of treatment with stereotactic ablative body radiotherapy (SABR) for oligometastases. Objective To document toxic effects of treatment with SABR in a large cohort from a population-based, provincial cancer program. Design, Setting, and Participants From November 2016 to July 2020, 381 patients across all 6 cancer centers in British Columbia were treated in this single-arm, phase 2 trial of treatment with SABR for patients with oligometastatic or oligoprogressive disease. During this period, patients were only eligible to receive treatment with SABR in these settings in trials within British Columbia; therefore, this analysis is population based, with resultant minimal selection bias compared with previously published SABR series. Interventions Stereotactic ablative body radiotherapy to up to 5 metastases. Main Outcomes and Measures Rate of grade 2, 3, 4, and 5 toxic effects associated with SABR. Findings Among 381 participants (122 women [32%]), the mean (SD; range) age was 68 (11.1; 30-97) years, and the median (range) follow-up was 25 (1-54) months. The most common histological findings were prostate cancer (123 [32%]), colorectal cancer (63 [17%]), breast cancer (42 [11%]), and lung cancer (33 [9%]). The number of SABR-treated sites were 1 (263 [69%]), 2 (82 [22%]), and 3 or more (36 [10%]). The most common sites of SABR were lung (188 [34%]), nonspine bone (136 [25%]), spine (85 [16%]), lymph nodes (78 [14%]), liver (29 [5%]), and adrenal (15 [3%]). Rates of grade 2, 3, 4, and 5 toxic effects associated with SABR (based on the highest-grade toxic effect per patient) were 14.2%; (95% CI, 10.7%-17.7%), 4.2% (95% CI, 2.2%-6.2%), 0%, and 0.3% (95% CI, 0%-0.8%), respectively. The cumulative incidence of grade 2 or higher toxic effects associated with SABR at year 2 by Kaplan-Meier analysis was 8%, and for grade 3 or higher, 4%. Conclusions and Relevance This single-arm, phase 2 clinical trial found that the incidence of grade 3 or higher SABR toxic effects in this population-based study was less than 5%. Furthermore, the rates of grade 2 or higher toxic effects (18.6%) were lower than previously published for SABR-COMET (29%). These results suggest that SABR treatment for oligometastases has acceptable rates of toxic effects and potentially support further enrollment in randomized phase 3 clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT02933242.
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Affiliation(s)
- Robert Olson
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Will Jiang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Mitchell Liu
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Alanah Bergman
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Devin Schellenberg
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Benjamin Mou
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Abraham Alexander
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Hannah Carolan
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Fred Hsu
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Abbotsford, British Columbia, Canada
| | - Stacy Miller
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Siavash Atrchian
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Elisa Chan
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Clement Ho
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Islam Mohamed
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Angela Lin
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Tanya Berrang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Andrew Bang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Quinn Matthews
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Sarah Baker
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Ante Mestrovic
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Derek Hyde
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Chad Lund
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Howard Pai
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Boris Valev
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Shilo Lefresene
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
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Jiang W, Baker S, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Atrchian S, Chan E, Mohamed I, Berrang T, Bang A, Chng N, Matthews Q, Pai H, Lefresne S, Tyldesley S, Olson R. Population Based Phase II Trial of Stereotactic Ablative Radiotherapy (SABR): Overall Survival Results of the SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baker S, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. Validation of the Prognostic Utility of ESTRO/EORTC Oligometastatic Disease Classification: A Secondary Analysis from the Population-Based Phase II SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Van Oirschot M, Bergman A, Verbakel W, Ward L, Gagne I, Huang V, Chng N, Houston P, Symes K, Thomas C, Basran P, Bowes D, Harrow S, Olson R, Senan S, Warner A, Palma D, Gaede S. Does Compromising Target Coverage Impact Overall Survival when Treating Oligometastatic Disease with Stereotactic Ablative Radiotherapy (SABR)? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baker S, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. Predictors of Early Polymetastatic Relapse Following Stereotactic Ablative Radiotherapy for up to 5 Oligometastases: A Secondary Analysis of the Phase II SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baker S, Mou B, Jiang W(WN, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. 65: Predictors of Early Polymetastatic Relapse Following Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases: A Secondary Analysis of the Phase II SABR-5 Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baker S, Jiang W(WN, Mou B, Lund C, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Chng N, Matthews Q, Benny A, Tyldesley S, Olson R. 36: Progression-Free Survival and Local Control Following Stereotactic Ablative Radiotherapy for Up to Five Oligometastases: An Analysis from the Population-Based Phase II SABR-5 Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Narinesingh D, Nichol A, Bergman A, Popescu T. Abstract P3-19-10: Subcutaneous layer dosimetry of the breast and chest wall at clinical beam energies without bolus: A Monte Carlo and analytical anisotropic algorithm (AAA) calculation study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-19-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: Breast skin thickness is 3 mm (1). The subcutaneous layer (SL) lies immediately beneath the skin and is at risk for local recurrence after breast cancer surgery and adjuvant radiotherapy. As the SL lies within the buildup region for megavoltage radiation treatment, placement of bolus for patients receiving chest wall (CW) radiotherapy (RT) is routine at many centers. The dermal toxicity of bolus is well known: in 12 studies of CW RT, the pooled risk of Grade 3 acute toxicity is 9.6% with bolus and 1.2% without bolus (2). Meanwhile, bolus is rarely used after breast-conserving surgery (BCS) RT for patients with similar cancers. This study examines variation in tangential RT dose coverage of the SL in the intact breast and bolus-free CW with clinically relevant photon beam energies using Monte Carlo (MC) calculations and a commercial treatment planning system (TPS). METHODS: Thirty CT datasets from patients without skin involvement were identified. There were two groups of patients: 15 treated with BCS RT and 15 treated with CW RT. In each group, 5-patient subgroups had tangent-beam RT planned without bolus with 6, 10, and 15 MV photons, respectively, using the Analytical Anisotropic Algorithm (AAA) algorithm (v.13.6.23) in Eclipse v.15.6 (Varian Medical Systems Inc., Palo Alto, CA). On each CT, the SL was segmented as a high-resolution shell from 3 to 5 mm below the body contour in the Eclipse TPS v.15.6 (Varian Medical Systems Inc., Palo Alto, CA). A 1x1x1 mm MC dose simulation was performed using EGSnrc code (BEAMnrc/DOSXYZnrc). The MC dose distributions were imported back into the TPS for comparison with AAA calculations. The V95% and V90% for the SL were calculated for each case and the mean V95% and V90% were reported for each subgroup. A t-test was used with a two-sided alpha = 0.05 for statistical analysis. RESULTS: The mean separation increased with use of higher energies for both BCS and CW RT. The MC-calculated mean SL V90% and V95% were higher for CW RT than for BCS RT at each energy. The V90% coverage was 91.5% for CW and 74.4 % for BCS at 6 MV (p<0.001), 89.3% for CW and 61.3% for BCS (p<0.001) at 10 MV and 87.1% for CW and 60.9% for BCS (p<0.001) at 15 MV (Table 1). For SL V95% the CW coverage was higher than the BCS coverage for every energy. For SL V90% at 6 MV, the AAA and MC calculations agreed within 2.5%, with the MC being slightly higher. The agreement between AAA and MC decreased for higher energies with MC reporting higher SL V90% coverage by up to 16.3%. The higher MC-calculated dose to the SL is consistent with the literature (3). CONCLUSION: MC and AAA SL dose calculations agreed well for 6 MV, but AAA underestimated the dose for 10 and 15 MV. For 6-15 MV photons, the MC-calculated dosimetric coverage of the SL is higher for CW RT than BCS RT. Since radiation oncologists are satisfied with the SL coverage by BCS RT, bolus is not needed for CW RT, because, without bolus, CW RT delivers a higher SL dose than BCS RT. REFERENCES:. 1.Pope TL Jr, et al.J Can Assoc Radiol. 1984 Dec;35(4):365-8. PMID: 6526847. 2.Dahn HM, et al. Crit Rev Oncol Hematol. 2021 Jun 5;163:10339. PMID: 34102286. 3.Panettieri V, et al., Radiother Oncol 2009; 93: 94-101
Table 1.Monte Carlo calculated mean V90% and V95% for Breast and Chest Wall for each energyV95%V95%V95%V90%V90%V90%Energy(MV)Chest Wall(Mean)Breast. (Mean)p-valueChest Wall(Mean)Breast. (Mean)p-value661.9%35.1%<0.00191.5%74.4%<0.0011065.2%39.7%<0.00189.3%61.3%<0.0011561.7%38.9%0.01287.1%60.9%<0.001
Citation Format: Dylan Narinesingh, Alan Nichol, Alanah Bergman, Tony Popescu. Subcutaneous layer dosimetry of the breast and chest wall at clinical beam energies without bolus: A Monte Carlo and analytical anisotropic algorithm (AAA) calculation study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-10.
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Longchamps RJ, Yang SY, Castellani CA, Shi W, Lane J, Grove ML, Bartz TM, Sarnowski C, Liu C, Burrows K, Guyatt AL, Gaunt TR, Kacprowski T, Yang J, De Jager PL, Yu L, Bergman A, Xia R, Fornage M, Feitosa MF, Wojczynski MK, Kraja AT, Province MA, Amin N, Rivadeneira F, Tiemeier H, Uitterlinden AG, Broer L, Van Meurs JBJ, Van Duijn CM, Raffield LM, Lange L, Rich SS, Lemaitre RN, Goodarzi MO, Sitlani CM, Mak ACY, Bennett DA, Rodriguez S, Murabito JM, Lunetta KL, Sotoodehnia N, Atzmon G, Ye K, Barzilai N, Brody JA, Psaty BM, Taylor KD, Rotter JI, Boerwinkle E, Pankratz N, Arking DE. Genome-wide analysis of mitochondrial DNA copy number reveals loci implicated in nucleotide metabolism, platelet activation, and megakaryocyte proliferation. Hum Genet 2022; 141:127-146. [PMID: 34859289 PMCID: PMC8758627 DOI: 10.1007/s00439-021-02394-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
Mitochondrial DNA copy number (mtDNA-CN) measured from blood specimens is a minimally invasive marker of mitochondrial function that exhibits both inter-individual and intercellular variation. To identify genes involved in regulating mitochondrial function, we performed a genome-wide association study (GWAS) in 465,809 White individuals from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank (UKB). We identified 133 SNPs with statistically significant, independent effects associated with mtDNA-CN across 100 loci. A combination of fine-mapping, variant annotation, and co-localization analyses was used to prioritize genes within each of the 133 independent sites. Putative causal genes were enriched for known mitochondrial DNA depletion syndromes (p = 3.09 × 10-15) and the gene ontology (GO) terms for mtDNA metabolism (p = 1.43 × 10-8) and mtDNA replication (p = 1.2 × 10-7). A clustering approach leveraged pleiotropy between mtDNA-CN associated SNPs and 41 mtDNA-CN associated phenotypes to identify functional domains, revealing three distinct groups, including platelet activation, megakaryocyte proliferation, and mtDNA metabolism. Finally, using mitochondrial SNPs, we establish causal relationships between mitochondrial function and a variety of blood cell-related traits, kidney function, liver function and overall (p = 0.044) and non-cancer mortality (p = 6.56 × 10-4).
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Affiliation(s)
- R J Longchamps
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Y Yang
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C A Castellani
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - W Shi
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Lane
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - M L Grove
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, Human Genetics Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - T M Bartz
- Cardiovascular Health Research Unit, Departments of Medicine and Biostatistics, University of Washington, Seattle, WA, USA
| | - C Sarnowski
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - C Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - K Burrows
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - A L Guyatt
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK
| | - T R Gaunt
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - T Kacprowski
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
- Data Science in Biomedicine, Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Brunswick, Germany
| | - J Yang
- Rush Alzheimer's Disease Center and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - P L De Jager
- Center for Translational and Systems Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - L Yu
- Rush Alzheimer's Disease Center and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - A Bergman
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R Xia
- Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Fornage
- Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genetics Center, The University of Texas Health Science Center at Houston, Houston, USA
| | - M F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - M K Wojczynski
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - A T Kraja
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - M A Province
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - N Amin
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard T.H. School of Public Health, Boston, USA
| | - A G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J B J Van Meurs
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C M Van Duijn
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L M Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - S S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - R N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - M O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - C M Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - A C Y Mak
- Cardiovascular Research Institute and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - D A Bennett
- Rush Alzheimer's Disease Center and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - S Rodriguez
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - J M Murabito
- Boston University School of Medicine, Boston University, Boston, MA, USA
| | - K L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - N Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - G Atzmon
- Department of Natural Science, University of Haifa, Haifa, Israel
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - K Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - N Barzilai
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - J A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Psaty
- Cardiovascular Health Research Unit, Departments of Epidemiology, Medicine and Health Services, University of Washington, Seattle, WA, USA
| | - K D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - J I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - E Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, Human Genetics Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Baylor College of Medicine, Human Genome Sequencing Center, Houston, TX, USA
| | - N Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - D E Arking
- Department of Genetic Medicine, McKusick-Nathans Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Olson R, Jiang W, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Chng N, Matthews Q, Huang V, Mestrovic T, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S. Population Based Phase II Trial of Stereotactic Ablative Radiotherapy (SABR) for up to 5 Oligometastases: Preliminary Results of the SABR-5 Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Narinesingh D, Nichol A, Bergman A, Popescu T. 56: Comparative Coverage of the Subcutaneous Layer in the Breast and Chest Wall Using Monte Carlo Calculation At Various Energies. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mou B, Hyde D, Araujo C, Bartha L, Bergman A, Liu M. 139: Adoption and Implementation of Single Fraction Lung Stereotactic Ablative Radiotherapy in a Multi-Centre Provincial Cancer Program During the COVID-19 Pandemic. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McNabb KC, Bergman A, Farley JE. Risk factors for poor engagement in drug-resistant TB care in South Africa: a systematic review. Public Health Action 2021; 11:139-145. [PMID: 34567990 PMCID: PMC8455023 DOI: 10.5588/pha.21.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metrics of poor patient engagement, including missed appointments, treatment interruption, sub-optimal medication adherence, and loss to follow-up, have been linked to poor clinical multidrug-resistant TB (MDR-TB) outcomes. Understanding the risk factors for poor patient engagement is necessary to improve outcomes and control TB. This review synthesizes the risk factors for poor patient engagement in MDR-TB treatment across South Africa. DESIGN A systematic review of five databases (PubMed, Embase, CINAHL, Cochrane, and Web of Science) was conducted, covering articles published between 2010 and 2020. Articles were included if they provided information about risk factors associated with poor engagement among adults (⩾15 years) in treatment for MDR-TB in South Africa. Reviews, editorials, abstracts, and case studies were excluded. RESULTS Six studies met the inclusion criteria. Male sex and younger age were the most consistently identified risk factors for poor engagement; however, there was a lack of consistency in the choice of covariates, measurement of the variables, analytic methods, and significant factors associated with poor engagement between studies. Alcohol use, substance use, living with HIV, pulmonary TB site, and ethnicity were all identified as risk factors in at least one included study, while formal housing and steady employment were found to be protective. CONCLUSION The available literature offers little cohesive data to address poor patient engagement in this population. Further research needs to focus on identifying and addressing risk factors for poor patient engagement. This is particularly salient within the context of newer all-oral and short-course MDR-TB treatment regimens.
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Affiliation(s)
- K C McNabb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - A Bergman
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Bergman A. Introducing the HERA Core Agenda for the European Environment, Climate & Health Research. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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de Vries MR, Ewing MM, de Jong RCM, MacArthur MR, Karper JC, Peters EAB, Nordzell M, Karabina SAP, Sexton D, Dahlbom I, Bergman A, Mitchell JR, Frostegård J, Kuiper J, Ninio E, Jukema JW, Pettersson K, Quax PHA. Identification of IgG1 isotype phosphorylcholine antibodies for the treatment of inflammatory cardiovascular diseases. J Intern Med 2021; 290:141-156. [PMID: 33342002 PMCID: PMC8359267 DOI: 10.1111/joim.13234] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Phosphorylcholine (PC) is an important pro-inflammatory damage-associated molecular pattern. Previous data have shown that natural IgM anti-PC protects against cardiovascular disease. We aimed to develop a monoclonal PC IgG antibody with anti-inflammatory and anti-atherosclerotic properties. METHODS Using various techniques PC antibodies were validated and optimized. In vivo testing was performed in a femoral artery cuff model in ApoE3*Leiden mice. Safety studies are performed in rats and cynomolgus monkeys. RESULTS A chimeric anti-PC (PC-mAb(T15), consisting of a human IgG1 Fc and a mouse T15/E06 Fab) was produced, and this was shown to bind specifically to epitopes in human atherosclerotic tissues. The cuff model results in rapid induction of inflammatory genes and altered expression of genes associated with ER stress and choline metabolism in the lesions. Treatment with PC-mAb(T15) reduced accelerated atherosclerosis via reduced expression of endoplasmic reticulum stress markers and CCL2 production. Recombinant anti-PC Fab fragments were identified by phage display and cloned into fully human IgG1 backbones creating a human monoclonal IgG1 anti-PC (PC-mAbs) that specifically bind PC, apoptotic cells and oxLDL. Based on preventing macrophage oxLDL uptake and CCL2 production, four monoclonal PC-mAbs were selected, which to various extent reduced vascular inflammation and lesion development. Additional optimization and validation of two PC-mAb antibodies resulted in selection of PC-mAb X19-A05, which inhibited accelerated atherosclerosis. Clinical grade production of this antibody (ATH3G10) significantly attenuated vascular inflammation and accelerated atherosclerosis and was tolerated in safety studies in rats and cynomolgus monkeys. CONCLUSIONS Chimeric anti-PCs can prevent accelerated atherosclerosis by inhibiting vascular inflammation directly and through reduced macrophage oxLDL uptake resulting in decreased lesions. PC-mAb represents a novel strategy for cardiovascular disease prevention.
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Affiliation(s)
- M. R. de Vries
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
| | - M. M. Ewing
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
- Deptartment of CardiologyLUMCLeidenThe Netherlands
| | - R. C. M. de Jong
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
| | - M. R. MacArthur
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - J. C. Karper
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
| | - E. A. B. Peters
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
| | | | - S. A. P. Karabina
- INSERM UMR_S 933Hôpital Armand‐TrousseauSorbonne UniversitéParisFrance
| | | | - I. Dahlbom
- Dept. of MedicineKarolinska University Hospital Huddinge and Karolinska InstitutetStockholmSweden
| | | | - J. R. Mitchell
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - J. Frostegård
- Dept. of MedicineKarolinska University Hospital Huddinge and Karolinska InstitutetStockholmSweden
| | - J. Kuiper
- Division of BioTherapeuticsLACDRLeidenThe Netherlands
| | - E. Ninio
- INSERM UMR_S 1166‐ICANGenomics and Pathophysiology of Cardiovascular DiseasesInstitute of Cardiometabolism and NutritionPitié‐Salpêtrière HôpitalSorbonne UniversitéParisFrance
| | - J. W. Jukema
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
- Deptartment of CardiologyLUMCLeidenThe Netherlands
| | | | - P. H. A. Quax
- From theDeptartment of SurgeryLUMCLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLUMCLeidenThe Netherlands
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Kadoya N, Sakulsingharoj S, Kron T, Yao A, Hardcastle N, Bergman A, Okamoto H, Mukumoto N, Nakajima Y, Jingu K, Nakamura M. Development of a physical geometric phantom for deformable image registration credentialing of radiotherapy centers for a clinical trial. J Appl Clin Med Phys 2021; 22:255-265. [PMID: 34159719 PMCID: PMC8292683 DOI: 10.1002/acm2.13319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/13/2021] [Accepted: 05/19/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study aimed to develop a physical geometric phantom for the deformable image registration (DIR) credentialing of radiotherapy centers for a clinical trial and tested the feasibility of the proposed phantom at multiple domestic and international institutions. METHODS AND MATERIALS The phantom reproduced tumor shrinkage, rectum shape change, and body shrinkage using several physical phantoms with custom inserts. We tested the feasibility of the proposed phantom using 5 DIR patterns at 17 domestic and 2 international institutions (21 datasets). Eight institutions used the MIM software (MIM Software Inc, Cleveland, OH); seven used Velocity (Varian Medical Systems, Palo Alto, CA), and six used RayStation (RaySearch Laboratories, Stockholm, Sweden). The DIR accuracy was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). RESULTS The mean and one standard deviation (SD) values (range) of DSC were 0.909 ± 0.088 (0.434-0.984) and 0.909 ± 0.048 (0.726-0.972) for tumor and rectum proxies, respectively. The mean and one SD values (range) of the HD value were 5.02 ± 3.32 (1.53-20.35) and 5.79 ± 3.47 (1.22-21.48) (mm) for the tumor and rectum proxies, respectively. In three patterns evaluating the DIR accuracy within the entire phantom, 61.9% of the data had more than a DSC of 0.8 in both tumor and rectum proxies. In two patterns evaluating the DIR accuracy by focusing on tumor and rectum proxies, all data had more than a DSC of 0.8 in both tumor and rectum proxies. CONCLUSIONS The wide range of DIR performance highlights the importance of optimizing the DIR process. Thus, the proposed method has considerable potential as an evaluation tool for DIR credentialing and quality assurance.
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Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Siwaporn Sakulsingharoj
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Radiation Oncology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tomas Kron
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Adam Yao
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Alanah Bergman
- Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto, Japan.,Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Mou B, Hyde D, Araujo C, Bartha L, Bergman A, Liu M. Implementation of Single-Fraction Lung Stereotactic Ablative Radiotherapy in a Multicenter Provincial Cancer Program During the COVID-19 Pandemic. Cureus 2021; 13:e15598. [PMID: 34277219 PMCID: PMC8270065 DOI: 10.7759/cureus.15598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background During the novel coronavirus disease 2019 (COVID-19) pandemic, cancer centers considered shortened courses of radiotherapy to minimize the risk of infectious exposure of patients and staff members. Amidst a pandemic, the process of implementing new treatment approaches can be particularly challenging in larger institutions with multiple treatment centers. We describe the implementation of single-fraction (SF) lung stereotactic ablative radiotherapy (SABR) in a multicenter provincial cancer program. Materials and Methods British Columbia, Canada has a provincial cancer program with six geographically distributed radiotherapy centers serving a population of 5.1 million, over 944,735 square kilometers. In March 2020, provincial mitigation strategies were developed in case of reduced access to radiotherapy due to the COVID-19 pandemic. SF lung SABR was identified by the provincial lung radiation oncology group as a mitigation measure supported by high-quality randomized evidence that could provide comparable outcomes and toxicity to existing fractionated SABR protocols. A working group consisting of radiation oncologists and medical physicists reviewed the medical literature and drafted consensus guidelines that were reviewed by a group of center representatives as a component of provincial lung radiotherapy mitigation strategic planning. Individual centers were encouraged to implement SF lung SABR as their resources and staffing would allow. Centers were then surveyed about barriers to implementation. Results On March 24, 2020, a working group was created and consensus guidelines for SF lung SABR were drafted. The final version was approved and distributed by the working group on March 26, 2020. The provincial lung radiotherapy mitigation strategy group adopted the guidelines for implementation on April 1, 2020. Implementation was completed at the first center on April 27, 2020. Barriers to implementation were identified at five of six centers. Two centers in regions with disproportionately high COVID-19 cases described inadequate staffing as a barrier to implementation. One center encountered delays due to pre-scheduled commissioning of new treatment techniques. Three centers cited competing priorities as reasons for delay. As of May 2021, two centers had active SF lung SABR programs in place, three centers were in the process of implementation, and one center had no immediate plans for implementation due to ongoing resource issues. Conclusion SF lung SABR was adopted by a provincial cancer program within weeks of conception through rapid communication during the development of COVID-19 pandemic mitigation strategies for radiotherapy. Although consensus guidelines were written and approved in an expedited timeframe, the completion of implementation by individual centers was variable due to differences in resource allocation and staffing among the centers. Strong organizational structures and early identification of potential barriers may improve the efficiency of implementing new treatment initiatives in large multicenter radiotherapy programs.
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Affiliation(s)
- Benjamin Mou
- Radiation Oncology, BC Cancer Kelowna, Kelowna, CAN
| | - Derek Hyde
- Medical Physics, BC Cancer Kelowna, Kelowna, CAN
| | | | - Leigh Bartha
- Radiation Therapy, BC Cancer Kelowna, Kelowna, CAN
| | | | - Mitchell Liu
- Radiation Oncology, BC Cancer Vancouver, Vancouver, CAN
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Bergman A, Camborde ML, Crumley C, Cumayas C, Dang D, Gete E, Karan T, Ma R, Mark C, Mendez C, Menna T, Mestrovic A, Nakano S, Pourmoghaddas A, Rostamzadeh M, Sahota H, Tai I, Tammark A, Tyldesley S. 71: First Trajectory-Based Vmat Clinical Delivery in Canada: Dynamic Wave Arc (Dwa). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tina (Wanting) Z, Dunne EM, Bergman A, Mestrovic T, Rodgerson C, Camborde ML, Karan T, Liu M, Schellenberg D, Ma R. 205: Outcomes of Stereotactic Radiation Treatment (SBRT) for Hepatocellular Carcinoma (HCC) Using Dynamic Tumour Tracking (DTT). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Berthelet E, Tran E, Zhang S, Hamilton S, Wu J, Olson R, Bergman A. 153 The Impact of Advanced Image Registration and 3-D EQD2 Dose Conversion on PTV and CTV Coverage in the Retreatment of Nasopharyngeal Cancer: A Case Study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dunne EM, Bergman A, Rodgerson C, Camborde ML, Karan T, Liu M, Schellenberg D, Ma R. 225 Dynamic Tumour Tracking (DTT) for Hepatocellular Carcinoma Using a Gimbaled Linac Stereotactic Body Radiation Therapy (SBRT) System. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moustakis C, Chan M, Kim J, Nilsson J, Bergman A, Bichay T, Cilla S, Deodato F, Doro R, Eich H, Fau P, Fong M, Haverkamp U, Heinze S, Köhn J, de Klerck E, Lambrecht U, Masi L, Mayville A, Morganti A, Milder M, Rades D, Ramm U, Ryu S, Soltys S, Tazeh Maha FE, Toom WD, Wang L, Blanck O. A Multi-Platform Treatment Planning Benchmark Study for Spinal Radiosurgery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Beaton L, Bergman A, Nichol A, Aparicio M, Wong G, Gondara L, Speers C, Weir L, Davis M, Tyldesley S. Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clin Transl Radiat Oncol 2019; 19:39-45. [PMID: 31485490 PMCID: PMC6715791 DOI: 10.1016/j.ctro.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/11/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular risk factors predict for cardiac death after breast radiotherapy. Cardiovascular risk factors should be modified in breast cancer patients. Radiation induced cardiac death at 10-years is low if mean heart dose is <3.3 Gy. Radiation induced cardiac death at 10-years is low if maximum LAD dose is <45.4 Gy. Studies are needed to evaluate heart and LAD constraints in the CT-planning era.
Background Breast/chest wall irradiation (RT) increases risk of cardiovascular death. International Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines state for partial heart irradiation a “V25Gy <10% will be associated with a <1% probability of cardiac mortality” in long-term follow-up after RT. We assessed whether women treated with breast/chest wall RT 10-years ago who died of cardiovascular disease (CVD) violated QUANTEC guidelines. Materials/methods A population-based database identified all cardiovascular deaths in women with early-stage breast cancer <80 years, treated with adjuvant breast/chest wall RT from 2002 to 2006. Ten-year rate of cardiovascular death was calculated using a Kaplan-Meier method. Patients were matched on a 2:1 basis with controls that did not die of CVD. For left-sided cases, the heart and left anterior descending (LAD) artery were retrospectively delineated. Dose-volume histograms were calculated, and heart V25Gy compared to QUANTEC guidelines. Results 5249 eligible patients received breast/chest wall RT from 2002 to 2006: 76 (1.4% at 10-years) died of CVD by June 2015. Forty-two patients received left-sided RT (1.7% CVD death at 10-years), 34 right-sided RT (1.3% at 10-years). Heart V25Gy did not exceed 10% in any left-sided cases. No cardiac dosimetry parameter distinguished left-sided cases from controls. Conclusions QUANTEC guidelines were not violated in any patient that died of CVD after left-sided RT. The risk of radiation induced cardiac death at 10-years appears to be very low if MHD is <3.3 Gy and maximum LAD dose (EQD23 Gy) is <45.4 Gy. Further studies are needed to evaluate heart and LAD constraints in the CT-planning era.
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Affiliation(s)
- Laura Beaton
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alanah Bergman
- Department of Medical Physics, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Aparicio
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Graham Wong
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Lorna Weir
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot Davis
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Olson R, Liu M, Bergman A, Lam S, Hsu F, Mou B, Berrang T, Mestrovic A, Chng N, Hyde D, Matthews Q, Lund C, Glick D, Pai H, Basran P, Carolan H, Valev B, Tyldesley S, Schellenberg D. EP-1616 Population-based Phase II Trial of Stereotactic Radiotherapy for up to 5 Oligometastases: SABR-5. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McVicar N, Thomas S, Liu M, Carolan H, Bergman A. Re-irradiation volumetric modulated arc therapy optimization based on cumulative biologically effective dose objectives. J Appl Clin Med Phys 2018; 19:341-345. [PMID: 30371001 PMCID: PMC6236857 DOI: 10.1002/acm2.12481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022] Open
Abstract
The objective of this note is to introduce a clinical tool that generates ideal base plan dose distributions to enable re‐irradiation volumetric modulated arc therapy (VMAT) optimization based on cumulative biological effective dose objectives for specific organs at risk (OARs). The tool is demonstrated with a lung cancer case that required re‐irradiation at our clinic. First, previous treatment dose is deformed onto the retreatment computed tomography (CT) using commercial software. Then, the in‐house Matlab tool alters the deformed previous dose using radiobiological concepts on a voxel‐by‐voxel manner to generate an ideal base plan dose distribution. Ideal base plans that were generated using the in‐house Matlab tool were compatible with the Varian Eclipse™ treatment planning system. The tool enabled optimization of VMAT re‐irradiation plans using cumulative dose limits for OARs and all OAR cumulative dose objectives were met on the first optimization for the recurrent lung cancer case tested.
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Affiliation(s)
- Nevin McVicar
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Steven Thomas
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Hannah Carolan
- Department of Radiation Oncology, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Alanah Bergman
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
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Olson R, Liu M, Bergman A, Lam S, Hsu F, Mou B, Berrang T, Mestrovic A, Chng N, Hyde D, Matthews Q, Lund C, Glick D, Pai H, Basran P, Carolan H, Valev B, Lefresene S, Tyldesley S, Schellenberg D. Population-based phase II trial of stereotactic ablative radiotherapy (SABR) for up to 5 oligometastases: SABR-5. BMC Cancer 2018; 18:954. [PMID: 30286739 PMCID: PMC6172706 DOI: 10.1186/s12885-018-4859-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oligometastases refer to a state of disease where cancer has spread beyond the primary site, but is not yet widely metastatic, often defined as 1-3 or 1-5 metastases in number. Stereotactic ablative radiotherapy (SABR) is an emerging radiotherapy technique to treat oligometastases that require further prospective population-based toxicity estimates. METHODS This is a non-randomized phase II trial where all participants will receive experimental SABR treatment to all sites of newly diagnosed or progressing oligometastatic disease. We will accrue 200 patients to assess toxicity associated with this experimental treatment. The study was powered to give a 95% confidence on the risk of late grade 4 toxicity, anticipating a < 5% rate of grade 4 toxicity. DISCUSSION SABR treatment of oligometastases is occurring off-trial at a high rate, without sufficient evidence of its efficacy or toxicity. This trial will provide necessary toxicity data in a population-based cohort, using standardized doses and organ at risk constraints, while we await data on efficacy from randomized phase III trials. TRIAL REGISTRATION Registered through clinicaltrials.gov NCT02933242 on October 14, 2016 prospectively before patient accrual.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada
- Unviersity of Northern British Columbia, Prince George, Canada
- BC Cancer – Prince George, 1215 Lethbridge Street, Prince George, BC V2M7A9 Canada
| | - Mitchell Liu
- University of British Columbia, Vancouver, Canada
- BC Cancer – Vancouver, Vancouver, Canada
| | | | - Sonya Lam
- BC Cancer – Vancouver, Vancouver, Canada
| | - Fred Hsu
- BC Cancer – Abbotsford, Abbotsford, Canada
| | | | | | | | - Nick Chng
- BC Cancer – Prince George, 1215 Lethbridge Street, Prince George, BC V2M7A9 Canada
| | | | - Quinn Matthews
- BC Cancer – Prince George, 1215 Lethbridge Street, Prince George, BC V2M7A9 Canada
| | | | | | | | | | | | - Boris Valev
- BC Cancer – Prince George, 1215 Lethbridge Street, Prince George, BC V2M7A9 Canada
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Mehra N, van Riet J, Smits M, Westdorp H, Gorris M, van Ee T, van der Doelen M, van Oort I, Sedelaar M, Textor J, Cuppen E, Grunberg K, Ligtenberg M, Zwart W, Bergman A, van de Werken H, Schalken J, de Vries I, Lolkema M, Gerritsen W. In-depth assessment of metastatic prostate cancer with high tumour mutational burden. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Westgeest H, Kuppen M, van den Eertwegh A, Van Moorselaar J, Mehra N, van Oort I, van den Bergh A, Coenen J, Aben K, Somford R, de Wit R, Bergman A, Lavalaye J, Uyl-de Groot C, Gerritsen W. Cabazitaxel treatment in metastatic castration-resistant prostate cancer (mCRPC) clinical trials compared to usual care in CAPRI: An observational study in the Netherlands. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Louhanepessy R, Badrising S, Vd Noort V, Coenen J, Oostdijk A, Hamberg P, Zuetenhorst J, Beeker A, Wagenaar N, Lam M, Celik F, Vegt E, Zwart W, Bergman A. Pain and quality of life in metastasized Castration Resistant Prostate Cancer patients treated with Radium-223 (ROTOR registry): A prospective observational registry in a non-study population. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Kuppen M, Westgeest H, van den Eertwegh A, Van Moorselaar J, Mehra N, van Oort I, van den Bergh A, Coenen J, Aben K, Somford R, Lavalaye J, Bergman A, Uyl-de Groot C, Gerritsen W. Symptomatic skeletal related events (SSE) and SSE-free-survival in real world castration-resistant prostate cancer (CRPC) patients: Results from CAPRI. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Moustakis C, Chan MKH, Kim J, Nilsson J, Bergman A, Bichay TJ, Palazon Cano I, Cilla S, Deodato F, Doro R, Dunst J, Eich HT, Fau P, Fong M, Haverkamp U, Heinze S, Hildebrandt G, Imhoff D, de Klerck E, Köhn J, Lambrecht U, Loutfi-Krauss B, Ebrahimi F, Masi L, Mayville AH, Mestrovic A, Milder M, Morganti AG, Rades D, Ramm U, Rödel C, Siebert FA, den Toom W, Wang L, Wurster S, Schweikard A, Soltys SG, Ryu S, Blanck O. Treatment planning for spinal radiosurgery : A competitive multiplatform benchmark challenge. Strahlenther Onkol 2018; 194:843-854. [PMID: 29802435 DOI: 10.1007/s00066-018-1314-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. METHODS Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. RESULTS All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). CONCLUSIONS High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.
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Affiliation(s)
- Christos Moustakis
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Mark K H Chan
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Jinkoo Kim
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Joakim Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Alanah Bergman
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Tewfik J Bichay
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Savino Cilla
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Medical Physics Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Radiation Oncology Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Raffaela Doro
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Jürgen Dunst
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Pierre Fau
- University of Aix Marseille, Marseille, France.,Physics Department, Institut Paoli Calmettes, Marseille, France
| | - Ming Fong
- Vancouver Cancer Centre, Department of Radiation Therapy, BC Cancer Agency, Vancouver, BC, Canada
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Simon Heinze
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Erik de Klerck
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Janett Köhn
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrike Lambrecht
- Department of Radiation Oncology, University Clinic Erlangen, Erlangen, Germany
| | - Britta Loutfi-Krauss
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fatemeh Ebrahimi
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Alan H Mayville
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Ante Mestrovic
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Maaike Milder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES University of Bologna-S. Orsola Malpighi Hospital, Bologna, Italy
| | - Dirk Rades
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Ulla Ramm
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Wilhelm den Toom
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lei Wang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Stefan Wurster
- Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Achim Schweikard
- Institute for Robotic and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Oliver Blanck
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany
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Beaton L, Bergman A, Nichol A, Weir L, Tyldesley S. Do Women Who Died of Cardiac Disease Within 10 Years of Breast or Chest Wall Radiation Therapy Violate the “QUANTEC” Cardiac Dose-Volume Histogram Guidelines? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stefánsson T, Bergman A, Ekbom A, Nyman R, Påhlman L. Accuracy of Double Contrast Barium Enema and Sigmoideoscopy in the Detection of Polyps in Patients with Diverticulosis. Acta Radiol 2016. [DOI: 10.1177/028418519403500509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The sensitivity between double contrast barium enema (DCBE) and sigmoideoscopy in diagnosing neoplastic lesions in the sigmoid colon was compared in patients with diverticulosis. In 52 patients with severe diverticulosis (≥15 diverticulas) the DCBE detected one out of 4 polyps found by sigmoideoscopy. In the remaining 54 patients with mild diverticulosis (<15 diverticulas) DCBE detected 7 out of 10 polyps found by sigmoideoscopy. Successful bowel preparation did not influence the outcome of the DCBE. Sigmoideoscopy was incomplete in 17 (16%) of the patients; females were more difficult to examine than males (p= 0.012), as were those with a previous pelvic operation (p= 0.032). We conclude that neither DCBE nor sigmoideoscopy alone is sufficient to detect all neoplastic lesions in the sigmoid colon in patients with sigmoid diverticulosis of the colon.
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Dussaux A, Schoenherr P, Koumpouras K, Chico J, Chang K, Lorenzelli L, Kanazawa N, Tokura Y, Garst M, Bergman A, Degen CL, Meier D. Local dynamics of topological magnetic defects in the itinerant helimagnet FeGe. Nat Commun 2016; 7:12430. [PMID: 27535899 PMCID: PMC4992142 DOI: 10.1038/ncomms12430] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
Chiral magnetic interactions induce complex spin textures including helical and conical spin spirals, as well as particle-like objects such as magnetic skyrmions and merons. These spin textures are the basis for innovative device paradigms and give rise to exotic topological phenomena, thus being of interest for both applied and fundamental sciences. Present key questions address the dynamics of the spin system and emergent topological defects. Here we analyse the micromagnetic dynamics in the helimagnetic phase of FeGe. By combining magnetic force microscopy, single-spin magnetometry and Landau–Lifschitz–Gilbert simulations we show that the nanoscale dynamics are governed by the depinning and subsequent motion of magnetic edge dislocations. The motion of these topologically stable objects triggers perturbations that can propagate over mesoscopic length scales. The observation of stochastic instabilities in the micromagnetic structure provides insight to the spatio-temporal dynamics of itinerant helimagnets and topological defects, and discloses open challenges regarding their technological usage. Topological defects may strongly influence the evolution of a materials' micromagnetic structure whilst their manipulation forms the basis for emerging technological concepts. Here, the authors study the depinning and motion of magnetic edge dislocations in the domain structure of helimagnetic FeGe.
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Affiliation(s)
- A Dussaux
- Department of Physics, ETH Zürich, Otto Stern Weg 1, Zurich 8093, Switzerland
| | - P Schoenherr
- Department of Materials, ETH Zürich, Vladimir-Prelog-Weg 4, Zurich 8093, Switzerland
| | - K Koumpouras
- Department of Physics and Astronomy, Uppsala University, PO Box 516, Uppsala 75120, Sweden
| | - J Chico
- Department of Physics and Astronomy, Uppsala University, PO Box 516, Uppsala 75120, Sweden
| | - K Chang
- Department of Physics, ETH Zürich, Otto Stern Weg 1, Zurich 8093, Switzerland
| | - L Lorenzelli
- Department of Physics, ETH Zürich, Otto Stern Weg 1, Zurich 8093, Switzerland
| | - N Kanazawa
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
| | - Y Tokura
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan.,RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - M Garst
- Institute for Theoretical Physics, Universität zu Köln, Köln D-50937, Germany
| | - A Bergman
- Department of Physics and Astronomy, Uppsala University, PO Box 516, Uppsala 75120, Sweden
| | - C L Degen
- Department of Physics, ETH Zürich, Otto Stern Weg 1, Zurich 8093, Switzerland
| | - D Meier
- Department of Materials, ETH Zürich, Vladimir-Prelog-Weg 4, Zurich 8093, Switzerland.,Department of Materials Science and Engineering, Norwegian University of Science and Technology, Trondheim 7491, Norway
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Bergman A, Langer T, Tur M. High spatial resolution, low-noise Brillouin dynamic gratings reflectometry based on digital pulse compression. Opt Lett 2016; 41:3643-3646. [PMID: 27472639 DOI: 10.1364/ol.41.003643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Digital pulse compression was used to enhance the performance of optical time-domain reflectometry, employing Brillouin dynamic gratings (BDGs) in polarization-maintaining fibers. The fundamental and unique issues in BDG field-reflection are addressed, and rules for proper selection of the coding and detection techniques are formulated. While coding in BDG applications generally requires coherent processing of the reflection, conditions are established for use of direct detection. A 256-bit Golay complementary unipolar probe code is used to demonstrate an eightfold signal-to-noise ratio enhancement in the measurement of the Brillouin gain spectrum (BGS), with a spatial resolution of 2 cm and a full-BGS acquisition rate of 133⅓ kHz, resulting in an equivalent reduction in the estimation error of small Brillouin frequency shifts.
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Kazierad DJ, Bergman A, Tan B, Erion DM, Somayaji V, Lee DS, Rolph T. Effects of multiple ascending doses of the glucagon receptor antagonist PF-06291874 in patients with type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:795-802. [PMID: 27059951 DOI: 10.1111/dom.12672] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 01/21/2023]
Abstract
AIMS To assess the pharmacokinetics, pharmacodynamics, safety and tolerability of multiple ascending doses of the glucagon receptor antagonist PF-06291874 in patients with type 2 diabetes mellitus (T2DM). METHODS Patients were randomized to oral PF-06291874 or placebo on a background of either metformin (Part A, Cohorts 1-5: 5-150 mg once daily), or metformin and sulphonylurea (Part B, Cohorts 1-2: 15 or 30 mg once daily) for 14-28 days. A mixed-meal tolerance test (MMTT) was administered on days -1 (baseline), 14 and 28. Assessments were conducted with regard to pharmacokinetics, various pharmacodynamic variables, safety and tolerability. Circulating amino acid concentrations were also measured. RESULTS PF-06291874 exposure was approximately dose-proportional with a half-life of ∼19.7-22.7 h. Day 14 fasting plasma glucose and mean daily glucose values were reduced from baseline in a dose-dependent manner, with placebo-corrected decreases of 34.3 and 42.4 mg/dl, respectively, at the 150 mg dose. After the MMTT, dose-dependent increases in glucagon and total glucagon-like peptide-1 (GLP-1) were observed, although no meaningful changes were noted in insulin, C-peptide or active GLP-1 levels. Small dose-dependent increases in LDL cholesterol were observed, along with reversible increases in serum aminotransferases that were largely within the laboratory reference range. An increase in circulating gluconeogenic amino acids was also observed on days 2 and 14. All dose levels of PF-06291874 were well tolerated. CONCLUSION PF-06291874 was well tolerated, has a pharmacokinetic profile suitable for once-daily dosing, and results in reductions in glucose with minimal risk of hypoglycaemia.
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Affiliation(s)
| | | | - B Tan
- Pfizer, Cambridge, MA, USA
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48
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Ben Bouchta Y, Bergman A. SU-F-T-502: FFF Beams, Jaw-Tracking and Treatment Techniques: Out of Field Dose Considerations for Pediatric Radiation Therapy Delivery. Med Phys 2016. [DOI: 10.1118/1.4956687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Emani S, Lampert B, Smith S, Pleister A, Wissman S, MacBrair K, Bergman A, Whitson B, Kilic A. Expensive Taste: US Medicare Policy Regarding Destination Therapy VADs Leads to Additional Medical Costs. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nichol A, Ma R, Hsu F, Gondara L, Carolan H, Olson R, Schellenberg D, Germain F, Cheung A, Peacock M, Bergman A, Vollans E, Vellani R, McKenzie M. Volumetric Radiosurgery for 1 to 10 Brain Metastases: A Multicenter, Single-Arm, Phase 2 Study. Int J Radiat Oncol Biol Phys 2016; 94:312-21. [DOI: 10.1016/j.ijrobp.2015.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
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