1
|
Saha S, Huang SH, O'Sullivan B, Su J, Xu W, Hosni A, Waldron J, Irish J, de Almeida J, Witterick I, Monteiro E, Gilbert RW, Catton CN, Chung P, Brown D, Goldstein D, Razak AA, Gullane P, Hahn E. Outcomes of Head and Neck Cutaneous Angiosarcoma Treated in the IMRT Era. Int J Radiat Oncol Biol Phys 2023; 117:e620-e621. [PMID: 37785859 DOI: 10.1016/j.ijrobp.2023.06.2004] [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) Clinical behavior, natural history, and varied presentations of cutaneous angiosarcomas of the head and neck region (HN), in conjunction with its rarity, have rendered standardization of treatment elusive. We aimed to assess outcomes and patterns of failure for patients treated with surgery and radiation (Sx+RT), and radiation alone (RT). MATERIALS/METHODS A retrospective review of all HN angiosarcoma patients amenable for upfront Sx or RT in our institution between 2004-2018 was completed. Generally, treatment included Sx when feasible, and RT for large or extensive/ill-defined tumors. Demographic, tumor characteristics, local (LC), regional (RC), distant control (DC), and overall survival (OS), as well as patterns (in-field, marginal, out-of-field) of local failure at 5-year were estimated. Univariate analysis (UVA) was conducted to assess association with outcomes. RESULTS A total of 33 patients were eligible (14 Sx+RT and 19 RT). Tumor locations were: scalp (16, 48%). face (n = 12, 36%), and overlapping (5, 15%). Lesion types were: nodular (n = 23, 70%), flat (n = 4, 12%) and mixed (n = 6, 18%). Tumor size was larger in the RT group (median: 10.00 vs 2.85 cm, p<0.01). RT and Sx+RT patients had otherwise similar baseline characteristics: median age 74.3; male 70%; and ECOG performance status ≤1 85%. RT dose fractionations ranged from 50-70 Gy in 25-35 fractions in the RT group and 50-66 Gy in 25-33 fractions in the Sx+RT group. Four (12%) patients received neoadjuvant chemotherapy. Median follow up was 5.5 years. Five-year LC, RC, DC, and OS for RT vs Sx+RT groups were 68% vs 85% (p = 0.28); 95% vs 86% (p = 0.89); 79% vs 86% (p = 0.39); and 45% vs 55% (p = 0.71), respectively. The in-field/marginal/out-of-field local failure rate at 5 years were 16% vs 7% (p = 0.46), 26% vs 15% (p = 0.41), and 13% vs 0% (p = 0.24) for the RT vs Sx+RT groups, respectively. UVA showed that scalp location and ulceration/bleeding were strong adverse features for OS. Bone invasion was significantly associated with lower DC (Table). Lesion type (nodular/flat/mixed), tumor size, and treatment type (Sx+RT vs RT), were not significantly associated with LC or pattern of local failure. CONCLUSION Scalp tumors, as compared to face, portended poorer prognosis, and ulceration/bleeding and bone invasion were associated with increased distant metastases. Sx+RT was the preferred treatment modality when possible and typically used for smaller and better defined tumors. RT was reserved for larger and extensive/ill-defined disease; despite this, in the IMRT era, RT achieves reasonable rates of control, markedly superior to historical series.
Collapse
Affiliation(s)
- S Saha
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - S H Huang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - J Su
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Irish
- Department of Otolaryngology - Head & Neck Surgery, University Health Network-University of Toronto, Toronto, ON, Canada
| | - J de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - I Witterick
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - E Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - R W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C N Catton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - P Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - D Brown
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A A Razak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - P Gullane
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Michalski JM, Winter KA, Prestidge BR, Sanda MG, Amin M, Bice WS, Gay HA, Ibbott GS, Crook JM, Catton CN, Raben A, Bosch W, Beyer DC, Frank SJ, Papagikos MA, Rosenthal SA, Barthold HJ, Roach M, Moughan J, Sandler HM. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. J Clin Oncol 2023; 41:4035-4044. [PMID: 37315297 PMCID: PMC10461953 DOI: 10.1200/jco.22.01856] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/15/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE To determine whether addition of external beam radiation therapy (EBRT) to brachytherapy (BT) (COMBO) compared with BT alone would improve 5-year freedom from progression (FFP) in intermediate-risk prostate cancer. METHODS Men with prostate cancer stage cT1c-T2bN0M0, Gleason Score (GS) 2-6 and prostate-specific antigen (PSA) 10-20 or GS 7, and PSA < 10 were eligible. The COMBO arm was EBRT (45 Gy in 25 fractions) to prostate and seminal vesicles followed by BT prostate boost (110 Gy if 125-Iodine, 100 Gy if 103-Pd). BT arm was delivered to prostate only (145 Gy if 125-Iodine, 125 Gy if 103-Pd). The primary end point was FFP: PSA failure (American Society for Therapeutic Radiology and Oncology [ASTRO] or Phoenix definitions), local failure, distant failure, or death. RESULTS Five hundred eighty-eight men were randomly assigned; 579 were eligible: 287 and 292 in COMBO and BT arms, respectively. The median age was 67 years; 89.1% had PSA < 10 ng/mL, 89.1% had GS 7, and 66.7% had T1 disease. There were no differences in FFP. The 5-year FFP-ASTRO was 85.6% (95% CI, 81.4 to 89.7) with COMBO compared with 82.7% (95% CI, 78.3 to 87.1) with BT (odds ratio [OR], 0.80; 95% CI, 0.51 to 1.26; Greenwood T P = .18). The 5-year FFP-Phoenix was 88.0% (95% CI, 84.2 to 91.9) with COMBO compared with 85.5% (95% CI, 81.3 to 89.6) with BT (OR, 0.80; 95% CI, 0.49 to 1.30; Greenwood T P = .19). There were no differences in the rates of genitourinary (GU) or GI acute toxicities. The 5-year cumulative incidence for late GU/GI grade 2+ toxicity is 42.8% (95% CI, 37.0 to 48.6) for COMBO compared with 25.8% (95% CI, 20.9 to 31.0) for BT (P < .0001). The 5-year cumulative incidence for late GU/GI grade 3+ toxicity is 8.2% (95% CI, 5.4 to 11.8) compared with 3.8% (95% CI, 2.0 to 6.5; P = .006). CONCLUSION Compared with BT, COMBO did not improve FFP for prostate cancer but caused greater toxicity. BT alone can be considered as a standard treatment for men with intermediate-risk prostate cancer.
Collapse
Affiliation(s)
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center/ACR, Philadelphia, PA
| | | | - Martin G. Sanda
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA
| | - Mahul Amin
- University of Tennessee Health Science Center, Memphis, TN
| | | | - Hiram A. Gay
- Washington University—Siteman Cancer Center, St. Louis, MO
| | | | - Juanita M. Crook
- BCCA-Cancer Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Charles N. Catton
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Adam Raben
- Delaware/Christiana Care NCI Community Oncology Research Program, Newark, DE
| | - Walter Bosch
- Washington University—Siteman Cancer Center, St. Louis, MO
| | | | | | - Michael A. Papagikos
- Novant Health New Hanover Regional Medical Center—Zimmer Cancer Institute, Wilmington, NC
| | | | | | - Mack Roach
- UCSF Medical Center-Mount Zion, San Francisco, CA
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center/ACR, Philadelphia, PA
| | | |
Collapse
|
3
|
Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A. Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group. Ann Surg Oncol 2022; 29:7335-7348. [PMID: 35767103 DOI: 10.1245/s10434-022-11864-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgery is the mainstay of treatment for retroperitoneal sarcoma (RPS), but local recurrence is common. Biologic behavior and recurrence patterns differ significantly among histologic types of RPS, with implications for management. The Transatlantic Australasian RPS Working Group (TARPSWG) published a consensus approach to primary RPS, and to complement this, one for recurrent RPS in 2016. Since then, additional studies have been published, and collaborative discussion is ongoing to address the clinical challenges of local recurrence in RPS. METHODS An extensive literature search was performed, and the previous consensus statements for recurrent RPS were updated after review by TARPSWG members. The search included the most common RPS histologic types: liposarcoma, leiomyosarcoma, solitary fibrous tumor, undifferentiated pleomorphic sarcoma, and malignant peripheral nerve sheath tumor. RESULTS Recurrent RPS management was evaluated from diagnosis to follow-up evaluation. For appropriately selected patients, resection is safe. Nomograms currently are available to help predict outcome after resection. These and other new findings have been combined with expert recommendations to provide 36 statements, each of which is attributed a level of evidence and grade of recommendation. In this updated document, more emphasis is placed on histologic type and clarification of the intent for surgical treatment, either curative or palliative. Overall, the fundamental tenet of optimal care for patients with recurrent RPS remains individualized treatment after multidisciplinary discussion by an experienced team with expertise in RPS. CONCLUSIONS Updated consensus recommendations are provided to help guide decision-making for treatment of locally recurrent RPS and better selection of patients who would potentially benefit from surgery.
Collapse
Affiliation(s)
- William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Carol J Swallow
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada.
| | - Dirk C Strauss
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Samuel J Ford
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rebecca A Gladdy
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität Munich, University Hospital, Munich, Germany
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcoma and Rare Tumor Surgery, European Institute of Oncology, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrew Hayes
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Max L Almond
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Wendy Johnston
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada
| | - Hayden Snow
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rick L Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Myles J Smith
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.,The Institute of Cancer Research, Chester Beatty Laboratories, London, UK
| | - Toufik Bouhadiba
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Anant Desai
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Rachel Voss
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Roberta Sanfilippo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Jones
- The Institute of Cancer Research, Chester Beatty Laboratories, London, UK.,Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Khin Thway
- Sarcoma Unit, Department of Pathology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | |
Collapse
|
4
|
Isaac C, Kavanagh J, Griffin AM, Dickie CI, Mohankumar R, Chung PW, Catton CN, Shultz D, Ferguson PC, Wunder JS. Radiological progression of extremity soft tissue sarcoma following pre-operative radiotherapy predicts for poor survival. Br J Radiol 2022; 95:20210936. [PMID: 34826230 PMCID: PMC8822555 DOI: 10.1259/bjr.20210936] [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: 02/03/2023] Open
Abstract
OBJECTIVES To determine if radiological response to pre-operative radiotherapy is related to oncologic outcome in patients with extremity soft tissue sarcomas (STSs). METHODS 309 patients with extremity STS who underwent pre-operative radiation and wide resection were identified from a prospective database. Pre- and post-radiation MRI scans were retrospectively reviewed. Radiological response was defined by the modified Response Evaluation Criteria in Solid Tumours. Local recurrence-free, metastasis-free (MFS) and overall survival (OS) were compared across response groups. RESULTS Tumour volume decreased in 106 patients (34.3%; PR - partial responders), remained stable in 97 (31.4%; SD - stable disease), increased in 106 (34.3%; PD - progressive disease). The PD group were older (p = 0.007), had more upper extremity (p = 0.03) and high-grade tumours (p < 0.001). 81% of myxoid liposarcomas showed substantial decrease in size. There was no difference in initial tumour diameter (p = 0.5), type of surgery (p = 0.5), margin status (p = 0.4), or complications (p = 0.8) between the three groups. There were 10 (3.2%) local recurrences with no differences between the three response groups (p = 0.06). 5-year MFS was 52.1% for the PD group vs 73.8 and 78.5% for the PR and SD groups, respectively (p < 0.001). OS was similar (p < 0.001). Following multivariable analysis, worse MFS and OS were associated with higher grade, larger tumour size at diagnosis and tumour growth following pre-operative radiation. Older age was also associated with worse OS. CONCLUSION STS that enlarge according to Response Evaluation Criteria in Solid Tumour criteria following pre-operative radiotherapy identify a high risk group of patients with worse systemic outcomes but equivalent local control. ADVANCES IN KNOWLEDGE Post-radiation therapy, STS enlargement may identify patients with potential for worse systemic outcomes but equivalent local control. Therefore, adjunct therapeutic approaches could be considered in these patients.
Collapse
Affiliation(s)
- Christian Isaac
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - John Kavanagh
- Department of Medical Imaging, Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | | | - Colleen I Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Rakesh Mohankumar
- Department of Medical Imaging, Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - David Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
5
|
Ito E, Moraes FY, Ramotar M, Lunsky I, Soliman H, Catton CN, Kassam Z, Morton G, Tosoni S, Gospodarowicz M, Wong RKS, Liu FF, Chung PWM. Radiation Oncology Fellowship: a Value-Based Assessment Among Graduates of a Mature Program. J Cancer Educ 2021; 36:1295-1305. [PMID: 32683629 PMCID: PMC8605971 DOI: 10.1007/s13187-020-01767-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The University of Toronto - Department of Radiation Oncology (UTDRO) has had a well-established Fellowship Program for over 20 years. An assessment of its graduates was conducted to evaluate training experience and perceived impact on professional development. Graduates of the UTDRO Fellowship Program between 1991 and 2015 were the focus of our review. Current employment status was collected using online tools. A study-specific web-based questionnaire was distributed to 263/293 graduates for whom active e-mails were identified; questions focused on training experience, and impact on career progression and academic productivity. As a surrogate measure for the impact of UTDRO Fellowship training, a comparison of current employment and scholarly activities of individuals who obtained their Fellow of the Royal College of Physicians of Canada (FRCPC) designation in Radiation Oncology between 2000 and 2012, with (n = 57) or without (n = 230) UTDRO Fellowship training, was conducted. Almost all UTDRO Fellowship graduates were employed as staff radiation oncologists (291/293), and most of those employed were associated with additional academic (130/293), research (53/293), or leadership (68/293) appointments. Thirty-eight percent (101/263) of alumni responded to the online survey. The top two reasons for completing the Fellowship were to gain specific clinical expertise and exposure to research opportunities. Respondents were very satisfied with their training experience, and the vast majority (99%) would recommend the program to others. Most (96%) felt that completing the Fellowship was beneficial to their career development. University of Toronto, Department of Radiation Oncology Fellowship alumni were more likely to hold university, research, and leadership appointments, and author significantly more publications than those with FRCPC designation without fellowship training from UTDRO. The UTDRO Fellowship Program has been successful since its inception, with the majority of graduates reporting positive training experiences, benefits to scholarly output, and professional development for their post-fellowship careers. Key features that would optimize the fellowship experience and its long-term impact on trainees were also identified.
Collapse
Affiliation(s)
- Emma Ito
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Matthew Ramotar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
| | - Isis Lunsky
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Kassam
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Stronach Regional Cancer Centre, Newmarket, Ontario, Canada
| | - Gerard Morton
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Tosoni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
| | - Mary Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca K S Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter W M Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, M5G 2M9, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
6
|
Al‐Ezzi EM, Alqaisi HA, Iafolla MAJ, Wang L, Sridhar SS, Sacher AG, Fallah‐Rad N, Jiang DM, Watson GA, Catton CN, Warde PR, Hamilton RJ, Fleshner NE, Zlotta AR, Hansen AR. Clinicopathologic factors that influence prognosis and survival outcomes in men with metastatic castration-resistant prostate cancer treated with Radium-223. Cancer Med 2021; 10:5775-5782. [PMID: 34254464 PMCID: PMC8419779 DOI: 10.1002/cam4.4125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background In men with metastatic castration‐resistant prostate cancer (mCRPC) with primarily bone metastases, radium‐223 (223Ra) improves overall survival (OS). However, the selection of 223Ra is not guided by specific validated clinicopathologic factors, and thus outcomes are heterogeneous. Patients and methods This retrospective survival analysis was performed in men with mCRPC treated with 223Ra at our cancer center. Demographics and disease characteristics were collected. OS was calculated using the Kaplan–Meier method (log‐rank). The potential prognostic factors were determined using both univariable (UVA) and multivariable analysis (MVA) (Cox‐regression) methods. Results In total, 150 patients with a median age of 74 years (52–93) received 223Ra between May 2015 and July 2018, and 58% had 6–20 bone metastases. Ninety‐four (63%) patients received >4 223Ra doses, and 56 (37%) received ≤4. The following pre‐treatment factors were analyzed (median [range]): eastern cooperative oncology group performance status (ECOG PS), (1 [0–3]); Albumin (ALB), (39 g/L [24–47]); alkaline phosphatase (ALP), (110 U/L [35–1633]); and prostate‐specific antigen (PSA), (49 µg/L [0.83–7238]). The median OS for all patients was 14.5 months (95% CI: 11.2–18). These factors were associated with poor survival outcomes in UVA and MVA: ALB <35 g/L, ALP >150 U/L, ECOG PS 2–3, and PSA >80 µg/L. By assigning one point for each of these factors, a prognostic model was developed, wherein three distinct risk groups were identified: good, 0–1 (n = 103); intermediate, 2 (n = 30); and poor risk, 3–4 points (n = 17). The median OS was 19.4, 10.0, and 3.1 months, respectively (p < 0.001). Conclusions Pre‐treatment ALB, ALP, ECOG, and PSA, were significantly correlated with OS and could guide treatment selection for men with mCRPC by identifying those who are most or least likely to benefit from 223Ra. Validation in an independent dataset is required prior to widespread clinical utilization.
Collapse
Affiliation(s)
- Esmail M. Al‐Ezzi
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Husam A. Alqaisi
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Marco A. J. Iafolla
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Lisa Wang
- Department of BiostatisticsPrincess Margaret Cancer CentreTorontoONCanada
| | - Srikala S. Sridhar
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Adrian G. Sacher
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Nazanin Fallah‐Rad
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Di M. Jiang
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Geoffrey A. Watson
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Charles N. Catton
- Department of Radiation OncologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Padraig R. Warde
- Department of Radiation OncologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Rob J. Hamilton
- Division of Urologic OncologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Neil E. Fleshner
- Division of Urologic OncologyPrincess Margaret Cancer CentreTorontoONCanada
| | | | - Aaron R. Hansen
- Division of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoONCanada
| |
Collapse
|
7
|
Vornicova O, Wunder J, Chung PWM, Gupta AA, Gladdy RA, Catton CN, Salah S, Ferguson PC, Tsoi K, Shultz DB, Brar SS, Wong P, Swallow CJ, Abdul Razak AR, Al-Ezzi EM. The impact of multimodality therapies in marginally inoperable soft tissue sarcomas (STS): The Toronto Sarcoma Program (TSP) experience. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11548] [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: 11/20/2022] Open
Abstract
11548 Background: The mainstay therapy of operable STS remains surgery, which may include (neo)adjuvant therapies. Within the TSP, marginally inoperable STS are often treated with sequential chemo (CTX) and radiation (RT) therapy, followed by surgery (SX). Herein we present our experience of multi-modality therapies for marginally inoperable STS patients (pts). Methods: This was a dual-center, single program, retrospective review. Pts were included if deemed to have marginally inoperable primary or recurrent STS, as determined at the TSP tumor board. Pts included must have had CTX with the intent of having RT and SX after. Pts demographics, treatment details and clinical outcomes data were collected. Relapse free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Multivariate analysis of the influence of disease characteristics and treatment on outcomes was assessed using Cox regression. Results: From June 2005 to May 2019, 75 pts were identified. Median age was 52 years (range 16-72). Pts were predominantly male (55%). Histological subtypes included dedifferentiated liposarcoma (29%), leiomyosarcoma (27%), synovial sarcoma (19%) and others (25%). Primary tumor was located in the retroperitoneum (48%), extremity (23%), pelvis (12%), thorax (9%), and other sites (8%). All pts had doxorubicin and ifosfamide CTX (median 4 cycles; range 1-6), while RT dose delivered was 50.4Gy/28 fractions in 58 (77%) of cases. Twenty three pts (31%) achieved partial response, 40 pts (53%) had stable disease and 12 pts (16%) had progression of disease (PD) on CTX, of which half (8%) did not undergo further treatment. Nine pts (12%) underwent CTX followed by SX due to significant response, 9 pts (12%) underwent CTX and RT without SX due to persistent tumor unresectability or PD. The final 50 pts (67%) completed multi-modality treatment (CTX, RT & SX). Overall, 59 pts (79%) had SX; negative margins were achieved in 53 (71%). 19 pts (25%) had postoperative complications, causing death in 2 pts (2.7%). With a median follow-up of 72 months, median RFS and OS were 26.9 months (95% CI: 0-86.0), and 65 months (95% CI: 13.5-116.4). Extremity location was associated with superior RFS (median not reached [NR], HR 0.28 95% CI 0.09-0.83, p = 0.022), and OS (median NR, HR 0.29 95% CI 0.09-0.90, p = 0.032). Receipt of RT was associated with superior RFS (median NR, HR 0.23 95% CI 0.10-0.52, p < 0.001); and OS (median NR, HR 0.21 95% CI 0.09-0.50, p < 0.001). Pts who had PD after CTX were associated with poor outcomes - RFS (median 4.7 months, HR 2.03 95% CI 0.61-6.76, p = 0.24); and OS (median 21.9 months, HR 2.48 95% CI 0.73-8.47, P = 0.144). Conclusions: Multi-modality approach resulted in successful resection for most pts with marginally inoperable STS. Extremity location and RT administration were associated with better RFS and OS, while progression on CTX confers worse survival outcomes.
Collapse
Affiliation(s)
- Olga Vornicova
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jay Wunder
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter W. M. Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Abha A. Gupta
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rebecca Anne Gladdy
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Charles N. Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Samer Salah
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Charles Ferguson
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Kim Tsoi
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - David Benjamin Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Savtaj Singh Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Philip Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | |
Collapse
|
8
|
Basile G, Mattei JC, Alshaygy I, Griffin AM, Catton CN, Chung PW, Shultz DB, Razak ARA, Demicco EG, Ferguson PC, Wunder JS. Curability of patients with lymph node metastases from extremity soft-tissue sarcoma. Cancer 2020; 126:5098-5108. [PMID: 32910462 DOI: 10.1002/cncr.33189] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lymph node metastases (LNM) rarely occur in adult extremity soft-tissue sarcoma (STS), affecting approximately 5% of patients. To the authors' knowledge, few studies to date have evaluated the prognosis and survival of patients with LNM. METHODS A retrospective review was performed of a single-center, prospectively collected STS database. Demographic, treatment, and oncologic data for patients with STS of the extremity with LNM were obtained from clinical and radiographic records. RESULTS Of 2689 patients with extremity STS, a total of 120 patients (4.5%) were diagnosed with LNM. LNM occurred most frequently among patients diagnosed with clear cell sarcoma (27.6%), epithelioid sarcoma (21.9%), rhabdomyosarcoma (17.3%), angiosarcoma (14.0%), and extraskeletal myxoid chondrosarcoma (9.3%). A total of 98 patients (81.7%) underwent LNM surgical resection. Patients with isolated LNM had a greater 5-year overall survival (57.3%) compared with patients with American Joint Committee on Cancer (AJCC) eighth edition stage IV STS with only systemic metastases (14.6%) or both LNM and systemic disease (0%; P < .0001). Patients with isolated LNM had an overall survival rate (52.9%) similar to that of patients with localized AJCC stage III tumors (ie, large, high-grade tumors) (49.3%) (P = .8). Patients with late, isolated, metachronous LNM had a 5-year overall survival rate (61.2%) that was similar to that of patients with isolated synchronous LNM at the time of presentation (53.6%) (P = .4). CONCLUSIONS Many different types of STS develop LNM. Patients with extremity STS with isolated LNM should not be considered as having stage IV disease as they are according to the current AJCC eighth edition classification because they have significantly better survival than those with systemic metastases. Patients with isolated, late, metachronous LNM have a survival similar to that of patients with isolated synchronous LNM at the time of presentation. LAY SUMMARY The results of the current study demonstrated that patients diagnosed with isolated lymph node metastases have a prognosis similar to that of patients diagnosed with localized American Joint Committee on Cancer stage III soft-tissue sarcomas, which also equates to a significantly better overall survival compared with patients with systemic metastases. Therefore, the authors recommend modifications to the most recent eighth edition of the American Joint Committee on Cancer staging system to clearly distinguish patients with isolated lymph node metastases to acknowledge their better prognosis compared with those with systemic metastases.
Collapse
Affiliation(s)
- Georges Basile
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Camille Mattei
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Alshaygy
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M Griffin
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - David B Shultz
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Albiruni R A Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Glicksman R, Metser U, Vines D, Chan R, Valliant J, Chung PWM, Gospodarowicz MK, Bayley A, Catton CN, Warde PR, Helou J, Raman S, Green D, Perlis N, Fleshner N, Hamilton RJ, Zlotta A, Finelli A, Jaffray D, Berlin A. Primary analysis of a phase II study of metastasis-directed ablative therapy to PSMA ( 18F-DCFPyL) PET-MR/CT defined oligorecurrent prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5553 Background: Despite maximal local therapies (MLT) (radical prostatectomy followed by radiotherapy [RT]), 20-30% of men will progress to incurable prostate cancer (PCa). Most recurrences in this scenario are characterized by rise in PSA with negative bone scan (BS) and computed tomography (CT). We conducted a phase II trial for men with rising PSA after MLT using 18F-DCFPyL (PSMA) PET-MR/CT followed by metastasis-directed therapy (MDT) to PET positive foci. We report the results of our primary analysis. Methods: Patients with rising PSA (0.4-3.0 ng/mL) after MLT, negative BS/CT and no prior salvage ADT were eligible. All patients underwent PSMA PET-MR and PET-CT. Those with limited disease burden amenable to MDT underwent either stereotactic ablative RT (SABR) or surgery (lymph node dissection). No ADT was used. The primary endpoint was biochemical response rate (complete [undetectable PSA] or partial [PSA decline ≥50% from baseline]) following MDT. A Simon’s two-stage study design was employed. Estimated time of delay in salvage ADT was calculated using the Kaplan-Meier method. Toxicity was prospectively recorded (CTCAE v4.0). Results: After a median of 63 months (range 3-180) post MLT, 72 patients underwent PSMA PET-MR/CT with median PSA 0.98 ng/mL (range 0.4-3.1). Sixteen patients had negative and 56 had positive PET-MR/CT scans, of which 37 (51%) were amenable to MDT. The median number of treated lesions was 2 (range 1-5). Of the treated patients, 30 (81%) had miT0N1M0 disease, 2 (5.5%) had miT0N1M1a, 2 (5.5%) had miT0N0M1a and 3 (8%) had miT0N0M1b. Twenty-seven patients underwent SABR (median 30 Gy in 3 fractions) and 10 had surgery. At a median of 11 months (range 1-29) post MDT, 8 patients (22%) had complete (CR) and 14 (38%) had partial (PR) responses. Among the 8 CRs, 5 had surgery and 3 had SABR; of the 14 PRs, 2 had surgery and 12 had SABR. The estimated median delay in salvage ADT for the entire cohort, PR and CR subgroups was 13 months (IQR 8-20), 16 months (IQR 13-20) and 30 months (IQR not reached), respectively. Two grade 2+ toxicities were observed, both in surgical patients: deep venous thrombosis and ureteric injury requiring stent placement. Conclusions: 18F-DCFPyL PET-MR/CT has high detection rates (78%) in men with rising PSA after MLT. We observed a favorable therapeutic index with MDT (60% response rate) for patients with metachronous PSMA-unveiled oligometastatic PCa following MLT. Phase III studies using validated intermediate clinical endpoints are needed before integration into routine practice. Clinical trial information: NCT03160794 .
Collapse
Affiliation(s)
- Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Doug Vines
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rosanna Chan
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - John Valliant
- Centre for Probe Development and Commercialization, Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Peter W. M. Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mary K. Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Bayley
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Charles N. Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Richard Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joelle Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - David Green
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nathan Perlis
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Neil Fleshner
- Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert James Hamilton
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alexandre Zlotta
- Division of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
10
|
Wilson DAJ, Gazendam A, Visgauss J, Perrin D, Griffin AM, Chung PW, Catton CN, Shultz D, Ferguson PC, Wunder JS. Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma. Ann Surg Oncol 2020; 27:2033-2041. [PMID: 32152780 DOI: 10.1245/s10434-020-08240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The risk of tumor recurrence after resection of soft tissue sarcoma (STS) necessitates surveillance in follow-up. The objective of this study was to determine the frequency/timing of metastasis and local recurrence following treatment for soft tissue sarcoma, and to use these data to justify an evidence-based follow-up schedule. METHODS Utilizing a prospective database, a retrospective single center review was performed of all patients with minimum 2-year follow-up after resection of a localized extremity STS. Kaplan-Meier estimates were used to calculate the incidence of local recurrence and metastases on an annual basis for 10 years. RESULTS We identified a total of 230 low-grade, 626 intermediate-grade and 940 high-grade extremity STS and a total of 721 events, 150 local recurrences and 571 metastases. Based on tumor size and grade, follow-up cohorts were developed that had similar metastatic risk. Using pre-determined thresholds for metastatic event, a follow-up schedule was established for each cohort. CONCLUSION Based on our results we recommend that patients with small low-grade tumors undergo annual follow-up for 5 years following definitive local treatment. Patients with large low-grade tumors, small intermediate-grade and small high-grade tumors should have follow-up every 6 months for the first 2 years, then yearly to 10 years. Only patients with large intermediate- or high-grade tumors require follow-up every 3 months for the first 2 years, then every 6 months for years 3-5, followed by annually until 10 years.
Collapse
Affiliation(s)
- David A J Wilson
- Division of Orthopaedic Surgery, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Julia Visgauss
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University, Durham, NC, USA
| | - David Perrin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Peter W Chung
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Charles N Catton
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Crook JM, Tang C, Thames H, Blanchard P, Sanders J, Ciezki JP, Keyes M, Merrick GS, Catton CN, Raziee H, Stock R, Sullivan F, Anscher M, Frank SJ. Validation of biochemical definition of cure after low-dose rate prostate brachytherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.322] [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: 11/20/2022] Open
Abstract
322 Background: Prospectively collected outcome data for 14,196 patients with localized prostate cancer treated with LDR brachytherapy (BT) from 7 institutions were analyzed. For the 80% of patients with a 4 year PSA < 0.2 ng/ml, 99% were free of clinical failure at 10 years and 96% at 15 years. We sought to validate this result with 2 independent data sets from mature prospective clinical trials. Methods: In the initial analysis, patients were treated with either BT alone (61%), or in combination with external beam radiotherapy (EBRT:8%), androgen deprivation (ADT:22%) or both (9%). 42% were low risk, 50% intermediate (IR) and 8% high risk(HR). KM analysis was carried out using clinical failure (local, distant, regional or biochemical triggering salvage) as endpoints for each of 4 PSA categories: PSA<0.2 ng/ml, PSA >0.2 to < 0.5, PSA > 0.5 to < 1.0, and PSA>1.0 ng/ml. Results were compared to 12 year follow up data on a phase 2 trial of BT for IR prostate cancer (n=223; MDAnderson Cohort 1) and 10-year data from the BT arm of the phase 3 randomized ASCENDE RT trial (n=160, Cohort 2) for upper tier IR and HR prostate cancer. Results: The results of the initial KM analysis showed that for the 80% of patients with PSA < 0.2 ng/ml at 4 years, 99% were free of recurrence at 10 years (95% CI: 98.4-99.1) and 96% at 15 years (95% CI: 95-97). The association of treatment success with PSA range was highly significant (p<0.0005). Independent validation against BT alone in IR patients (Cohort 1) confirmed that 99% of patients with PSA at 4 years < 0.2 ng/ml were NED at 10 years (CI: 95.8-99.9). For the unfavorable IR and HR patients receiving 12 months ADT + pelvic EBRT and BT in ASCENDE-RT (Cohort 2), PSA < 0.2 ng/ml at 4 years was associated with 96.7% (CI: 89.9-98.9) being failure free at 10 years. Conclusions: As over 80% of patients achieve a PSA < 0.2 ng/ml at 4 years post-LDR BT, and this is associated with 97%-99% being disease free beyond 10 years, we suggest that this biochemical definition of cure be adopted for LDR brachytherapy patients with ≥ 4 years’ follow-up.
Collapse
Affiliation(s)
| | - Chad Tang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Charles N. Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Richard Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Steven J. Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
12
|
Pilar A, Bayley A, Shehata D, Liu Z(A, Berlin A, Catton CN, Kong V, Rosewall T, Gospodarowicz MK, Craig T, Helou J, Warde PR, Chung PWM. Determinants of biochemical failure and distant metastases-free survival in high-risk prostate cancer patients treated with external beam radiotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.371] [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: 11/20/2022] Open
Abstract
371 Background: Objectives were to1) identify predictors of biochemical failure(BCF) -free survival (FFS) & distant metastases free-survival (DMFS) in high-risk prostate cancer (HRPC) patients treated with external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT); 2) assess the impact of nodal irradiation & escalation of dose to the nodal volumes in HRPC. Methods: Between Feb 2000 & May 2011, 462 patients with HRPC were treated with EBRT +/- ADT. This spanned an era of technical development; prior to 2002 conventional dose radiotherapy was routinely delivered, between 2002-2008, dose escalation to the prostate & pelvic lymph nodes was undertaken in a phase II trial & subsequently all patients were treated with a dose-escalated protocol. The disease characteristics included, a median PSA of 20ng/ml (range: 1-563), T3-T4 in 33% (n=158), & Gleason grade group (GGG) 3-5 in 72% (n=331). The majority (n=405, 88%) received ADT with EBRT & median duration of ADT was 36 months (range: 0-197). Dose escalated EBRT was utilized in 52% (n=241) & nodal irradiation in 69% (n=317); escalation of dose to nodal volumes was performed in 20% (n=93). Results: The median follow-up was 8.7yrs (range: 0.9-18.9). Median nadir PSA was < 0.05ng/ml (range: <0.05-5.78) with median time to nadir (TTN) of 11 months (range: 2-130). Cumulative incidence rates of BCF at 5 and 10-yrs were 23% & 45%; corresponding rates for DM were 6.6% & 14%, respectively. The 5 & 10-yr FFS rates were 75% & 51%; corresponding DMFS rates were 91.5% & 80%, respectively. On multivariate analysis, T stage (p<0.001), GGG (p<0.001), ADT (p=0.002), dose escalation to prostate (P=0.012) & median nadir PSA (p<0.001) were independent predictors of FFS. The GGG (p=0.007), median nadir PSA (p=<0.001) & Nodal RT (p=0.03) were independent predictors of DMFS. PSA of 20 & TTN predicted neither FFS nor DMFS. Conclusions: Nadir PSA level was an independent predictor of FFS & DMFS. Undetectable PSA level was associated with prolonged FFS & DMFS. Dose escalation to prostate resulted in an improved FFS & Nodal irradiation in an improved DMFS. Further studies are required to identify subgroups that may benefit the most from nodal irradiation.
Collapse
Affiliation(s)
- Avinash Pilar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Bayley
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Danny Shehata
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zhihui (Amy) Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Charles N. Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vickie Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tara Rosewall
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mary K. Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joelle Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Richard Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Peter W. M. Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
13
|
Veitch ZWN, Ferguson PC, Griffin A, Alshammari K, Al-Ezzi EM, Malone ER, Demicco E, Dickson B, Catton CN, Chung PWM, Gupta AA, Abdul Razak AR, Wunder J. Clinical characteristics of nonosteogenic, non-Ewing’s sarcoma of the bone: Experience at the Toronto Sarcoma Program. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11029] [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: 11/20/2022] Open
Abstract
11029 Background: Non-osteogenic sarcoma of the bone is a rare entity comprising a heterogenous group of malignant tumors. Clinical characteristics and outcome data are sparse in the literature. We evaluated the characteristics and long-term outcomes of patients (pts) with this disease. Methods: Pts with non-osteogenic sarcoma of the bone treated at the Toronto Sarcoma Program from 1987-2017 were identified from our institutional sarcoma database. Patient characteristics (ie: age, gender, tumor size, histology, grade, necrosis, tumor location), treatment modality (ie: surgical management, chemotherapy, radiotherapy), and survival information were collected. Survival was estimated by Kaplan-Meier (log-rank). Multi-variate analysis (MVA) was used to evaluate characteristics for sarcoma specific survival. Results: Of 130 pts identified, 106 had non-metastatic disease with a median age of 46 (range 18-89). Male-to-female predominance was 1.5:1. Common histologies were undifferentiated pleomorphic sarcoma (UPS; 42%), leiomyosarcoma (21%), and fibrosarcoma (11%). Tumors were generally high grade (59%) and > 5 cm in size (73%). The majority of pts received chemotherapy (68%), with Cisplatin/Doxorubicin based regimens (95%). R0 resection was achieved in 85% of cases. Survival for the entire cohort, showed a median (m)DFS of 8.13 years (95%CI:2.52-18.02), and a mOS of 11.72 (95%CI:7.00-not reached [NR]). Median sarcoma specific survival was NR, however 15- and 25-year survivals were 60.4% and 52.6% respectively. MVA demonstrated axial tumor location (HR = 13.03; p = 0.005), no chemotherapy (HR = 4.50; p = 0.017) and tumor grade (G2: HR = 36.21; p = 0.012; G3: HR = 20.30; p = 0.015) as risk factors for sarcoma specific death. Tumor size > 10cm (p = 0.085) and necrosis > 90% (p = 0.082) trended towards significance. Conclusions: Non-osteogenic sarcoma of the bone is a rare tumor entity, with a predominant UPS histology. Patient outcomes are reasonable, with measurable long-term survival. Axial tumor location, absence of chemotherapy, and high-grade disease predict for worse survival outcome. Further evaluation with larger data series is warranted to more fully understand this disease.
Collapse
Affiliation(s)
| | - Peter Charles Ferguson
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Kanan Alshammari
- University of Toronto - Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Brendan Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Charles N. Catton
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Peter W. M. Chung
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abha A. Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Jay Wunder
- University Musculoskeletal Oncology Unit and Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Catton CN, Shultz DB. Should we expand the carbon ion footprint of prostate cancer? Lancet Oncol 2019; 20:608-609. [DOI: 10.1016/s1470-2045(19)30094-4] [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] [Received: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
|
15
|
Glicksman R, Metser U, Vines D, Chan R, Valliant J, Chung PWM, Gospodarowicz MK, Bayley A, Catton CN, Warde PR, Helou JA, Lalani N, Green DE, Perlis N, Fleshner NE, Hamilton RJ, Zlotta A, Finelli A, Jaffray DA, Berlin A. Preliminary results of a two stage phase II study of 18F-DCFPyL PET-MR for enabling oligometastases ablative therapy in subclinical prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.250] [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: 11/20/2022] Open
Abstract
250 Background: Despite maximal local therapies (MLT) (radical prostatectomy followed by radiotherapy [RT]), 20-30% of men will have incurable progression of prostate cancer (PC). Most recurrences in this scenario are characterized by continuous PSA rises and failure of standard imaging (bone scan [BS] and computed tomography [CT]) to detect recurrence sites. We conducted a phase II trial for men with rising PSA after MLT using 18F-DCFPyL PET-MR followed by targeted ablation of PET positive foci. We report the results of our pre-defined analysis. Methods: Patients with rising PSA (0.43.0 ng/mL) after MLT, negative BS/CT and no prior salvage ADT were eligible. All patients underwent 18F-DCFPyL PET-MR followed by immediate PET-CT acquisition. Those with limited disease, where possible, underwent stereotactic ablative RT (SABR) or surgery. No ADT was used. The primary endpoint was biochemical response rate (complete [undetectable PSA] or partial [PSA decline ≥50% compared to baseline]). A Simon’s two stage study design was employed. Stage 1 included 12 response evaluable patients, requiring 1 or more responses in the absence of grade 3+ toxicities to proceed to stage 2 (additional 25 response evaluable patients). Results: After a median of 58 months (range 29-120) post MLT, 20 patients underwent PET-MR/CT to have 12 response evaluable patients. Median PSA at enrollment was 1.3 ng/mL (range 0.4-2.8). Three patients had negative PET-MR/CT, while 17 had positive scans, of which 12 (60%) were amenable to response evaluable ablation. The median number of detected lesions in those treated was 2 (range 1-5). Ten patients underwent SABR (27-30 Gy/3 fractions) and 2 had surgery. One patient (8%) had complete and 4 (33%) had partial PSA responses at a median of 3.3 months (range 2.8-6.0) after ablation, while the remaining 7 (59%) did not have biochemical response. No grade 3+ toxicities were observed. Conclusions: 18F-DCFPyL PET/MR has high detection rates in men with rising PSA after MLT. We observed favorable early results with SABR or surgery (41% RR). Trial completion will inform if this approach offers potential for cure in an early molecularly-defined PC oligometastatic state. Clinical trial information: NCT03160794.
Collapse
Affiliation(s)
- Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Doug Vines
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rosanna Chan
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - John Valliant
- Centre for Probe Development and Commercialization, Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Peter W. M. Chung
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mary K. Gospodarowicz
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Charles N Catton
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Richard Warde
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joelle Antoine Helou
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nafisha Lalani
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David E Green
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Nathan Perlis
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Neil Eric Fleshner
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Alexandre Zlotta
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David A. Jaffray
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Techna Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
16
|
Johnston WL, Catton CN, Swallow CJ. Unbiased data mining identifies cell cycle transcripts that predict non-indolent Gleason score 7 prostate cancer. BMC Urol 2019; 19:4. [PMID: 30616540 PMCID: PMC6322345 DOI: 10.1186/s12894-018-0433-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/24/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with newly diagnosed non-metastatic prostate adenocarcinoma are typically classified as at low, intermediate, or high risk of disease progression using blood prostate-specific antigen concentration, tumour T category, and tumour pathological Gleason score. Classification is used to both predict clinical outcome and to inform initial management. However, significant heterogeneity is observed in outcome, particularly within the intermediate risk group, and there is an urgent need for additional markers to more accurately hone risk prediction. Recently developed web-based visualization and analysis tools have facilitated rapid interrogation of large transcriptome datasets, and querying broadly across multiple large datasets should identify predictors that are widely applicable. METHODS We used camcAPP, cBioPortal, CRN, and NIH NCI GDC Data Portal to data mine publicly available large prostate cancer datasets. A test set of biomarkers was developed by identifying transcripts that had: 1) altered abundance in prostate cancer, 2) altered expression in patients with Gleason score 7 tumours and biochemical recurrence, 3) correlation of expression with time until biochemical recurrence across three datasets (Cambridge, Stockholm, MSKCC). Transcripts that met these criteria were then examined in a validation dataset (TCGA-PRAD) using univariate and multivariable models to predict biochemical recurrence in patients with Gleason score 7 tumours. RESULTS Twenty transcripts met the test criteria, and 12 were validated in TCGA-PRAD Gleason score 7 patients. Ten of these transcripts remained prognostic in Gleason score 3 + 4 = 7, a sub-group of Gleason score 7 patients typically considered at a lower risk for poor outcome and often not targeted for aggressive management. All transcripts positively associated with recurrence encode or regulate mitosis and cell cycle-related proteins. The top performer was BUB1, one of four key MIR145-3P microRNA targets upregulated in hormone-sensitive as well as castration-resistant PCa. SRD5A2 converts testosterone to its more active form and was negatively associated with biochemical recurrence. CONCLUSIONS Unbiased mining of large patient datasets identified 12 transcripts that independently predicted disease recurrence risk in Gleason score 7 prostate cancer. The mitosis and cell cycle proteins identified are also implicated in progression to castration-resistant prostate cancer, revealing a pivotal role for loss of cell cycle control in the latter.
Collapse
Affiliation(s)
- Wendy L Johnston
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Carol J Swallow
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A urologist referred a 69-year-old man for a radiotherapy opinion regarding a recently diagnosed adenocarcinoma of the prostate. Annual serum prostate-specific antigen (PSA) testing over 7 years demonstrated a rise in PSA from 1.36 ng/mL to 5.8 ng/mL, prompting a transrectal ultrasound that revealed a heterogeneous 37-mL gland containing no visualized hypoechoic nodules. Biopsy disclosed a Gleason score 3+4 (grade group 2) adenocarcinoma of the prostate. The synoptic report stated that six of 14 cores and 17% of the tissue were involved, with the greatest core involvement being 80% at the right apex. Perineural invasion was present without lymphovascular invasion. Disease was present bilaterally at the base, midgland, and apex.His medical history was significant only for treated peptic ulcer disease and he was taking no medication. His International Prostate Symptom Score was six of 35, and he reported being sexually active with good erectile function. There was no family history of prostate cancer. He is retired. Digital rectal examination revealed moderate benign prostatic hypertrophy with no suspicious nodules. A staging computerized tomography (CT) scan of the abdomen and pelvis and a whole-body bone scan ordered by his referring urologist reported no evidence of metastatic disease. The patient had discussed surgical options with his urologist and now wished to consider radiotherapy approaches.
Collapse
Affiliation(s)
- Charles N Catton
- Charles N. Catton, Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada; Himu Lukka, Juravinsiki Regional Cancer Centre and McMaster University, Hamilton, ON, Canada; and Jarad Martin, Calvary Mater Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Himu Lukka
- Charles N. Catton, Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada; Himu Lukka, Juravinsiki Regional Cancer Centre and McMaster University, Hamilton, ON, Canada; and Jarad Martin, Calvary Mater Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Jarad Martin
- Charles N. Catton, Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada; Himu Lukka, Juravinsiki Regional Cancer Centre and McMaster University, Hamilton, ON, Canada; and Jarad Martin, Calvary Mater Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
18
|
Gundle KR, Griffin AM, Dickson BC, Chung PW, Catton CN, O’Sullivan B, Wunder JS, Ferguson PC. Reply to A. Levy et al. J Clin Oncol 2018; 36:2358-2359. [DOI: 10.1200/jco.2018.78.7325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kenneth R. Gundle
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M. Griffin
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C. Dickson
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Peter W. Chung
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Charles N. Catton
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Brian O’Sullivan
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Jay S. Wunder
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Ferguson
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Martin JM, Supiot S, Keall PJ, Catton CN. Moderately hypofractionated prostate external-beam radiotherapy: an emerging standard. Br J Radiol 2018; 91:20170807. [PMID: 29322821 PMCID: PMC6223284 DOI: 10.1259/bjr.20170807] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/01/2023] Open
Abstract
Research over recent years has demonstrated that curative external-beam radiotherapy can be safely and efficaciously delivered with roughly half the number of treatments which was previously considered standard. We review the data supporting this change in practice, methods for implementation, as well as emerging future directions.
Collapse
Affiliation(s)
- Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, NSW, Australia
| | - Stephane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales, NSW, Australia
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Tsang DS, Jones JM, Samadi O, Shah S, Mitsakakis N, Catton CN, Jeon W, To J, Breunis H, Alibhai SMH. Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?—a before/after study. Support Care Cancer 2018. [DOI: 10.1007/s00520-018-4150-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
21
|
Helou J, Catton CN, Bauman G, Fazelzad R, Raphael J. Abiraterone or docetaxel in men with metastatic castration-sensitive prostate cancer: A pooled analysis of castration resistance-free survival and toxicity. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
354 Background: Recent meta-analyses suggested an improvement in overall survival (OS) with the addition of Abiraterone (A) vs Docetaxel (D) to androgen deprivation therapy (ADT) in the treatment of men with metastatic castration-sensitive prostate cancer. However, none have reported castration resistance-free survival (CFS) and toxicity data; two clinically relevant outcomes for physicians and patients. Methods: We conducted a systematic review and meta-analysis to assess CFS and toxicity of adding A or D to ADT in men with castration-sensitive prostate cancer. The electronic databases Ovid MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE, were searched for randomized controlled trials. Pooled hazard ratios (HR) for CFS, and pooled risk ratios (RR) for grade 3 or higher toxicity were analyzed using the Mantel-Haenszel method and generic inverse variance. To account for between-studies heterogeneity, random-effect models were used to compute pooled estimates. Subgroup analyses compared patients on A and D in terms of CFS. Results: Five studies were included. The addition of A or D to ADT decreased the risk of development of castration-resistance by 53% (5 studies, 4,462 participants, HR = 0.47, 95% CI 0.33-0.67). In a subgroup analysis, the addition of A seemed to be better than D for the outcome CFS (5 studies, HR = 0.31, 95% CI 0.27-0.34 versus HR = 0.62, 95% CI 0.56-0.69, test for subgroup difference, p< 0.001). Different profiles of toxicity were seen with A and D. While A increased the risk of hypokalemia (3,107 participants, HR = 6.63, 95% CI 3.5-12.5) and cardiac toxicity (3,107 participants, HR = 2.4, 95% CI 1.7-3.3), D increased the risk of neutropenia (2,151 participants, HR = 13, 95% CI 8.9-18.8) and neuropathy (2,151 participants, HR = 2.25, 95% CI 1.18-4.3). Conclusions: The addition of A and D to ADT increases CFS in men with castration-sensitive prostate cancer, with a longer CFS noted for A compared to D. Considering CFS and OS, A may be preferred to D as initial therapy. Toxicity profiles differed between A and D. Quality of life and cost differences between A and D are other important factors and were not considered in this analysis.
Collapse
Affiliation(s)
- Joelle Helou
- University of Toronto Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Charles N Catton
- University of Toronto Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Glenn Bauman
- Western University, London Regional Cancer Program, London, ON, Canada
| | - Rouhi Fazelzad
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jacques Raphael
- Western University, London Regional Cancer Program, London, ON, Canada
| |
Collapse
|
22
|
Gundle KR, Kafchinski L, Gupta S, Griffin AM, Dickson BC, Chung PW, Catton CN, O'Sullivan B, Wunder JS, Ferguson PC. Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection. J Clin Oncol 2018; 36:704-709. [PMID: 29346043 DOI: 10.1200/jco.2017.74.6941] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P < .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7% to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers ( P < .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P < .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but < 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.
Collapse
Affiliation(s)
- Kenneth R Gundle
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Kafchinski
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Gupta
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M Griffin
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C Dickson
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Catton
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
23
|
Gervais MK, Burtenshaw SM, Maxwell J, Dickson BC, Catton CN, Blackstein M, McCready D, Escallon J, Gladdy RA. Clinical outcomes in breast angiosarcoma patients: A rare tumor with unique challenges. J Surg Oncol 2017; 116:1056-1061. [PMID: 29205355 DOI: 10.1002/jso.24780] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 05/26/2017] [Accepted: 06/29/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Breast angiosarcoma (AS) accounts for less than 1% of all breast cancers. The goal of this study was to determine patient outcomes in radiation-associated angiosarcoma of the breast (RAAS) and sporadic AS. We evaluated patterns of recurrence and predictors of breast AS survival. METHODS Patients with pathologically confirmed AS from 1994 to 2014 referred to Mount Sinai Hospital/Princess Margaret Cancer Centre were included. Primary outcome was overall survival (OS). Secondary outcomes were disease-free survival (DFS), clinicopathologic characteristics, patterns of recurrence and factors predictive of survival. Kaplan-Meier and log-rank tests were used for OS and DFS. RESULTS Twenty-six patients were included: 6 with sporadic AS and 20 with RAAS. Median follow-up was 24 months. Five-year OS for RAAS and sporadic subgroups were 44% and 40%, respectively (P = ns). Five-year DFS for RAAS and sporadic subgroups were 23% and 20%, respectively (P = ns). Overall recurrence rate was 67% with median time to recurrence of 11 months. Age, tumor depth, margin status, and tumor size were not statistically significant predictive factors for OS and DFS. DISCUSSION Breast AS is associated with poor survival and high recurrence rates. Prognosis may be mainly determined by its aggressive biology. Referral to tertiary care centers for multimodality treatment is recommended.
Collapse
Affiliation(s)
- Mai-Kim Gervais
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Sally M Burtenshaw
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Jessica Maxwell
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Martin Blackstein
- Department of Medical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - David McCready
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Jaime Escallon
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Rebecca A Gladdy
- Division of General Surgery, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
24
|
Gundle KR, Gupta S, Kafchinski L, Griffin AM, Kandel RA, Dickson BC, Chung PW, Catton CN, O’Sullivan B, Ferguson PC, Wunder JS. An Analysis of Tumor- and Surgery-Related Factors that Contribute to Inadvertent Positive Margins Following Soft Tissue Sarcoma Resection. Ann Surg Oncol 2017; 24:2137-2144. [DOI: 10.1245/s10434-017-5848-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Indexed: 12/15/2022]
|
25
|
Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, Bauman GS, Bahary JP, Ahmed S, Cheung P, Tai KH, Wu JS, Parliament MB, Tsakiridis T, Corbett TB, Tang C, Dayes IS, Warde P, Craig TK, Julian JA, Levine MN. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J Clin Oncol 2017; 35:1884-1890. [PMID: 28296582 DOI: 10.1200/jco.2016.71.7397] [Citation(s) in RCA: 451] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Men with localized prostate cancer often are treated with external radiotherapy (RT) over 8 to 9 weeks. Hypofractionated RT is given over a shorter time with larger doses per treatment than standard RT. We hypothesized that hypofractionation versus conventional fractionation is similar in efficacy without increased toxicity. Patients and Methods We conducted a multicenter randomized noninferiority trial in intermediate-risk prostate cancer (T1 to 2a, Gleason score ≤ 6, and prostate-specific antigen [PSA] 10.1 to 20 ng/mL; T2b to 2c, Gleason ≤ 6, and PSA ≤ 20 ng/mL; or T1 to 2, Gleason = 7, and PSA ≤ 20 ng/mL). Patients were allocated to conventional RT of 78 Gy in 39 fractions over 8 weeks or to hypofractionated RT of 60 Gy in 20 fractions over 4 weeks. Androgen deprivation was not permitted with therapy. The primary outcome was biochemical-clinical failure (BCF) defined by any of the following: PSA failure (nadir + 2), hormonal intervention, clinical local or distant failure, or death as a result of prostate cancer. The noninferiority margin was 7.5% (hazard ratio, < 1.32). Results Median follow-up was 6.0 years. One hundred nine of 608 patients in the hypofractionated arm versus 117 of 598 in the standard arm experienced BCF. Most of the events were PSA failures. The 5-year BCF disease-free survival was 85% in both arms (hazard ratio [short v standard], 0.96; 90% CI, 0.77 to 1.2). Ten deaths as a result of prostate cancer occurred in the short arm and 12 in the standard arm. No significant differences were detected between arms for grade ≥ 3 late genitourinary and GI toxicity. Conclusion The hypofractionated RT regimen used in this trial was not inferior to conventional RT and was not associated with increased late toxicity. Hypofractionated RT is more convenient for patients and should be considered for intermediate-risk prostate cancer.
Collapse
Affiliation(s)
- Charles N Catton
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Himu Lukka
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Chu-Shu Gu
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jarad M Martin
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Stéphane Supiot
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Peter W M Chung
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Glenn S Bauman
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jean-Paul Bahary
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Shahida Ahmed
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Patrick Cheung
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Keen Hun Tai
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jackson S Wu
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Matthew B Parliament
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Theodoros Tsakiridis
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Tom B Corbett
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Colin Tang
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Ian S Dayes
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Padraig Warde
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Tim K Craig
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jim A Julian
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Mark N Levine
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| |
Collapse
|
26
|
Raziee H, Berlin A, Chung PWM, Helou JA, Jiang H, Crook JM, Catton CN. Permanent seed brachytherapy for low risk prostate cancer, long term outcome, and urinary toxicity. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.66] [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: 11/20/2022] Open
Abstract
66 Background: Low dose rate seed brachytherapy is an established treatment modality for low risk prostate cancer (CaP). Herein, we report long term biochemical control and urinary toxicity from a single institution. Methods: Data from a prospectively-collected institutional database was used, completed with retrospective chart reviews. All patients with low-risk CaP (NCCN criteria) who underwent ultrasound-guided permanent iodine-125 brachytherapy from March 1999 to December 2005 were included. Urinary function was evaluated by the International Prostate Symptom Score (IPSS). PSA relapse was defined by Phoenix Criteria (nadir + 2 ng/ml). Time to IPSS return-to-baseline score ±3 was recorded. Results: 582 patients with a median age of 64 years were included. Median initial PSA was 5.5 ng/ml (0.3-10). 66% and 34% were T1 and T2a, respectively. Gleason score was 6 (96%) and < 6 (4%). Prescription dose was 145Gy, with a median V100 coverage of 94% (IQR [interquartile range] 89-97%) and median D90 of 157Gy (IQR 144-171 Gy). With a median follow up of 131 months (IQR 94-149 months), 27 patients showed biochemical failure (4.6%), and PSA bounce was detected in 38 cases (7%). Biochemical progression-free rates were 97% (96-98%), 96% (94-97%), and 94% (91-96%) at 5, 10, and 15 years, respectively. Median PSA level at 5, 10 and 15 years was 0.06, 0.05 and 0.018 ng/ml, respectively. PSA relapses were observed out to 148 months. At 1, 5, 10 and 15 years, 5.5%, 16.5%, 39.5% and 89.2% of patients were lost to PSA follow up. Median baseline IPSS score was 5. In 515 (88.5%) patients IPSS returned to baseline, with a median time to return-to-baseline of 9 months. The proportion of return-to-baseline at 1, 2, 5, and 10 years was 62%, 75%, 88%, and 90%, respectively. 22 (4%) patients required post-implant urinary catheter. After 3, 6 and 12 months, 9 (1.5%), 6 (1%) and 4 (0.7%) patients continued to be catheterized. Conclusions: Within the limits of retrospective analysis, permanent seed brachytherapy for low risk prostate cancer is an effective treatment modality with low urinary toxicity. Treatment resulted in excellent long-term biochemical control although late relapses were observed.
Collapse
Affiliation(s)
- Hamid Raziee
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter W. M. Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joelle Antoine Helou
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Haiyan Jiang
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
27
|
Davidson D, Barr RD, Riad S, Griffin AM, Chung PW, Catton CN, O'Sullivan B, Ferguson PC, Davis AM, Wunder JS. Health-related quality of life following treatment for extremity soft tissue sarcoma. J Surg Oncol 2016; 114:821-827. [PMID: 27634326 DOI: 10.1002/jso.24424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/16/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The primary objective of this study was to estimate the change in health-related quality of life (HRQL) 1 year following treatment for extremity soft tissue sarcoma (STS), measured by the EQ-5D. Secondary objectives included determining clinical variables associated with HRQL at 1 year, estimating the proportion with a clinically important difference (CID) in HRQL, and evaluating variability within EQ-5D domains. METHODS Patients over the age of 16 years, treated for a localized extremity STS, were included. The EQ-5D change score from pre-treatment to 1-year follow-up was determined. The association of clinical variables with EQ-5D scores was estimated using a linear regression model. The proportion of patients with a CID in HRQL score was determined. A vector analysis of the EQ-5D domains was undertaken. RESULTS The mean EQ-5D change score was 0.02. Age, sex, disease status, and initial EQ-5D score were associated with EQ-5D score at 1 year. There was a CID improvement in 32% and a deterioration in 24%. The anxiety and depression domain demonstrated the most change between baseline and 1 year after treatment. CONCLUSION Most patients maintain a high level of HRQL following treatment for extremity STS. J. Surg. Oncol. 2016;114:821-827. © 2016 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Darin Davidson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Soha Riad
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Aileen M Davis
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation and Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.,Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
28
|
Hamilton TD, Cannell AJ, Kim M, Catton CN, Blackstein ME, Dickson BC, Gladdy RA, Swallow CJ. Results of Resection for Recurrent or Residual Retroperitoneal Sarcoma After Failed Primary Treatment. Ann Surg Oncol 2016; 24:211-218. [DOI: 10.1245/s10434-016-5523-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Indexed: 12/21/2022]
|
29
|
McPartlin AJ, Glicksman R, Pintilie M, Tsuji D, Mok G, Bayley A, Chung P, Bristow RG, Gospodarowicz MK, Catton CN, Milosevic M, Warde PR. PMH 9907: Long-term outcomes of a randomized phase 3 study of short-term bicalutamide hormone therapy and dose-escalated external-beam radiation therapy for localized prostate cancer. Cancer 2016; 122:2595-603. [PMID: 27219522 DOI: 10.1002/cncr.30093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/03/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role of hormone therapy (HT) with dose-escalated external-beam radiotherapy (DE-EBRT) in the treatment of intermediate-risk prostate cancer (IRPC) remains controversial. The authors report the long-term outcome of a phase 3 study of DE-EBRT with or without HT for patients with localized prostate cancer (LPC). METHODS From 1999 to 2006, 252 of an intended 338 patients with LPC were randomized to receive DE-EBRT with or without 5 months of neoadjuvant and concurrent bicalutamide 150 mg once daily. The study was closed early because of contemporary concerns surrounding bicalutamide. The primary outcome was biochemical failure (BF) incidence, and the secondary endpoints were overall survival (OS), local control (LC), and quality of life. The BF and OS rates were estimated using the cumulative incidence function and Kaplan-Meier methods and were compared using the Gray test and the log-rank test. RESULTS Eleven patients were excluded from analysis. Characteristics were well balanced in each treatment arm. Ninety-five percent of patients had IRPC. The prescribed dose increased from 75.6 grays (Gy) in 42 fractions to 78 Gy in 39 fractions over the period. At a median follow-up of 9.1 years, 98 BFs occurred, with no significant effect of HT versus no HT on the BF rate (40% vs 47%; P = .32), the OS rate (82% vs 86%; P = .37), the LC rate (52% vs 48 %; P = .32) or quality of life, in the patients who completed the questionnaires. Dose escalation to 75.6 Gy versus >75.6 Gy reduced the BF rate by 26% (P = .004). CONCLUSIONS For patients who predominantly have IRPC, the addition of HT to DE-EBRT did not significantly affect BF, OS, or LC. Bicalutamide appeared to be well tolerated. The conclusions from the study are limited by incomplete recruitment. Cancer 2016;122:2595-603. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Andrew J McPartlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Melania Pintilie
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Debbie Tsuji
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Gary Mok
- Department of Radiology, Radiation Oncology, and Nuclear Medicine, University Hospital Center of Montreal, Montreal, Quebec, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Robert G Bristow
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mary K Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Charles N Catton
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael Milosevic
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Padraig R Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Catton CN, Lukka H, Julian JA, Gu CS, Martin J, Supiot S, Chung PWM, Bauman G, Bahary JP, Ahmed S, Cheung P, Tai KH, Wu J, Parliament M, Levine MN. A randomized trial of a shorter radiation fractionation schedule for the treatment of localized prostate cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Himu Lukka
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Jim A. Julian
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Jarad Martin
- Oncology Research Australia, Toowoomba, Australia
| | - Stéphane Supiot
- Institut de Cancérologie de l'Ouest René Gauducheau, Nantes Saint Herblain, France
| | - Peter W. M. Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Glenn Bauman
- London Regional Cancer Program, London, ON, Canada
| | | | | | | | - Keen Hun Tai
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Jackson Wu
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | | |
Collapse
|
31
|
Salah S, Lott A, Ferguson PC, Wunder J, Gupta AA, Catton CN, O'Sullivan B, Swallow CJ, Chung PWM, Amir E, Abdul Razak AR. The impact of multimodality therapy in marginally inoperable soft tissue sarcomas (STS): The Toronto Sarcoma Program Experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Samer Salah
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anthony Lott
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Charles Ferguson
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jay Wunder
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Abha A. Gupta
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter W. M. Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eitan Amir
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | |
Collapse
|
32
|
Griffin AM, Dickie CI, Catton CN, Chung PWM, Ferguson PC, Wunder JS, O'Sullivan B. The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications in extremity soft tissue sarcoma. Ann Surg Oncol 2015; 22:2824-30. [PMID: 26018726 DOI: 10.1245/s10434-015-4631-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship of the time interval between completion of preoperative radiation therapy (RT) and surgical resection on wound complications (WCs) in extremity soft tissue sarcoma (STS). METHODS Overall, 798 extremity STS patients were managed with preoperative RT and surgery from 1989 to 2013. WCs were defined as requiring secondary operations/invasive procedures for wound care, use of vacuum-assisted closure, prolonged dressing changes, or infection within 120 days of surgery. RESULTS Mean tumor size was 8.8 cm. A total of 743 (93 %) tumors were primary presentations, 565 (71 %) patients had lower extremity tumors, and 238 patients (30 %) had a prior unplanned excision. Of 242 patients (30 %) who developed a WC, 206 (37 %) had lower extremity tumors and 36 (15 %) had upper extremity tumors. Mean time from RT completion to surgery was 41.3 (range 4-470) days; 42.0 (range 4-470) days for upper extremity cases, and 41.1 (range 4-109) days for lower extremity cases. Similarly, mean time interval for patients who developed a WC was 40.9 (range 4-100) days, and 41.5 (range 4-470) days for those who did not develop a WC (p = 0.69). Thirty-nine cases (5 %) had surgery within 3 weeks of RT; 15 (38 %) patients developed WCs versus 227 (30 %) patients who had their tumors excised after 3 weeks (p = 0.28). One hundred and twenty-nine (16 %) patients had surgery within 4 weeks, and 39 (30 %) patients developed WCs versus 203 (30 %) patients who had their tumors excised after 4 weeks (p = 1.0). A trend towards a higher rate of WCs was seen for those patients who had surgery after 6 weeks (28 % prior vs. 34 % after; p = 0.08). There was no difference in WCs with intensity-modulated RT (IMRT) versus non-IMRT cases (p = 0.6). CONCLUSION The time interval between preoperative RT and surgical excision in extremity STS had minimal influence on the development of WCs. Four- or 5-week intervals showed equivalent complication rates between the two groups, suggesting an optimal interval to reduce potential WCs.
Collapse
Affiliation(s)
- Anthony M Griffin
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada,
| | | | | | | | | | | | | |
Collapse
|
33
|
Swallow CJ, Cannell A, Dickson B, Burtenshaw S, Chung PWM, Gladdy RA, O'Sullivan B, Catton CN. Local control following resection of primary retroperitoneal sarcoma with and without preoperative radiotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Brendan Dickson
- Department of Pathology, Mount Sinai Hospital and The University of Toronto, Toronto, ON, Canada
| | | | - Peter W. M. Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | | | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| |
Collapse
|
34
|
Baldini EH, Abrams RA, Bosch W, Roberge D, Haas RLM, Catton CN, Indelicato DJ, Olsen JR, Deville C, Chen YL, Finkelstein SE, DeLaney TF, Wang D. Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists. Int J Radiat Oncol Biol Phys 2015; 92:1053-1059. [PMID: 26194680 DOI: 10.1016/j.ijrobp.2015.04.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 01/15/2015] [Revised: 04/06/2015] [Accepted: 04/21/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. METHODS AND MATERIALS Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. RESULTS Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. CONCLUSIONS For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.
Collapse
Affiliation(s)
- Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Ross A Abrams
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Walter Bosch
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - David Roberge
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Rick L M Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida
| | - Jeffrey R Olsen
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Curtiland Deville
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
35
|
Jones JM, Olson K, Catton P, Catton CN, Fleshner NE, Krzyzanowska MK, McCready DR, Wong RKS, Jiang H, Howell D. Cancer-related fatigue and associated disability in post-treatment cancer survivors. J Cancer Surviv 2015; 10:51-61. [PMID: 25876557 DOI: 10.1007/s11764-015-0450-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [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: 08/07/2014] [Accepted: 03/23/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is the most prevalent and distressing symptom among cancer patients and survivors. However, research on its prevalence and related disability in the post-treatment survivorship period remains limited. We sought to describe the occurrence of CRF within three time points in the post-treatment survivorship trajectory. METHODS A self-administered mail-based questionnaire which included the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and the World Health Organisation Disability Assessment Schedule 2.0 was sent to three cohorts of disease-free breast, prostate or colorectal cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment). Clinical information was extracted from chart review. Frequencies of significant fatigue by diagnostic group and time cohorts were studied and compared. Multivariate logistic regressions were conducted to examine the associations between CRF and demographic, clinical, and psychosocial variables. RESULTS One thousand two hundred ninety-four questionnaire packages were returned (63 % response rate). A total of 29 % (95 % CI [27 % to 32 %]) of the sample reported significant fatigue (FACT-F ≤34), and this was associated with much higher levels of disability (p < 0.0001). Breast (40 % [35 % to 44 %]) and colorectal (33 % [27 % to 38 %]) cancer survivors had significantly higher rates of fatigue compared with the prostate group (17 % [14 % to 21 %]) (p < 0.0001). Fatigue levels did not differ between the three time cohorts. The main factors associated with CRF included physical symptom burden, depression, and co-morbidity (AUC, 0.919 [0.903 to 0.936]). CONCLUSIONS Clinically relevant levels of CRF are present in approximately 1/3 of cancer survivors up to 6 years post-treatment, and this is associated with high levels of disability. IMPLICATIONS FOR CANCER SURVIVORS Clinicians need to be aware of the chronicity of CRF and assess for it routinely in medical practice. While there is no gold standard treatment, non-pharmacological interventions with established efficacy can reduce its severity and possibly minimize its disabling impact on patient functioning. Attention must be paid to the co-occurrence and need for possible treatment of depression and other co-occurring physical symptoms as contributing factors.
Collapse
Affiliation(s)
- Jennifer M Jones
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Street, Munk Building B PMB 148, Toronto, ON, M5G 2C4, Canada.
| | | | - Pamela Catton
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Street, Munk Building B PMB 148, Toronto, ON, M5G 2C4, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Neil E Fleshner
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David R McCready
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rebecca K S Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Haiyan Jiang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Doris Howell
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Street, Munk Building B PMB 148, Toronto, ON, M5G 2C4, Canada
| |
Collapse
|
36
|
O'Donnell PW, Griffin AM, Eward WC, Sternheim A, Catton CN, Chung PW, O'Sullivan B, Ferguson PC, Wunder JS. The effect of the setting of a positive surgical margin in soft tissue sarcoma. Cancer 2014; 120:2866-75. [PMID: 24894656 DOI: 10.1002/cncr.28793] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [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: 11/15/2013] [Revised: 01/17/2014] [Accepted: 02/03/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures. METHODS One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection. RESULTS After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery. CONCLUSIONS After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes.
Collapse
Affiliation(s)
- Patrick W O'Donnell
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
O'Sullivan B, Griffin AM, Dickie CI, Sharpe MB, Chung PWM, Catton CN, Ferguson PC, Wunder JS, Deheshi BM, White LM, Kandel RA, Jaffray DA, Bell RS. Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma. Cancer 2013; 119:1878-84. [PMID: 23423841 DOI: 10.1002/cncr.27951] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study sought to determine if preoperative image-guided intensity-modulated radiotherapy (IG-IMRT) can reduce morbidity, including wound complications, by minimizing dose to uninvolved tissues in adults with lower extremity soft tissue sarcoma. METHODS The primary endpoint was the development of an acute wound complication (WC). IG-IMRT was used to conform volumes to avoid normal tissues (skin flaps for wound closure, bone, or other uninvolved soft tissues). From July 2005 to June 2009, 70 adults were enrolled; 59 were evaluable for the primary endpoint. Median tumor size was 9.5 cm; 55 tumors (93%) were high-grade and 58 (98%) were deep to fascia. RESULTS Eighteen (30.5%) patients developed WCs. This was not statistically significantly different from the result of the National Cancer Institute of Canada SR2 trial (P = .2); however, primary closure technique was possible more often (55 of 59 patients [93.2%] versus 50 of 70 patients [71.4%]; P = .002), and secondary operations for WCs were somewhat reduced (6 of 18 patients [33%] versus 13 of 30 patients [43%]; P = .55). Moderate edema, skin, subcutaneous, and joint toxicity was present in 6 (11.1%), 1 (1.9%), 5 (9.3%), and 3 (5.6%) patients, respectively, but there were no bone fractures. Four local recurrences (6.8%, none near the flaps) occurred with median follow-up of 49 months. CONCLUSIONS The 30.5% incidence of WCs was numerically lower than the 43% risk derived from the National Cancer Institute of Canada SR2 trial, but did not reach statistical significance. Preoperative IG-IMRT significantly diminished the need for tissue transfer. RT chronic morbidities and the need for subsequent secondary operations for WCs were lowered, although not significantly, whereas good limb function was maintained.
Collapse
Affiliation(s)
- Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Biau DJ, Ferguson PC, Chung P, Griffin AM, Catton CN, O'Sullivan B, Wunder JS. Local recurrence of localized soft tissue sarcoma: a new look at old predictors. Cancer 2012; 118:5867-77. [PMID: 22648518 DOI: 10.1002/cncr.27639] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to examine the effect of known predictors of local recurrence of soft tissue sarcoma in a competing risk setting. METHODS The outcome of interest was the cumulative probability of local recurrence per category of relevant predictors, with death as a competing event. In total, 1668 patients with a localized soft tissue sarcoma of the extremity or trunk were included. RESULTS Tumor size (hazard ratio, 3.3), depth (hazard ratio, 3.2), and histologic grade (hazard ratio, 4.5) were the variables that had the most effect on the risk of metastasis and, accordingly, were the most likely to induce competition. Surgical margins (hazard ratio, 3.3), histologic grade (hazard ratio, 2.1), presentation status (hazard ratio, 2.4), and tumor depth (hazard ratio, 1.5) were the variables that had the most effect on the risk of local recurrence. The 10-year cumulative probabilities of local recurrence were markedly different within categories for presentation status (P < .001) and surgical margin status (P < .001). However, because of the competing effect of death, there was little difference in the 10-year cumulative probabilities of local recurrence with regard to tumor depth (12% and 11.4% for deep and superficial tumors, respectively; P = .2), tumor size (10.6% and 13.3% for large and small tumors, respectively; P = .99), or histologic tumor grade (12.6%, 10.7%, and 11.1% for high, intermediate, and low-grade tumors, respectively; P = .17). CONCLUSIONS Because of the competition between local recurrence and death, histologic tumor grade, tumor size, and tumor depth had little influence on the cumulative probability of local recurrence. The authors concluded that local management should be based on presentation status and surgical margins rather than other, previously acknowledged factors.
Collapse
Affiliation(s)
- David J Biau
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
39
|
Smith MJF, Ridgway PF, Catton CN, Cannell A, O'Sullivan B, Mikula LA, Jones JJ, Swallow CJ. Does combined dose intensification radiotherapy improve disease control in resectable retroperitoneal sarcoma? Long-term results of a phase I/II trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.10050] [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: 11/20/2022] Open
Abstract
10050 Background: Late failure is a challenging problem in retroperitoneal sarcoma (RPS) and reported 10 yr overall survival (OS) rates range from 20-30%. Use of preoperative external beam radiotherapy (XRT) in the management of RPS remains controversial. No RCT and very few prospective trials of any type have been completed. We investigated the effects of preop XRT plus dose escalation with early postop brachytherapy (BT) on long term survival and recurrence in RPS. Methods: From 06/96 to 10/00, 40 patients (25 female) with resectable RPS were entered onto a phase I/II trial of preop XRT (50 Gy) plus postop BT (20-25 Gy). As previously reported, BT to the upper abdomen was associated with significant grade III-V postop toxicity, and from 12/98 on, BT was applied only to cases where the “field at risk” excluded the upper abdomen. Kaplan Meier survival curves were constructed; OS and recurrence free survival (RFS) were compared by log rank (SPSS 19.0). Results: Median age at study entry was 58 (38-70) yrs. Twenty nine patients presented to our center with primary disease (73%), and 22 (55%) had high grade tumors. All patients had preop XRT and total gross resection, while half (n=19) received BT. As of 12/2011, median follow-up time is 108 mos. For the entire study cohort, OS at 5 and 10 yrs were 70% and 65%, respectively; RFS at 5 and 10 yrs were 65% and 58%, respectively. RFS at 5 yrs was reduced in high vs. low grade RPS (50% vs. 83%, p=0.028), but by 10 yrs. was similar in high and low grade tumors (50% vs. 67%, p=ns). RFS was reduced in patients who presented with recurrent vs. primary disease (27% vs. 69% at 10 yrs., p=0.018), as was OS (36% vs. 76% at 10 yrs., p=0.034). Neither OS nor RFS was improved in the cohort of patients who received BT compared to the cohort who did not: at 10 yrs. RFS was 53% +BT and 62% -BT, while OS was 53% and 76%, respectively, p=ns. Conclusions: In this prospective study with mature follow-up, long term OS and RFS in patients who underwent combined preop XRT plus resection of RPS compare favorably with those reported in retrospective institutional and population-based series. Postoperative BT did not contribute to disease control.
Collapse
Affiliation(s)
| | | | - Charles N Catton
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | | | | | - Lynn A Mikula
- Department of Surgical Oncology, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Department of Surgical Oncology, Princess Margaret and Mount Sinai Hospitals, Toronto, ON, Canada
| |
Collapse
|
40
|
Jones JM, Howell D, Olson KL, Jiang H, Catton CN, Catton P, Fleshner NE, McCready DR, Wong R, Pintilie M, Dirlea M, Krzyzanowska MK. Prevalence of cancer-related fatigue in a population-based sample of colorectal, breast, and prostate cancer survivors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9131 Background: Cancer-related fatigue (CRF) is the most prevalent and distressing cancer-related symptom and has a greater negative impact on patients' daily activities and quality of life than other cancer-related symptoms, including pain and depression. However, the prevalence and severity of persistent CRF and related disability in the post-treatment survivorship period has seldom been examined in populations other than breast cancer. The primary objective of the study was to describe the prevalence of significant CRF and associated levels of disability in a mixed cancer population sample at 3 time points in the post-treatment survivorship trajectory. Methods: Based on cancer registry data, a self-administered mail based questionnaire using Dillman's Tailored Design Method was sent to 3 cohorts of disease-free cancer survivors (6-18 months; 2-3 years; and 5-6 years post-treatment) previously treated for non-metastatic breast, prostate or colorectal cancer. Fatigue was measured using the FACT-F and disability was measured with the WHO-Disability Assessment Schedule. Clinical information was extracted from chart review. Frequencies of significant fatigue by disease sites and time points were studied and compared using chi-square test. Disability between those with and without CRF was also compared using Cochran-Armitage trend test. Results: 1294 questionnaire packages were completed (63% response rate). The FACT-F score was 39.1+10.9; 29% (95% CI: [27%, 32%]) of the sample reported significant fatigue (FACT-F≤34) and this was associated with much higher levels of disability (p<0.0001). Breast (40% [35%, 44%]) and colorectal (33% [27%, 38%]) survivors had significantly higher rates of fatigue (≤34) compared to the prostate group (17% [14%, 21%]) (p<0.0001). Fatigue levels remained relatively stable across the 3 time points. Conclusions: CRF was a significant and debilitating symptom for a substantial minority of the respondents across all 3 time points. Effective CRF management strategies are needed and have the potential to significantly reduce morbidity associated with cancer and its treatments and to improve quality of life for the growing population of cancer survivors.
Collapse
Affiliation(s)
- Jennifer M Jones
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Doris Howell
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Haiyan Jiang
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Charles N Catton
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Pamela Catton
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Neil Eric Fleshner
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - David R. McCready
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Rebecca Wong
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Melania Pintilie
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Mihaela Dirlea
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | | |
Collapse
|
41
|
|
42
|
Catton CN, Parker CC, Sydes MR. Adjuvant Radiotherapy After Prostatectomy: Does Waiting for a Detectable Prostate-Specific Antigen Level Make Sense?: In Regard to King CR (Int J Radiat Oncol Biol Phys 2011;80:1–3). Int J Radiat Oncol Biol Phys 2011; 81:1594. [DOI: 10.1016/j.ijrobp.2011.06.1969] [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] [Received: 05/13/2011] [Accepted: 06/04/2011] [Indexed: 11/26/2022]
|
43
|
Biau DJ, Ferguson PC, Turcotte RE, Chung P, Isler MH, Riad S, Griffin AM, Catton CN, O'Sullivan B, Wunder JS. Adverse Effect of Older Age on the Recurrence of Soft Tissue Sarcoma of the Extremities and Trunk. J Clin Oncol 2011; 29:4029-35. [DOI: 10.1200/jco.2010.34.0711] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine the effect of age on the recurrence of soft tissue sarcoma in the extremities and trunk. Patients and Methods This was a multicenter study that included 2,385 patients with median age at surgery of 57 years. The end points considered were local recurrence and metastasis. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors. Results Older patients presented with tumors that were larger (P < .001) and of higher grade (P < .001). The proportion of positive margins increased significantly as patients age (P < .001), but radiation therapy was relatively underused in patients older than age 60 years. The 5-year cumulative incidences of local recurrence were 7.2% (95% CI, 4% to 11.7%) for patients age 30 years or younger and 12.9% (95% CI, 9.1% to 17.5%) for patients age 75 years or older. The corresponding 5-year cumulative incidences of metastasis were 17.5% (95% CI, 12.1% to 23.7%) and 33.9% (95% CI, 28.1% to 39.8%) for the same groups. Regression models showed that age was significantly associated with local recurrence (P < .001) and metastasis (P < .001) in nonadjusted models. After adjusting for imbalance in presentation and treatment variables, age remained significantly associated with local recurrence (P = .031) and metastasis (P = .019). Conclusion Older patients have worse outcomes because they tend to present with worse tumors and are treated less aggressively. However, there remained a significant increase in the risk of both local and systemic recurrence associated with increasing age that could not be explained by tumor or treatment characteristics.
Collapse
Affiliation(s)
- David J. Biau
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Peter C. Ferguson
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Robert E. Turcotte
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Peter Chung
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Marc H. Isler
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Soha Riad
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Anthony M. Griffin
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Charles N. Catton
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jay S. Wunder
- David J. Biau, Peter C. Ferguson, Soha Riad, Anthony M. Griffin, and Jay S. Wunder, Mount Sinai Hospital, Princess Margaret Hospital, and University of Toronto; Peter Chung, Charles N. Catton, and Brian O'Sullivan, Princess Margaret Hospital, University of Toronto, Toronto, Ontario; Robert E. Turcotte, McGill University Health Centre; and Marc H. Isler, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| |
Collapse
|
44
|
Riad S, Biau D, Holt GE, Werier J, Turcotte RE, Ferguson PC, Griffin AM, Dickie CI, Chung PW, Catton CN, O'sullivan B, Wunder JS. The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma. Cancer 2011; 118:2682-92. [DOI: 10.1002/cncr.26543] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/01/2011] [Accepted: 08/02/2011] [Indexed: 11/12/2022]
|
45
|
Rosewall T, Bayley AJ, Chung P, Le LW, Xie J, Baxi S, Catton CN, Currie G, Wheat J, Milosevic M. The effect of delineation method and observer variability on bladder dose-volume histograms for prostate intensity modulated radiotherapy. Radiother Oncol 2011; 101:479-85. [PMID: 21864921 DOI: 10.1016/j.radonc.2011.06.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify the effect of delineation method on bladder DVH, observer variability (OV) and contouring time for prostate IMRT plans. MATERIALS AND METHODS Planning CT scans and IMRT plans of 30 prostate cancer patients were anonymized. For 20 patients, 1 observer delineated the bladder using 9 methods. The effect of delineation method on the DVH curve, discrete dose levels and delineation time was quantified. For the 10 remaining CTs, 6 observers delineated bladder wall using 4 methods. Observer-based volume variation and intraclass correlation coefficient (ICC) were used to describe the dosimetric effects of OV. RESULTS Manual delineation of the bladder wall (BW_m) was significantly slower than any other method (mean: 20 min vs. ≤ 13 min) and the dosimetric effect of OV was significantly larger (V70 Gy ICC: 0.78 vs. 0.98). Only volumes created using a 2.5mm contraction from the outer surface, and a method providing a consistent wall volume, showed no notable dosimetric differences from BW_m in both absolute and relative volume. CONCLUSIONS Automatic contractions from the outer surface provide quicker, more reproducible and reasonably accurate substitutes for BW_m. The widespread use of automatic contractions to create a bladder wall volume would assist in the consistent application of IMRT dose constraints and the interpretation of reported dose.
Collapse
Affiliation(s)
- Tara Rosewall
- Princess Margaret Hospital and Department of Radiation Oncology, University of Toronto, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Retroperitoneal sarcomas (RPS) are rare tumours that typically present late and carry a poor prognosis even following grossly complete resection. In an attempt to improve the outlook for patients with RPS, sarcoma specialists have employed various adjuvant therapies, including extermal beam radiation, intraoperative radiation, brachyradiation and systemic chemotherapy. This article reviews the presentation and prognosis of RPS, and focuses on the results of new treatment strategies compared with conventional management. A Medline search of the English literature was performed to identify all retrospective and prospective reports relating to the management of adult RPS published since 1980. Series that did not analyse RPS separately from other intra-abdominal or extra-abdominal sarcomas or other malignancies were excluded, and information on investigation, presentation, prognostic
factors, treatment and outcome was extracted from the remaining reports. Survival and local control data were collected from reports that contained at least 30 cases of RPS (n = 31). While surgical resection remains the cornerstone of treatment for RPS, the majority of patients will relapse and die from sarcoma within 5 years of resection. Adjuvant radiation may improve these results, but further trials are required to definitively demonstrate its benefit. Possible reasons for the failure of conventional treatment are discussed, and alternative strategies designed to overcome these obstacles are presented.
Collapse
Affiliation(s)
- R Cheifetz
- Department of Surgical Oncology Mount Sinai Hospital and Princess Margaret Hospital University of Toronto Ontario Toronto Canada
| | | | | | | | | | | |
Collapse
|
47
|
Colterjohn NR, Davis AM, O'Sullivan B, Catton CN, Wunder JS, Bell RS. Functional outcome in limb-salvage surgery for soft tissue tumours of the foot and ankle. Sarcoma 2011; 1:67-74. [PMID: 18521204 PMCID: PMC2395356 DOI: 10.1080/13577149778326] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Purpose. This paper describes the functional and oncologic outcome of 30 cases (in 29 patients) treated with limb-salvage surgery for localized soft tissue sarcoma (STS) or fibromatosis of the foot and ankle.Subjects. Patients were eligible for the study if they had a STS or fibromatosis in the distal one-third of the tibia or the foot such that ablative surgery would require a below-knee amputation; had no metastatic disease at presentation; and had a minimum of 2 years of follow-up.Methods. Function was prospectively evaluated using the modified Enneking functional rating scale (MSTS) at 3, 6, 12 months and at most recent follow-up. Premorbid work status and change following surgery, lower leg oedema, and the use of orthotics and ambulatory aids were consecutively assessed. Tumour characteristics were recorded and patients were followed for systemic and local recurrence.Results. Thirty-six consecutive cases were managed by a multi-disciplinary sarcoma team. Six patients underwent below-knee amputation due to extensive local disease, while 30 cases were treated with limb-salvage surgery. Of the patients treated with limb salvage, there were 19 high-grade sarcomas, five low-grade sarcomas and six cases of fibromatosis. Microscopically negative margins were achieved in 26 of 30 cases. Ten cases required bone excision, and eight patients needed free vascularized tissue flaps. Twenty-five patients received adjuvant radiotherapy. Seven patients had post-operative complications. At mean follow-up of 52 months (range 24-109 months), four patients had developed systemic recurrence. There was one local recurrence in a patient with fibromatosis, while another patient with fibromatosis developed recurrence a considerable distance from the surgical and radiation field. Mean scores on the MSTS were 27.5 (range 11-35), 29.9 (range 13-35), 31.4 (range 17-35) and 31.0 (range 13-35) at 3, 6, 12 months and at most recent follow-up, respectively. Eighty-five per cent of the patients scored good to excellent at their last visit. Twelve patients reported persistent pain with two continuing to require occasional narcotics. Six had persistent mild oedema. Four required shoe modifications and three continue to use a cane. Six patients were unable to return to their premorbid employment with the majority of these previously employed in jobs requiring physical labour or long periods of either standing or walking.Discussion. Thirty of 36 patients (83%) presenting with foot and ankle STS or fibromatosis were candidates for limb preservation. With excellent local control and good functional outcome demonstrated in this study, limb salvage should be a primary goal in the management of selected patients with STS and fibromatosis of the foot and ankle.
Collapse
Affiliation(s)
- N R Colterjohn
- University Musculoskeletal Oncology Unit and Division of Orthopaedic Surgery Mount Sinai Hospital and the University of Toronto Canada
| | | | | | | | | | | |
Collapse
|
48
|
O’Sullivan B, Catton CN, Chung PW, Griffin AM, Al Yami A, Ferguson PC, Bell RS, Wunder JS. In Reply Drs. Delaney and Chen. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.02.029] [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: 10/18/2022]
|
49
|
Dickie CI, Griffin AM, Parent AL, Chung PWM, Catton CN, Svensson J, Ferguson PC, Wunder JS, Bell RS, Sharpe MB, O'Sullivan B. The relationship between local recurrence and radiotherapy treatment volume for soft tissue sarcomas treated with external beam radiotherapy and function preservation surgery. Int J Radiat Oncol Biol Phys 2011; 82:1528-34. [PMID: 21640506 DOI: 10.1016/j.ijrobp.2011.03.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/24/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the geometric relationship between local recurrence (LR) and external beam radiotherapy (RT) volumes for soft-tissue sarcoma (STS) patients treated with function-preserving surgery and RT. METHODS AND MATERIALS Sixty of 768 (7.8%) STS patients treated with combined therapy within our institution from 1990 through 2006 developed an LR. Thirty-two received preoperative RT, 16 postoperative RT, and 12 preoperative RT plus a postoperative boost. Treatment records, RT simulation images, and diagnostic MRI/CT data sets of the original and LR disease were retrospectively compared. For LR location analysis, three RT target volumes were defined according to the International Commission on Radiation Units and Measurements 29 as follows: (1) the gross tumor or operative bed; (2) the treatment volume (TV) extending 5 cm longitudinally beyond the tumor or operative bed unless protected by intact barriers to spread and at least 1-2 cm axially (the TV was enclosed by the isodose curve representing the prescribed target absorbed dose [TAD] and accounted for target/patient setup uncertainty and beam characteristics), and (3) the irradiated volume (IRV) that received at least 50% of the TAD, including the TV. LRs were categorized as developing in field within the TV, marginal (on the edge of the IRV), and out of field (occurring outside of the IRV). RESULTS Forty-nine tumors relapsed in field (6.4% overall). Nine were out of field (1.1% overall), and 2 were marginal (0.3% overall). CONCLUSIONS The majority of STS tumors recur in field, indicating that the incidence of LR may be affected more by differences in biologic and molecular characteristics rather than aberrations in RT dose or target volume coverage. In contrast, only two patients relapsed at the IRV boundary, suggesting that the risk of a marginal relapse is low when the TV is appropriately defined. These data support the accurate delivery of optimal RT volumes in the most precise way using advanced technology and image guidance.
Collapse
Affiliation(s)
- Colleen I Dickie
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Smitsmans MH, de Bois J, Sonke JJ, Catton CN, Jaffray DA, Lebesque JV, van Herk M. Residual Seminal Vesicle Displacement in Marker-Based Image-Guided Radiotherapy for Prostate Cancer and the Impact on Margin Design. Int J Radiat Oncol Biol Phys 2011; 80:590-6. [DOI: 10.1016/j.ijrobp.2010.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/18/2010] [Accepted: 06/25/2010] [Indexed: 11/29/2022]
|