1
|
Walls GM, McCann C, O'Connor J, O'Sullivan A, I Johnston D, McAleese J, McGarry CK, Cole AJ, Jain S, Butterworth KT, Hanna GG. Pulmonary vein dose and risk of atrial fibrillation in patients with non-small cell lung cancer following definitive radiotherapy: An NI-HEART analysis. Radiother Oncol 2024; 192:110085. [PMID: 38184145 DOI: 10.1016/j.radonc.2024.110085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND PURPOSE Symptomatic arrhythmia is common following radiotherapy for non-small cell lung cancer (NSCLC), frequently resulting in morbidity and hospitalization. Modern treatment planning technology theoretically allows sparing of cardiac substructures. Atrial fibrillation (AF) comprises the majority of post-radiotherapy arrhythmias, but efforts to prevent this cardiotoxicity have been limited as the causative cardiac substructure is not known. In this study we investigated if incidental radiation dose to the pulmonary veins (PVs) is associated with AF. MATERIAL AND METHODS A single-centre study of patients completing contemporary (chemo)radiation for NSCLC, with modern planning techniques. Oncology, cardiology and death records were examined, and AF events were verified by a cardiologist. Cardiac substructures were contoured on planning scans for retrospective dose analysis. RESULTS In 420 eligible patients with NSCLC treated with intensity-modulated (70%) or 3D-conformal (30%) radiotherapy with a median OS of 21.8 months (IQR 10.8-35.1), there were 26 cases of new AF (6%). All cases were grade 3 except two cases of grade 4. Dose metrics for both the left (V55) and right (V10) PVs were associated with the incidence of new AF. Metrics remained statistically significant after accounting for the competing risk of death and cardiovascular covariables for both the left (HR 1.02, 95%CI 1.00-1.03, p = 0.005) and right (HR 1.01 (95%CI 1.00-1.02, p = 0.033) PVs. CONCLUSION Radiation dose to the PVs during treatment of NSCLC was associated with the onset of AF. Actively sparing the PVs during treatment planning could reduce the incidence of AF during follow-up, and screening for AF may be warranted for select cases.
Collapse
Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland.
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - John O'Connor
- School of Engineering, University of Ulster, York Street, Belfast, Northern Ireland
| | - Anna O'Sullivan
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland
| | - David I Johnston
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland
| |
Collapse
|
2
|
Walls GM, O'Connor J, Harbinson M, Duane F, McCann C, McKavanagh P, Johnston DI, Giacometti V, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. The Association of Incidental Radiation Dose to the Heart Base with Overall Survival and Cardiac Events after Curative-intent Radiotherapy for Non-small Cell Lung Cancer: Results from the NI-HEART Study. Clin Oncol (R Coll Radiol) 2024; 36:119-127. [PMID: 38042669 DOI: 10.1016/j.clon.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023]
Abstract
AIMS Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer radiotherapy. The dose to the heart base has been associated with poor survival in multiple institutional and clinical trial datasets using unsupervised, voxel-based analysis. Validation has not been undertaken in a cohort with individual patient delineations of the cardiac base or for the endpoint of cardiac events. The purpose of this study was to assess the association of heart base radiation dose with overall survival and the risk of cardiac events with individual heart base contours. MATERIALS AND METHODS Patients treated between 2015 and 2020 were reviewed for baseline patient, tumour and cardiac details and both cancer and cardiac outcomes as part of the NI-HEART study. Three cardiologists verified cardiac events including atrial fibrillation, heart failure and acute coronary syndrome. Cardiac substructure delineations were completed using a validated deep learning-based autosegmentation tool and a composite cardiac base structure was generated. Cox and Fine-Gray regressions were undertaken for the risk of death and cardiac events. RESULTS Of 478 eligible patients, most received 55 Gy/20 fractions (96%) without chemotherapy (58%), planned with intensity-modulated radiotherapy (71%). Pre-existing cardiovascular morbidity was common (78% two or more risk factors, 46% one or more established disease). The median follow-up was 21.1 months. Dichotomised at the median, a higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (20.2 months versus 28.3 months; hazard ratio 1.40, 95% confidence interval 1.14-1.75, P = 0.0017) and statistical significance was retained in multivariate analyses. Furthermore, heart base Dmax was associated with pooled cardiac events in a multivariate analysis (hazard ratio 1.75, 95% confidence interval 1.03-2.97, P = 0.04). CONCLUSIONS Heart base Dmax was associated with the rate of death and cardiac events after adjusting for patient, tumour and cardiovascular factors in the NI-HEART study. This validates the findings from previous unsupervised analytical approaches. The heart base could be considered as a potential sub-organ at risk towards reducing radiation cardiotoxicity.
Collapse
Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - M Harbinson
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - F Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - C McCann
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK
| | - P McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Dundonald, UK
| | - D I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - A R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - A J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - K T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - C K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| |
Collapse
|
3
|
Hanna GG, McDonald F. SBRT for oligoprogressive disease: using the evidence to maximise the benefits. Lancet 2024; 403:122-124. [PMID: 38104574 DOI: 10.1016/s0140-6736(23)02351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Gerard G Hanna
- Department of Oncology, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Bucknell NW, Hardcastle N, Woon B, Selbie L, Bressel M, Byrne K, Callahan J, Hanna GG, Hofman MS, Ball D, Kron T, Siva S. The HI-FIVE Trial: A Prospective Trial Using 4-Dimensional 68Ga Ventilation-Perfusion Positron Emission Tomography-Computed Tomography for Functional Lung Avoidance in Locally Advanced Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:887-892. [PMID: 37245537 DOI: 10.1016/j.ijrobp.2023.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Functional lung avoidance (FLA) radiation therapy aims to spare regions of functional lung to reduce toxicity. We report the results of the first prospective trial of FLA using 4-dimensional gallium 68 ventilation-perfusion positron emission tomography-computed tomography (68Ga-4D-V/Q PET/CT). METHODS AND MATERIALS Inclusion criteria required a diagnosis of stage III non-small cell lung cancer and the ability to undergo radical-intent chemoradiation therapy. Functional volumes were generated using planning 68Ga-4D-V/Q PET/CT. These volumes were used to generate a clinical FLA plan to 60 Gy in 30 fractions. The primary tumor was boosted to 69 Gy. A comparison anatomic plan was generated for each patient. Feasibility was met if FLA plans (compared with anatomic plans) allowed (1) a reduction in functional mean lung dose of ≥2% and a reduction in the functional lung volume receiving 20 Gy (fV20Gy) of ≥4%, and (2) a mean heart dose ≤30 Gy and relative heart volume receiving 50 Gy of <25%. RESULTS In total, 19 patients were recruited; 1 withdrew consent. Eighteen patients underwent chemoradiation with FLA. Of the 18 patients, 15 met criteria for feasibility. All patients completed the entire course of chemoradiation therapy. Using FLA resulted in an average reduction of the functional mean lung dose of 12.4% (SD, ±12.8%) and a mean relative reduction of the fV20Gy of 22.9% (SD, ±11.9%). At 12 months, Kaplan-Meier estimates for overall survival were 83% (95% CI, 56%-94%) and estimates for progression-free survival were 50% (95% CI, 26%-70%). Quality-of-life scores were stable across all time points. CONCLUSIONS Using 68Ga-4D-V/Q PET/CT to image and avoid functional lung is feasible.
Collapse
Affiliation(s)
- Nicholas W Bucknell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Beverley Woon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Selbie
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mathias Bressel
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Keelan Byrne
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason Callahan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ball
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Hegi-Johnson F, Rudd SE, Wichmann CW, Akhurst T, Roselt P, Sursock S, Trinh J, John T, Devereux L, Donnelly PS, Hicks RJ, Scott AM, Steinfort D, Fox S, Blyth B, Parakh S, Hanna GG, Callahan J, Burbury K, MacManus M. PD-L1 Positron Emission Tomography Imaging in Patients With Non-Small Cell Lung Cancer: Preliminary Results of the ImmunoPET Phase 0 Study. Int J Radiat Oncol Biol Phys 2023; 117:675-682. [PMID: 37406824 DOI: 10.1016/j.ijrobp.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fiona Hegi-Johnson
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Stacey E Rudd
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Christian W Wichmann
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia; Department of Molecular Imaging and Therapy, Austin Health and University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Akhurst
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Roselt
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sandra Sursock
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenny Trinh
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Devereux
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul S Donnelly
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Medical School, University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, Central Medical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia; Department of Molecular Imaging and Therapy, Austin Health and University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Steinfort
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Fox
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin Blyth
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Sagun Parakh
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Callahan
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael MacManus
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Bucknell NW, Kron T, Herschtal A, Hardcastle N, Irving L, MacManus M, Hanna GG, Moore A, Murnane A, Siva S, Ball D. Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:378-386. [PMID: 37087060 DOI: 10.1016/j.ijrobp.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE The TROG 09.02 CHISEL trial compared conventional radiation therapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomized to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the 6-minute walk test (SMWT) between patients who received SBRT and those who received CRT. METHODS AND MATERIALS We analyzed the PFTs and SMWTs of all patients recruited to the CHISEL [trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12 months after treatment. RESULTS One hundred and one patients were enrolled; 33 patients were treated with CRT, 61 were treated with SBRT, and 7 did not receive treatment. Primary tumor size was similar between arms: SBRT 25 mm (standard deviation [SD], 9) and CRT 28 mm (SD, 9). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. Planning target volume size was significantly larger in the CRT arm, 142.79 cc (SD, 61.14), compared with the SBRT group, 46.15 cc (SD, 23.39). The mean biologically effective dose received by the target was significantly larger in the SBRT group, 125.92 Gy (SD, 21.58), compared with CRT, 65.49 Gy (SD, 6.32). Mean dose to the lungs minus the gross target volume incorporating motion was 8.9 Gy (SD, 2.34) in the CRT group and 4.37 Gy (SD, 1.42) in the SBRT group. CONCLUSIONS Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the 2 groups.
Collapse
Affiliation(s)
- Nicholas W Bucknell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Alisha Moore
- TROG Cancer Research, Waratah, New South Wales, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Walls G, Johnston D, Harbsinson M, McCann C, McKavanagh P, Giacometti V, McAleese J, Cole A, Butterworth K, McGarry C, Jain S, Hanna GG. Simulation CT Features and Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69. [PMID: 37786027 DOI: 10.1016/j.ijrobp.2023.06.799] [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) Radiation cardiotoxicity is a significant clinical dilemma in non-small cell lung cancer (NSCLC) radiation therapy (RT). Baseline cardiovascular (CV) status may influence the risk of cardiotoxicity, and may be ascertainable from the appearance of the heart on simulation computed tomography (CT). We examined the association of CT features with incidental heart dose and risk of cardiac events in NSCLC. MATERIALS/METHODS Patients treated with curative-intent RT between 2015 and 2020 at a regional center were identified. Clinical notes were interrogated for baseline patient and CV health details, and follow-up CV events. Cardiac events were verified by a cardiologist. A deep learning-based auto-segmentation tool was applied, allowing extraction of a pre-specified list of volume parameters in a programming environment. CAC was graded as none, mild, moderate and severe in patients with a non-contrast scan. The craniocaudal relationship of the PTV and heart (Feng atlas) were annotated. RESULTS A total of 478 patients were included, with a median age of 70 and Charlson Index of 5. The median mean heart dose was 6.3 Gy (IQR 2.7-11.4). The median lung V20 was 20.0% (IQR 14.8-27.1). Cardiovascular risk factors were common, with most patients having 2 (39%) or 3 (31%). A history of previous cardiac events was common, including myocardial infarction (14%), arrhythmia (11%) or heart failure (9%). A total of 6.9% and 7.1% patients developed a new atrial arrhythmia (AA) or heart failure (HF) after completing RT. The volume metrics with the highest AUC for AA and HF events were the left atrium (LA) (AUC 0.67, p = 0.0002) and left ventricle:right ventricle (LV:RV) ratio (AUC 0.66, p = 0.0021). Kaplan-Meier analysis for cardiac events dichotomizing at the optimal cut-point for maximum sensitivity and specificity demonstrated significantly different rates for both AA (LA 109cc, HR 3.35, 95% CI 1.64-6.83, p = 0.0009) and HF (LV:RV ratio 1.61, HR 2.37, 95% CI 1.19-4.74, p = 0.0143). Only 2 patients with non-contrast scans developed a myocardial infarction, both had mild CAC. The incidence of pooled cardiac events was not significantly different between patients with no (n = 2/21, 9.5%), mild (n = 10/38, 26.3%), moderate (n = 8/53, 15.1%) and severe (n = 7/24, 29.2%) CAC (p = 0.3916). Where the inferior border of the PTV was above the superior border of the heart, mean heart dose was significantly lower than compared with overlap of levels (1.9 Gy v 9.7 Gy, p<0.0001), and this was true for 3DCRT (n = 139, p<0.001), IMRT (n = 94, p<0.001) and VMAT (n = 145, p<0.001) patients. CONCLUSION LA volume and LV:RV volume ratio are predictive for the development of AA and HF respectively. CAC grade did not differentiate patients by risk of cardiac events. Where the craniocaudal level of the PTV doesn't overlap with the level of the heart, the cardiac dose is likely to be very low. Several simulation CT features are associated with cardiac events following treatment for NSCLC and prospective evidence of cardiac risk could enable medical optimization prior to RT.
Collapse
Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| |
Collapse
|
8
|
Walls GM, Jain S, Hanna GG. Response to, "Statin therapy, cardiac events, and survival in patients with non-small cell lung cancer receiving definitive radiotherapy". Radiother Oncol 2023; 187:109826. [PMID: 37516365 DOI: 10.1016/j.radonc.2023.109826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom.
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| |
Collapse
|
9
|
Walls G, O'Connor J, Harbsinson M, Duane FK, McCann C, McKavanagh P, Johnston D, Giacometti V, McAleese J, Hounsell A, Cole A, Butterworth K, McGarry C, Hanna GG, Jain S. Patient-Level and Endpoint-Specific Clinico-Dosimetric Analysis of the Cardiac Base as a Mediator of Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69-e70. [PMID: 37786026 DOI: 10.1016/j.ijrobp.2023.06.800] [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) Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer (NSCLC) radiation therapy. Radiation dose to the cardiac base is associated with poor overall survival in several clinical studies, but has not been validated in a non-dose escalated cohort, or with individual patient delineations. In this study we examined the impact of cardiac base dose on overall survival (OS) and cardiac events (CEs), and interrogated the relationships of the substructures comprising the heart base with OS and CEs. MATERIALS/METHODS Patients with stage I-III NSCLC treated with curative-intent radiation therapy between 2015 and 2020 at a regional cancer center were identified. Clinical notes were examined for baseline patient, tumor and cardiac details, and both cancer and cardiac outcomes. Three cardiologists verified CEs. Cardiac delineations were completed using a validated deep learning-based autosegmentation tool. Cox and Fine and Gray regressions were undertaken for the risk of death and CEs respectively, accounting for pre-specified evidence-based dose metrics and clinically relevant cardiac covariates. RESULTS Most patients received 55 Gy/20# (n = 461/478, 96%) without chemotherapy (58%), planned with VMAT (51%) or IMRT (20%). Pre-existing cardiovascular morbidity was common, with 78% having ≥2 risk factors, and 46% having >1 established cardiac disease. The median follow-up was 21.1 months. Dichotomized at the median, higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (21.6 months (95% CI 19.3-24.9) versus 29.4 months (95% CI 21.6-36.6), p = 0.021), and remained significant when statistically compared in published multivariate models. In a multivariate analysis for pooled acute CEs, heart base Dmax was associated with CEs (HR 1.75, 95% CI 1.01-1.06, p = 0.04), but this was not the case for individual CEs. Using Fine and Gray models to account for the competing risk of death, left main coronary maximum dose was associated with atrial fibrillation (p = 0.024), proximal right coronary artery V15 (p = 0.023) and mean dose (p = 0.032), and the right atrium mean dose (p = 0.029) were associated with heart failure. No dose-volume metrics were significantly associated with acute coronary syndrome. None of the constituent base substructures dose were significantly associated with death. CONCLUSION Dose to the heart base was associated with increased mortality and an increased pooled cardiac event rate. Accounting for endpoint-specific clinical covariates, only select constituent substructures of the heart base were associated with CEs and no substructures were independently associated with survival. Together, these findings are suggestive of possible interplay between the constituent base substructures in their mediation of radiation cardiotoxicity.
Collapse
Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - F K Duane
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Hounsell
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| |
Collapse
|
10
|
Walls GM, O'Connor J, Harbinson M, McCarron EP, Duane F, McCann C, McKavanagh P, Johnston DI, Erekkath J, Giacometti V, Gavin AT, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. Association between statin therapy dose intensity and radiation cardiotoxicity in non-small cell lung cancer: Results from the NI-HEART study. Radiother Oncol 2023; 186:109762. [PMID: 37348608 DOI: 10.1016/j.radonc.2023.109762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Radiation cardiotoxicity is a dose-limiting toxicity and major survivorship issue for patients with non-small cell lung cancer (NSCLC) completing curative-intent radiotherapy, however patients' cardiovascular baseline is not routinely optimised prior to treatment. In this study we examined the impact of statin therapy on overall survival and post-radiotherapy cardiac events. METHODS Patients treated between 2015-2020 at a regional center were identified. Clinical notes were interrogated for baseline patient, tumor and cardiac details, and both follow-up cancer control and cardiac events. Three cardiologists verified cardiac events. Radiotherapy planning scans were retrieved for application of validated deep learning-based autosegmentation. Pre-specified Cox regression analyses were generated with varying degrees of adjustment for overall survival. Fine and Gray regression for the risk of cardiac events, accounting for the competing risk of death and cardiac covariables was undertaken. RESULTS Statin therapy was prescribed to 59% of the 478 included patients. The majority (88%) of patients not prescribed a statin had at least one indication for statin therapy according to cardiovascular guidelines. In total, 340 patients (71%) died and 79 patients (17%) experienced a cardiac event. High-intensity (HR 0.68, 95%CI 0.50-0.91, p = 0.012) and medium-intensity (HR 0.70, 95%CI 0.51-0.97, p = 0.033) statin therapy were associated with improved overall survival after adjustment for patient, cancer, treatment, response and cardiovascular clinical factors. There were no consistent differences in the rate or grade of cardiac events according to statin intensity. CONCLUSIONS Statin therapy is associated with improved overall survival in patients receiving curative-intent radiotherapy for NSCLC, and there is evidence of a dose-response relationship. This study highlights the importance of a pre-treatment cardiovascular risk assessment in this cohort. Further studies are needed to examine if statin therapy is cardioprotective in patients undergoing treatment for NSCLC with considerable incidental cardiac radiation dose and a low baseline cardiac risk.
Collapse
Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom.
| | - John O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Mark Harbinson
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Eamon P McCarron
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom; Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast Health and Social Care Trust, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Frances Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Peter McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Upper Newtonards Road, Dundonald, Northern Ireland, United Kingdom
| | - David I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Jayaraj Erekkath
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Valentina Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Alan R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| |
Collapse
|
11
|
Walls GM, McCann C, Ball P, Atkins KM, Mak RH, Bedair A, O'Hare J, McAleese J, Harrison C, Tumelty KA, Crockett C, Black SL, Nelson C, O'Connor J, Hounsell AR, McGarry CK, Butterworth KT, Cole AJ, Jain S, Hanna GG. IA PULMONARY VEIN ATLAS FOR RADIOTHERAPY PLANNING. Radiother Oncol 2023; 184:109680. [PMID: 37105303 DOI: 10.1016/j.radonc.2023.109680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated. MATERIALS AND METHODS The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n=5) and radiation technologists (n=2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters. RESULTS The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25). CONCLUSION A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.
Collapse
Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Peter Ball
- Department of Radiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, 274 Grosvenor Rd, Belfast, Northern Ireland
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Ahmed Bedair
- North West Cancer Centre, ltnagelvin Hospital, Glenshane Road, Derry, Northern Ireland
| | - Jolyne O'Hare
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Claire Harrison
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Karen A Tumelty
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Cathryn Crockett
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Sarah-Louise Black
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Catherine Nelson
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - John O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Alan R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland.
| |
Collapse
|
12
|
Walls GM, McMahon M, Moore N, Nicol P, Bradley G, Whitten G, Young L, O'Hare JM, Lindsay J, Connolly R, Linden D, Ball PA, Hanna GG, McAleese J. Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease. BJR Open 2023; 5:20220049. [PMID: 37389005 PMCID: PMC10301718 DOI: 10.1259/bjro.20220049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
Objective Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Methods Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Results Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Conclusion Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. Advances in knowledge For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.
Collapse
Affiliation(s)
| | - Michael McMahon
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Natasha Moore
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Patrick Nicol
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Gemma Bradley
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Glenn Whitten
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Linda Young
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Jolyne M O'Hare
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - John Lindsay
- Department of Respiratory Medicine, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Ryan Connolly
- Department of Radiology, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Dermot Linden
- Department of Respiratory Medicine, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Peter A Ball
- Department of Radiology, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | | | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| |
Collapse
|
13
|
Walls GM, Hanna GG. Sinoatrial Node Radiation Dose and Atrial Fibrillation in Patients With Lung Cancer. JAMA Oncol 2023; 9:573-574. [PMID: 36795391 DOI: 10.1001/jamaoncol.2022.7875] [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: 02/17/2023]
Affiliation(s)
- Gerard M Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Gerard G Hanna
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| |
Collapse
|
14
|
Hegi-Johnson F, Rudd SE, Wichmann C, Akhurst T, Roselt P, Trinh J, John T, Devereux L, Donnelly PS, Hicks R, Scott AM, Steinfort D, Fox S, Blyth B, Parakh S, Hanna GG, Callahan J, Burbury K, MacManus M. ImmunoPET: IMaging of cancer imMUNOtherapy targets with positron Emission Tomography: a phase 0/1 study characterising PD-L1 with 89Zr-durvalumab (MEDI4736) PET/CT in stage III NSCLC patients receiving chemoradiation study protocol. BMJ Open 2022; 12:e056708. [PMID: 36400733 PMCID: PMC9677006 DOI: 10.1136/bmjopen-2021-056708] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND ImmunoPET is a multicentre, single arm, phase 0-1 study that aims to establish if 89Zr-durvalumab PET/CT can be used to interrogate the expression of PD-L1 in larger, multicentre clinical trials. METHODS The phase 0 study recruited 5 PD-L1+ patients with metastatic non-small cell lung cancer (NSCLC). Patients received 60MBq/70 kg 89Zr-durva up to a maximum of 74 MBq, with scan acquisition at days 0, 1, 3 or 5±1 day. Data on (1) Percentage of injected 89Zr-durva dose found in organs of interest (2) Absorbed organ doses (µSv/MBq of administered 89Zr-durva) and (3) whole-body dose expressed as mSv/100MBq of administered dose was collected to characterise biodistribution.The phase 1 study will recruit 20 patients undergoing concurrent chemoradiotherapy for stage III NSCLC. Patients will have 89Zr-durva and FDG-PET/CT before, during and after chemoradiation. In order to establish the feasibility of 89Zr-durva PET/CT for larger multicentre trials, we will collect both imaging and toxicity data. Feasibility will be deemed to have been met if more than 80% of patients are able complete all trial requirements with no significant toxicity. ETHICS AND DISSEMINATION This phase 0 study has ethics approval (HREC/65450/PMCC 20/100) and is registered on the Australian Clinical Trials Network (ACTRN12621000171819). The protocol, technical and clinical data will be disseminated by conference presentations and publications. Any modifications to the protocol will be formally documented by administrative letters and must be submitted to the approving HREC for review and approval. TRIAL REGISTRATION NUMBER Australian Clinical Trials Network ACTRN12621000171819.
Collapse
Affiliation(s)
- Fiona Hegi-Johnson
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stacey E Rudd
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christian Wichmann
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Tim Akhurst
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Roselt
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenny Trinh
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Devereux
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul S Donnelly
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rod Hicks
- The Department of Medicine, St Vincent's Medical School, University of Melbourne, Melbourne, Victoria, Australia
- The Department of Medicine, Central Medical School, the Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
- Molecular Imaging and Therapy, The University of Melbourne Medicine at Austin Health, Heidelberg, Victoria, Australia
| | - Daniel Steinfort
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Fox
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin Blyth
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sagun Parakh
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Callahan
- Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael MacManus
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Thippu Jayaprakash K, Hanna GG, Hatton MQ. Lung Cancer in 2022 and Beyond! Clin Oncol (R Coll Radiol) 2022; 34:695-697. [PMID: 36153212 DOI: 10.1016/j.clon.2022.09.003] [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] [Received: 08/09/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Affiliation(s)
- K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK.
| | - G G Hanna
- Cancer Centre, Belfast City Hospital, Belfast, UK; Queen's University Belfast, Belfast, UK
| | | |
Collapse
|
16
|
Gaudreault M, Yeo A, Kron T, Hanna GG, Siva S, Hardcastle N. Treatment Time Optimization in Single Fraction Stereotactic Ablative Radiation Therapy: A 10-Year Institutional Experience. Adv Radiat Oncol 2022; 7:100829. [PMID: 36148377 PMCID: PMC9486429 DOI: 10.1016/j.adro.2021.100829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Stereotactic ablative radiation therapy (SABR) delivered in a single fraction (SF) can be considered to have higher uncertainty given that the error probability is concentrated in a single session. This study aims to report the variation in technology and technique used and its effect on intrafraction motion based on a 10 years of experience in SF SABR. Methods and Materials Records of patients receiving SF SABR delivered at our instruction between 2010 and 2019 were included. Treatment parameters were extracted from the patient management database by using an in-house script. Treatment time was defined as the time difference between the first image acquisition to the last beam off of a single session. The intrafraction variation was measured from the 3-dimensional couch displacement measured after the first cone beam computed tomography (CBCT) acquired during a treatment. Results The number of SF SABR increased continuously from 2010 to 2019 and were mainly lung treatments. Treatment time was minimized by using volumetric modulated arc therapy, flattening filter-free dose rate, and coplanar field (24 ± 9 min). Treatment time increased as the number of CBCTs per session increased. The most common scenario involved both 2 and 3 CBCTs per session. On the average, a CBCT acquisition added 6 minutes to the treatment time. All treatments considered, the average intrafraction variation was 1.7 ± 1.6 mm. Conclusions SF SABR usage increased with time in our institution. The intrafraction motion was acceptable and therefore a single fraction is an efficacious treatment option when considering SABR.
Collapse
|
17
|
Kothari G, Woon B, Patrick CJ, Korte J, Wee L, Hanna GG, Kron T, Hardcastle N, Siva S. The impact of inter-observer variation in delineation on robustness of radiomics features in non-small cell lung cancer. Sci Rep 2022; 12:12822. [PMID: 35896707 PMCID: PMC9329346 DOI: 10.1038/s41598-022-16520-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Artificial intelligence and radiomics have the potential to revolutionise cancer prognostication and personalised treatment. Manual outlining of the tumour volume for extraction of radiomics features (RF) is a subjective process. This study investigates robustness of RF to inter-observer variation (IOV) in contouring in lung cancer. We utilised two public imaging datasets: ‘NSCLC-Radiomics’ and ‘NSCLC-Radiomics-Interobserver1’ (‘Interobserver’). For ‘NSCLC-Radiomics’, we created an additional set of manual contours for 92 patients, and for ‘Interobserver’, there were five manual and five semi-automated contours available for 20 patients. Dice coefficients (DC) were calculated for contours. 1113 RF were extracted including shape, first order and texture features. Intraclass correlation coefficient (ICC) was computed to assess robustness of RF to IOV. Cox regression analysis for overall survival (OS) was performed with a previously published radiomics signature. The median DC ranged from 0.81 (‘NSCLC-Radiomics’) to 0.85 (‘Interobserver’—semi-automated). The median ICC for the ‘NSCLC-Radiomics’, ‘Interobserver’ (manual) and ‘Interobserver’ (semi-automated) were 0.90, 0.88 and 0.93 respectively. The ICC varied by feature type and was lower for first order and gray level co-occurrence matrix (GLCM) features. Shape features had a lower median ICC in the ‘NSCLC-Radiomics’ dataset compared to the ‘Interobserver’ dataset. Survival analysis showed similar separation of curves for three of four RF apart from ‘original_shape_Compactness2’, a feature with low ICC (0.61). The majority of RF are robust to IOV, with first order, GLCM and shape features being the least robust. Semi-automated contouring improves feature stability. Decreased robustness of a feature is significant as it may impact upon the features’ prognostic capability.
Collapse
Affiliation(s)
- Gargi Kothari
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
| | - Beverley Woon
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Department of Radiology, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Cameron J Patrick
- Statistical Consulting Centre, University of Melbourne, Parkville, Australia
| | - James Korte
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Biomedical Engineering, School of Chemical and Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Leonard Wee
- Department of Radiotherapy (MAASTRO), GROW School of Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Clinical Data Science, Maastricht University, Maastricht, The Netherlands
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
18
|
Walls GM, Giacometti V, Apte A, Thor M, McCann C, Hanna GG, O'Connor J, Deasy JO, Hounsell AR, Butterworth KT, Cole AJ, Jain S, McGarry CK. Validation of an established deep learning auto-segmentation tool for cardiac substructures in 4D radiotherapy planning scans. Phys Imaging Radiat Oncol 2022; 23:118-126. [PMID: 35941861 PMCID: PMC9356270 DOI: 10.1016/j.phro.2022.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Cardiotoxicity is a common complication of lung cancer radiotherapy. Segmentation of cardiac substructures is time-consuming and challenging. Deep learning segmentation tools can perform this task in 3D and 4D scans. Performance is high when assessed geometrically, dosimetrically and clinically. Auto-segmentation tools may accelerate clinical workflows and enable research.
Background Emerging data suggest that dose-sparing several key cardiac regions is prognostically beneficial in lung cancer radiotherapy. The cardiac substructures are challenging to contour due to their complex geometry, poor soft tissue definition on computed tomography (CT) and cardiorespiratory motion artefact. A neural network was previously trained to generate the cardiac substructures using three-dimensional radiotherapy planning CT scans (3D-CT). In this study, the performance of that tool on the average intensity projection from four-dimensional (4D) CT scans (4D-AVE), now commonly used in lung radiotherapy, was evaluated. Materials and Methods The 4D-AVE of n=20 patients completing radiotherapy for lung cancer 2015–2020 underwent manual and automated cardiac substructure segmentation. Manual and automated substructures were compared geometrically and dosimetrically. Two senior clinicians also qualitatively assessed the auto-segmentation tool’s output. Results Geometric comparison of the automated and manual segmentations exhibited high levels of similarity across parameters, including volume difference (11.8% overall) and Dice similarity coefficient (0.85 overall), and were consistent with 3D-CT performance. Differences in mean (median 0.2 Gy, range −1.6–0.3 Gy) and maximum (median 0.4 Gy, range −2.2–0.9 Gy) doses to substructures were generally small. Nearly all structures (99.5 %) were deemed to be appropriate for clinical use without further editing. Conclusions Cardiac substructure auto-segmentation using a deep learning-based tool trained on a 3D-CT dataset was feasible on the 4D-AVE scan, meaning this tool is suitable for use on 4D-CT radiotherapy planning scans. Application of this tool would increase the practicality of routine clinical cardiac substructure delineation, and enable further cardiac radiation effects research.
Collapse
|
19
|
Salem A, Franks K, Greystoke A, Hanna GG, Harrow S, Hatton M, Hiley C, McDonald F, Faivre-Finn C. Unaccounted Confounders Limit the Ability to Draw Conclusions From Big Data Analysis Comparing Radiotherapy Fractionation Regimens in NSCLC. J Thorac Oncol 2022; 17:e55-e56. [PMID: 35623677 DOI: 10.1016/j.jtho.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Ahmed Salem
- Department of Basic Medical Sciences, Hashemite University, Zarqa, Jordan; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
| | - Kevin Franks
- Leeds Cancer Centre, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alastair Greystoke
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom
| | - Crispin Hiley
- Research Department of Oncology, University College London, London, United Kingdom
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
20
|
Gaudreault M, Chang D, Hardcastle N, Jackson P, Kron T, Hanna GG, Hofman MS, Siva S. Utility of Biology-Guided Radiotherapy to De Novo Metastases Diagnosed During Staging of High-Risk Biopsy-Proven Prostate Cancer. Front Oncol 2022; 12:854589. [PMID: 35494012 PMCID: PMC9039647 DOI: 10.3389/fonc.2022.854589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Biology-guided radiotherapy (BgRT) uses real-time functional imaging to guide radiation therapy treatment. Positron emission tomography (PET) tracers targeting prostate-specific membrane antigen (PSMA) are superior for prostate cancer detection than conventional imaging. This study aims at describing nodal and distant metastasis distribution from prostate cancer and at determining the proportion of metastatic lesions suitable for BgRT. Methods A single-institution patient subset from the ProPSMA trial (ID ACTRN12617000005358) was analysed. Gross tumour volumes (GTV) were delineated on the CT component of a PSMA PET/CT scan. To determine the suitability of BgRT tracking zones, the normalized SUV (nSUV) was calculated as the ratio of SUVmax inside the GTV to the SUVmean of adjacent three-dimensional shells of thickness 5 mm/10 mm/20 mm as a measure of signal to background contrast. Targets were suitable for BgRT if (1) nSUV was larger than an nSUV threshold and (2) non-tumour tissue inside adjacent shell was free of PET-avid uptake. Results Of this cohort of 84 patients, 24 had at least one pelvic node or metastatic site disease, 1 to 13 lesions per patient, with a total of 98 lesions (60 pelvic nodes/38 extra-pelvic nodal diseases and haematogenous metastases). Target volumes ranged from 0.08 to 9.6 cm3 while SUVmax ranged from 2.1 to 55.0. nSUV ranged from 1.9 to 15.7/2.4 to 25.7/2.5 to 34.5 for the 5 mm/10 mm/20 mm shell expansion. Furthermore, 74%/68%/34% of the lesions had nSUV ≥ 3 and were free of PSMA PET uptake inside the GTV outer shell margin expansion of 5 mm/10 mm/20 mm. Adjacent avid organs were another lesion, bladder, bowel, ureter, prostate, and liver. Conclusions The majority of PSMA PET/CT-defined radiotherapy targets would be suitable for BgRT by using a 10-mm tracking zone in prostate cancer. A subset of lesions had adjacent non-tumour uptake, mainly due to the proximity of ureter or bladder, and may require exclusion from emission tracking during BgRT.
Collapse
Affiliation(s)
- Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia
| | - David Chang
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Price Jackson
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael S Hofman
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Molecular Imaging and Therapeutic Nuclear Medicine, Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Diez P, Hanna GG, Aitken KL, van As N, Carver A, Colaco RJ, Conibear J, Dunne EM, Eaton DJ, Franks KN, Good JS, Harrow S, Hatfield P, Hawkins MA, Jain S, McDonald F, Patel R, Rackley T, Sanghera P, Tree A, Murray L. UK 2022 Consensus on Normal Tissue Dose-Volume Constraints for Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:288-300. [PMID: 35272913 DOI: 10.1016/j.clon.2022.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) in the UK has expanded over the past decade, in part as the result of several UK clinical trials and a recent NHS England Commissioning through Evaluation programme. A UK SABR Consortium consensus for normal tissue constraints for SABR was published in 2017, based on the existing literature at the time. The published literature regarding SABR has increased in volume over the past 5 years and multiple UK centres are currently working to develop new SABR services. A review and update of the previous consensus is therefore appropriate and timely. It is hoped that this document will provide a useful resource to facilitate safe and consistent SABR practice.
Collapse
Affiliation(s)
- P Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - G G Hanna
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - N van As
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - A Carver
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - R J Colaco
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Conibear
- Radiotherapy Department, Barts Cancer Centre, London, UK
| | - E M Dunne
- Department of Clinical Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - D J Eaton
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK; Department of Medical Physics, Guys and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K N Franks
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - J S Good
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Harrow
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - P Hatfield
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - M A Hawkins
- Department of Medical Physics and Biomechanical Engineering, University College London, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Jain
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - F McDonald
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - R Patel
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - T Rackley
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - P Sanghera
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - L Murray
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| |
Collapse
|
22
|
Bucknell NW, Belderbos J, Palma DA, Iyengar P, Samson P, Chua K, Gomez D, McDonald F, Louie AV, Faivre-Finn C, Hanna GG, Siva S. Avoiding toxicity with lung radiation therapy: An IASLC perspective. J Thorac Oncol 2022; 17:961-973. [DOI: 10.1016/j.jtho.2022.05.003] [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: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
|
23
|
Ong WL, Finn N, Te Marvelde L, Hornby C, Milne RL, Hanna GG, Pitson G, Elsaleh H, Millar JL, Foroudi F. Disparities in radiation therapy utilization for cancer patients in Victoria. J Med Imaging Radiat Oncol 2022; 66:830-839. [PMID: 35357080 PMCID: PMC9543524 DOI: 10.1111/1754-9485.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
Introduction To evaluate the proportion of cancer patients who received radiation therapy (RT) within 12 months of cancer diagnosis (RTU12) and identify factors associated with RTU12. Methods This is a population‐based cohort of individuals with incident cancer, diagnosed between 2013 and 2017 in Victoria. Data linkages were performed between the Victorian Cancer Registry and Victorian Radiotherapy Minimum Dataset. The primary outcome was the proportion of patients who had RTU12. For the three most common cancers (i.e., prostate, breast and lung cancer), the time trend in RTU12 and factors associated with RTU12 were evaluated. Results The overall RTU12 in our study cohort was 26–20% radical RT and 6% palliative RT. Of the 21,735 men with prostate cancer, RTU12 was 17%, with no significant change over time (P‐trend = 0.53). In multivariate analyses, increasing age and lower socioeconomic status were independently associated with higher RTU12 for prostate cancer. Of the 20,883 women with breast cancer, RTU12 was 64%, which increased from 62% in 2013 to 65% in 2017 (P‐trend < 0.05). In multivariate analyses, age, socioeconomic status and area of residency were independently associated with RTU12 for breast cancer. Of the 13,093 patients with lung cancer, RTU12 was 42%, with no significant change over time (P‐trend = 0.16). In multivariate analyses, younger age, male and lower socioeconomic status were independently associated with higher RTU12. Conclusion In this large population‐based state‐wide cohort of cancer patients, only 1 in 4 had RT within 12 months of diagnosis. There were marked sociodemographic disparities in RTU12 for prostate, breast and lung cancer patients.
Collapse
Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, Victoria, UK
| | - Norah Finn
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Colin Hornby
- Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Center for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Graham Pitson
- Department of Cancer Services, Barwon Health, Geelong, Victoria, Australia
| | - Hany Elsaleh
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
24
|
Fennell DA, Griffiths G, Ottensmeier C, Hanna GG, Danson S, Szlosarek P, Nye M. CONFIRM trial: what is the real efficacy of second-line immunotherapy in mesothelioma? - Authors' reply. Lancet Oncol 2022; 23:e14-e15. [PMID: 34973224 DOI: 10.1016/s1470-2045(21)00722-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
| | - Gareth Griffiths
- Cancer Research UK Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Christian Ottensmeier
- Clatterbridge Cancer Centre NHS Foundation trust, University of Liverpool, Liverpool, UK
| | - Gerard G Hanna
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia; Queen's University Belfast, Belfast, UK
| | - Sarah Danson
- Weston Park Cancer Centre, University of Sheffield, Sheffield, UK
| | - Peter Szlosarek
- Cancer Research UK Barts Centre, Queen Mary University of London, London, UK
| | | |
Collapse
|
25
|
Lee K, Le T, Hau E, Hanna GG, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Lim R. A systematic review into the radiological features predicting local recurrence after stereotactic ablative body radiotherapy (SABR) in patients with non-small cell lung cancer (NSCLC): Local recurrence features of NSCLC post-SABR. Int J Radiat Oncol Biol Phys 2021; 113:40-59. [PMID: 34879247 DOI: 10.1016/j.ijrobp.2021.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Post-treatment surveillance for local recurrence (LR) following SABR can include both fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT). Radiation-induced lung injury (RILI) shares a similar appearance to LR after treatment making the detection of LR on imaging difficult for clinicians. We aimed to summarise radiological features of CT and FDG-PET predicting LR, and to evaluate radiomics as another tool for detecting LR. METHODS AND MATERIALS We searched MEDLINE, EMBASE and PubMed databases for published studies and Web of Science, Wiley Online and Science Direct databases for conference abstracts that had patient populations with NSCLC and reported post-SABR radiological features of FDG-PET or CT and radiomics from either FDG-PET or CT. Studies for inclusion were independently reviewed by two authors. RESULTS Across 32 relevant studies, the incidence of LR was 13% (222/1726). On CT, certain gross radiological appearances, and kinetic features of changes in size, diameter, volume or 3 consecutive rises in volume of mass-like consolidation are suggestive of LR. Particular regard should be made for the presence of any ≥3 high-risk features (HRF) on CT or the individual HRF of enlarging opacity at ≥12 month's post-SABR as being highly suspicious of LR. On FDG-PET a relative reduction of <5% of SUVmax from baseline in the first 12 months or cut-offs of SUVmax >5 and SUVmean >3.44 after 12 months can indicate LR. There is limited evidence available to corroborate radiomic features suggestive of LR. CONCLUSION This research has identified common features of LR compared to RILI which may aid in early and accurate detection of LR post-SABR; further research is required to validate these findings.
Collapse
Affiliation(s)
- Katherine Lee
- Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Tue Le
- Radiation Oncology - Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gerard G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Children's Medical Research Institute, Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Salma Dammak
- The School of Biomedical Engineering, Western University, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Anselm Ong
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, New South Wales, Australia
| | | | - Jacqueline Buck
- Department of Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Rebecca Lim
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Fennell DA, Ewings S, Ottensmeier C, Califano R, Hanna GG, Hill K, Danson S, Steele N, Nye M, Johnson L, Lord J, Middleton C, Szlosarek P, Chan S, Gaba A, Darlison L, Wells-Jordan P, Richards C, Poile C, Lester JF, Griffiths G. Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial. Lancet Oncol 2021; 22:1530-1540. [PMID: 34656227 PMCID: PMC8560642 DOI: 10.1016/s1470-2045(21)00471-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND No phase 3 trial has yet shown improved survival for patients with pleural or peritoneal malignant mesothelioma who have progressed following platinum-based chemotherapy. The aim of this study was to assess the efficacy and safety of nivolumab, an anti-PD-1 antibody, in these patients. METHODS This was a multicentre, placebo-controlled, double-blind, parallel group, randomised, phase 3 trial done in 24 hospitals in the UK. Adult patients (aged ≥18 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed pleural or peritoneal mesothelioma, who had received previous first-line platinum-based chemotherapy and had radiological evidence of disease progression, were randomly assigned (2:1) to receive nivolumab at a flat dose of 240 mg every 2 weeks over 30 min intravenously or placebo until disease progression or a maximum of 12 months. The randomisation sequence was generated within an interactive web response system (Alea); patients were stratified according to epithelioid versus non-epithelioid histology and were assigned in random block sizes of 3 and 6. Participants and treating clinicians were masked to group allocation. The co-primary endpoints were investigator-assessed progression-free survival and overall survival, analysed according to the treatment policy estimand (an equivalent of the intention-to-treat principle). All patients who were randomly assigned were included in the safety population, reported according to group allocation. This trial is registered with Clinicaltrials.gov, NCT03063450. FINDINGS Between May 10, 2017, and March 30, 2020, 332 patients were recruited, of whom 221 (67%) were randomly assigned to the nivolumab group and 111 (33%) were assigned to the placebo group). Median follow-up was 11·6 months (IQR 7·2-16·8). Median progression-free survival was 3·0 months (95% CI 2·8-4·1) in the nivolumab group versus 1·8 months (1·4-2·6) in the placebo group (adjusted hazard ratio [HR] 0·67 [95% CI 0·53-0·85; p=0·0012). Median overall survival was 10·2 months (95% CI 8·5-12·1) in the nivolumab group versus 6·9 months (5·0-8·0) in the placebo group (adjusted HR 0·69 [95% CI 0·52-0·91]; p=0·0090). The most frequently reported grade 3 or worse treatment-related adverse events were diarrhoea (six [3%] of 221 in the nivolumab group vs two [2%] of 111 in the placebo group) and infusion-related reaction (six [3%] vs none). Serious adverse events occurred in 90 (41%) patients in the nivolumab group and 49 (44%) patients in the placebo group. There were no treatment-related deaths in either group. INTERPRETATION Nivolumab represents a treatment that might be beneficial to patients with malignant mesothelioma who have progressed on first-line therapy. FUNDING Stand up to Cancer-Cancer Research UK and Bristol Myers Squibb.
Collapse
Affiliation(s)
- Dean A Fennell
- Mesothelioma Research Programme, Leicester Cancer Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Sean Ewings
- Cancer Research UK, Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Christian Ottensmeier
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Gerard G Hanna
- Peter MacCullum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Kayleigh Hill
- Cancer Research UK, Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sarah Danson
- Department of Radiation Oncology, University of Sheffield, Sheffield, UK
| | - Nicola Steele
- Department of Oncology and Metabolism University of Glasgow, Glasgow, UK
| | - Mavis Nye
- Mavis Nye Foundation, University of Southampton, Southampton, UK
| | - Lucy Johnson
- Cancer Research UK, Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Calley Middleton
- Cancer Research UK, Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Peter Szlosarek
- Cancer Research UK Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Sam Chan
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Aarti Gaba
- Mesothelioma Research Programme, Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Liz Darlison
- University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Oncology, Mesothelioma UK, Leicester, UK
| | | | - Cathy Richards
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charlotte Poile
- Mesothelioma Research Programme, Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | | | - Gareth Griffiths
- Cancer Research UK, Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| |
Collapse
|
27
|
Perera SM, O'Callaghan C, Ugalde A, Santin O, Beer C, Prue G, Lane K, Hanna GG, Schofield P. Codesigning a supportive online resource for Australian cancer carers: a thematic analysis of informal carers' and healthcare professionals' perspectives about carers' responsibilities and content needs. BMJ Open 2021; 11:e055026. [PMID: 34598994 PMCID: PMC8488722 DOI: 10.1136/bmjopen-2021-055026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To gather preliminary qualitative data that will assist in the codesign and development of a new informational and supportive website to assist informal cancer carers in Australia. DESIGN AND SETTING Utilising a previously tested codesign process, informal carers' experiences and perspectives, including those of healthcare professionals', were examined via focus groups and/or interviews. Data were analysed via thematic analysis. PARTICIPANTS Rural (n=9) and urban (n=11) carers', and healthcare professionals' (n=8) perspectives were collected. Carers participated in a focus group (n=9) or telephone interview (n=11). Healthcare professionals completed an interview (n=6) or online survey (n=2). RESULTS Rural and urban carers typically felt ill prepared for their multitudinal caregiving responsibilities. Supporting patient-to-healthcare professional liaisons could especially challenge. Carers' biopsychosocial and fiscal strains were affected by patients' hardships and available informal supports. Rural carers described greater social support than urban carers. Both rural and urban carers also described discontentment related to a carer neglecting healthcare system. Both carers and healthcare professionals endorsed the need for a user-friendly, carer-specific website encompassing practical information and resources, peer-driven advice and evidence-based illness information, tailored to the Australian context. CONCLUSIONS Carers and healthcare professionals recognise the pressing need for an Australian, cancer carer-specific online resource. Findings will inform the next phase, where a resource will be designed, developed and tested.
Collapse
Affiliation(s)
- Sharnel Miriam Perera
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Clare O'Callaghan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Caritas Christi Hospice and Department of Psychosocial Cancer Care, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Cassandra Beer
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Prevention and Wellbeing, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - G Prue
- Medical Biology Centre, Queen's University Belfast School of Nursing and Midwifery, Northern Ireland, UK
| | - Katherine Lane
- Cancer Information and Support Services, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Psychology and Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Juneja M, Solomon B, Hanna GG. Nuclear protein in testis carcinoma: a diagnostic and therapeutic challenge. Intern Med J 2021; 51:1191-1192. [PMID: 34278690 DOI: 10.1111/imj.15414] [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] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Manu Juneja
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
29
|
Akanda ZZ, Neeson PJ, John T, Barnett S, Hanna GG, Miller A, Jennens R, Siva S. A narrative review of combined stereotactic ablative radiotherapy and immunotherapy in metastatic non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:2766-2778. [PMID: 34295676 PMCID: PMC8264312 DOI: 10.21037/tlcr-20-1117] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have significantly improved overall survival (OS) in metastatic non-small cell lung cancer (m-NSCLC). However, not all patients with m-NSCLC benefit from ICIs, and resistance to ICIs is an emerging challenge. The tumour microenvironment (TME) is immunosuppressive, and provides a myriad of mechanisms to facilitate escape of cancer cells from immune surveillance. The TME may also dampen the response to ICIs by inhibiting T cell effector responses. The poor prognosis of m-NSCLC has led to investigation of ICIs combined with other treatments with the intention of modulating the TME and sensitizing tumours to the effects of ICIs. Stereotactic ablative radiotherapy (SABR) in combination with ICIs is an area of intense interest. SABR is thought to evoke a pro-immunogenic response in the TME, with the capacity to turn a “cold”, unresponsive tumour to “hot” and receptive to ICI. In addition to improved local response, SABR is postulated to produce a heightened systemic immune response when compared to conventional radiotherapy (RT). Preclinical studies have demonstrated a synergistic effect of SABR + ICIs, and clinical studies in m-NSCLC showed safety and promising efficacy compared to systemic therapies alone. To optimize ICI + SABR, ICI choice, combinations, dosing and length of treatment, as well as sequencing of ICI + SABR all require further investigation. Appropriate sequencing may depend on the ICI(s) being utilized, with differing sites of metastases possibly eliciting differing immune responses. Single versus multisite radiation is controversial, whilst effects of irradiated tumour volume and nodal irradiation are increasingly recognized. Taken together, there is strong preclinical and biological rationale, with emerging clinical evidence, supporting the strategy of combining SABR + ICIs in m-NSCLC.
Collapse
Affiliation(s)
- Zarique Z Akanda
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul J Neeson
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Thomas John
- Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen Barnett
- Division of Thoracic Surgery, Austin Health, Heidelberg, Australia.,Austin Health Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Gerard G Hanna
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Alistair Miller
- Division of Respiratory Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ross Jennens
- Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
30
|
Abstract
Malignant pleural mesothelioma is an uncommon thoracic cancer with a relatively poor outcome, which has only seen modest improvements when compared to non-small cell lung cancer. The mainstays of treatment have been surgery and systemic therapy, with radiation reserved for palliation or as an adjunct. However, there is re-emergent interest in the use of radiotherapy in the treatment of mesothelioma, given recent technical advances in radiotherapy delivery which permit increased treatment accuracy. This overview article reviews the radiobiology of the mesothelioma and whether or not mesothelioma is an inherently radioresistant cancer and the potential impact that hypofractionation may have on different histological subtypes in mesothelioma. This overview also considers the role of radiation in palliation, as adjunct to surgical resection and as adjunct to pleural tract procedures. In particular we review the growing evidence that pleural tract or port site adjuvant radiotherapy provides no clinical benefit. This overview will also consider potential emerging therapeutic strategies such as pre-operative short course hypofractionated radiotherapy. The role of novel radiotherapy techniques such as stereotactic ablative radiotherapy, image guided radiotherapy, proton therapy and the potential role of radiotherapy as an immune stimulating agent in combination of immunotherapy, will also be discussed. Finally, given the many unanswered questions, this review discusses some of the emerging and ongoing clinical trials of radiotherapy in the treatment of mesothelioma.
Collapse
Affiliation(s)
- Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David L Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| |
Collapse
|
31
|
Alomran R, White M, Bruce M, Bressel M, Roache S, Karroum L, Hanna GG, Siva S, Goel S, David S. Stereotactic radiotherapy for oligoprogressive ER-positive breast cancer (AVATAR). BMC Cancer 2021; 21:303. [PMID: 33757458 PMCID: PMC7989018 DOI: 10.1186/s12885-021-08042-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The enhanced knowledge of cancer biology has led to considerable advancement in systemic therapy for advanced breast cancer. Recently, studies showed that cyclin-dependent kinase (CDK) 4/6 inhibitor, when added to endocrine therapy, had improved the outcomes of patients with advanced ER-positive HER2-negative breast cancer. However, the disease often progresses following a period of treatment response. In a subset of patients, disease progression may occur at limited sites, i.e., oligoprogressive disease (OPD). In the past few years, stereotactic radiotherapy (SRT) has emerged as a safe and effective treatment for advanced cancer when delivered to limited metastatic sites. Hence, it is worth investigating the role of SRT in the setting of oligoprogressive breast cancer. METHOD AVATAR is a multicentre phase II registry trial of SRT with endocrine therapy and CDK 4/6 inhibitor for the management of advanced ER-positive HER2-negative breast cancer. The study aims to enrol 32 patients with OPD limited to 5 lesions. The primary endpoint of the study is time to change systemic therapy measured from the commencement of SRT to change in systemic therapy. Secondary objectives include overall survival, progression free survival and treatment related toxicity. The exploratory objective is to describe the time to change in systemic therapy by the site (bone only vs. non-bone lesions) and number (1 vs. > 1) of OPD. DISCUSSION This study aims to explore the effect of SRT in maximising the benefit of systemic therapy in patients with oligoprogressive ER-positive HER2-negative breast cancer. This approach might help reduce the burden of disease and improve the life quality in these patients. TRIAL REGISTRATION ACTRN, ACTRN12620001212943 . Date of registration 16 November 2020- Retrospectively registered.
Collapse
Affiliation(s)
- Reem Alomran
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Melissa Bruce
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Mathias Bressel
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Susan Roache
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Lama Karroum
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Gerard G Hanna
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Shankar Siva
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Shom Goel
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Steven David
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
- Monash Medical Centre, Melbourne, Australia.
| |
Collapse
|
32
|
Abstract
The type of patients with stage III non-small-cell lung cancer (NSCLC) selected for concurrent chemoradiotherapy (cCRT) varies between and within countries, with higher-volume centres treating patients with more co-morbidities and higher-stage disease. However, in spite of these disease characteristics, these patients have improved overall survival, suggesting that there are additional approaches that should be optimised and potentially standardised. This paper aims to review the current knowledge and best practices surrounding treatment for patients eligible for cCRT. Initially, this includes timely acquisition of the full diagnostic workup for the multidisciplinary team to comprehensively assess a patient for treatment, as well as imaging scans, patient history, lung function and genetic tests. Such information can provide prognostic information on how a patient will tolerate their cCRT regimen, and to perhaps limit the use of additional supportive care, such as steroids, which could impact on further treatments, such as immunotherapy. Furthermore, knowledge of the safety profile of individual double-platinum chemotherapy regimens and the technological advances in radiotherapy could aid in optimising patients for cCRT treatment, improving its efficacy whilst minimising its toxicities. Finally, providing patients with preparatory and ongoing support with input from dieticians, palliative care professionals, respiratory and care-of-the-elderly physicians during treatment may also help in more effective treatment delivery, allowing patients to achieve the maximum potential from their treatments.
Collapse
Affiliation(s)
- Claire L Storey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gerard G Hanna
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Alastair Greystoke
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.
| |
Collapse
|
33
|
David S, Ho G, Day D, Harris M, Tan J, Goel S, Hanna GG, Srivastava R, Kruss G, McDowell L, White M. Enhanced toxicity with CDK 4/6 inhibitors and palliative radiotherapy: Non-consecutive case series and review of the literature. Transl Oncol 2020; 14:100939. [PMID: 33227663 PMCID: PMC7689545 DOI: 10.1016/j.tranon.2020.100939] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
CDK 4/6 inhibitors are commonly used in patients with advanced hormone receptor positive breast cancer. Many patients receive palliative radiotherapy for symptomatic disease concomitantly with a CDK 4/6 inhibitor. There is a paucity of data on the safety of combining a CDK 4/6 inhibitor with palliative radiotherapy. We report on 5 cases at our institution where enhanced radiotherapy toxicity was observed when RT was delivered during or prior to treatment with a CDK 4/6 inhibitor. We review pre-clinical and mechanistic data and hypothesise on possible mechanisms for this phenomenon.
Current first-line systemic treatment in most patients with metastatic hormone receptor-positive, HER-2 negative breast cancer is an aromatase inhibitor in combination with a cyclin dependant kinase (CDK) 4/6 inhibitor. Frequently, these patients require palliative radiotherapy (RT) for symptomatic disease management. There is a paucity of data on the safety of combining a CDK 4/6 inhibitor with palliative RT, with conflicting case reports in the literature. We report on 5 cases at our institution where enhanced radiotherapy toxicity was observed when palliative doses of RT was delivered during or prior to treatment with a CDK 4/6 inhibitor. After review of pre-clinical and mechanistic data, we hypothesise that the effects of CDK4/6 inhibition on normal tissue and the tumour microenvironment may impede tissue recovery and exacerbate acute radiation and radiation recall toxicities. Further studies are required to clarify the potential toxicities of this combination. Clinicians should consider the potential risks when combining CDK 4/6 inhibitors with palliative RT and individualise patient management accordingly.
Collapse
Affiliation(s)
- Steven David
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Monash Cancer Centre, East Bentleigh, VIC, Australia.
| | - Gwo Ho
- Monash Cancer Centre, East Bentleigh, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daphne Day
- Monash Cancer Centre, East Bentleigh, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Marion Harris
- Monash Cancer Centre, East Bentleigh, VIC, Australia
| | - Jennifer Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Monash Cancer Centre, East Bentleigh, VIC, Australia
| | - Shom Goel
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | | | - Gill Kruss
- Monash Cancer Centre, East Bentleigh, VIC, Australia
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
| | | |
Collapse
|
34
|
Newman S, Bucknell N, Bressel M, Tran P, Campbell BA, David S, Haghighi N, Hanna GG, Kok D, MacManus M, Phillips C, Plumridge N, Shaw M, Wirth A, Wheeler G, Ball D, Siva S. Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis. Clin Oncol (R Coll Radiol) 2020; 33:163-171. [PMID: 33129655 DOI: 10.1016/j.clon.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/27/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022]
Abstract
AIMS At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease. MATERIALS AND METHODS This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors. RESULTS Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS. CONCLUSIONS Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.
Collapse
Affiliation(s)
- S Newman
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Bucknell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - M Bressel
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - P Tran
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - B A Campbell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S David
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Haghighi
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G G Hanna
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - D Kok
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M MacManus
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - C Phillips
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Plumridge
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M Shaw
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - A Wirth
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G Wheeler
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - D Ball
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S Siva
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia.
| |
Collapse
|
35
|
Walls GM, Oughton JB, Chalmers AJ, Brown S, Collinson F, Forster MD, Franks KN, Gilbert A, Hanna GG, Hannaway N, Harrow S, Haswell T, Hiley CT, Hinsley S, Krebs M, Murden G, Phillip R, Ryan AJ, Salem A, Sebag-Montefoire D, Shaw P, Twelves CJ, Walker K, Young RJ, Faivre-Finn C, Greystoke A. CONCORDE: A phase I platform study of novel agents in combination with conventional radiotherapy in non-small-cell lung cancer. Clin Transl Radiat Oncol 2020; 25:61-66. [PMID: 33072895 PMCID: PMC7548952 DOI: 10.1016/j.ctro.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the leading cause of cancer mortality worldwide and most patients are unsuitable for 'gold standard' treatment, which is concurrent chemoradiotherapy. CONCORDE is a platform study seeking to establish the toxicity profiles of multiple novel radiosensitisers targeting DNA repair proteins in patients treated with sequential chemoradiotherapy. Time-to-event continual reassessment will facilitate efficient dose-finding.
Collapse
Key Words
- ATM, Ataxia telangiectasia mutated
- ATR, Ataxia telangiectasia and Rad3 related
- CRT, Chemoradiotherapy
- CT, Computed tomography
- CTCAE, Common terminology criteria for adverse events
- CTRad, Clinical and Translational Radiotherapy Research Working Group
- Continual reassessment method
- DDRi, DNA damage response inhibitor
- DLT, Dose limiting toxicity
- DNA damage repair inhibitor
- DNA, Deoxyribonucleic acid
- DNA-PK, DNA-dependent protein kinase
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organisation for Research and Treatment of Cancer
- ICRU, International Commission on Radiation Units and Measurements
- IMPs, Investigational medicinal products
- LA, Locally advanced
- MRC, Medical Research Council
- NCRI, National Cancer Research Institute
- NSCLC, Non-small cell lung cancer
- Non-small cell lung cancer
- PARP, Poly (ADP-ribose) polymerase
- PET, Positron emission tomography
- PFS, Progression free survival
- PROMs, Patient-reported outcome measures
- Platform trial
- RECIST, Response evaluation criteria in solid tumours
- RP2D, Recommended phase II dose
- RT, Radiotherapy
- SACT, Systemic anti-cancer therapy
- SRC, Safety review committee
- Sequential chemoradiotherapy
- TNM, Tumour node metastasis
- TiTE-CRM, Time to event continual reassessment method
- cfDNA, Cell-free DNA
Collapse
Affiliation(s)
- Gerard M. Walls
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Northern Ireland, UK
| | - Jamie B. Oughton
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | | | - Sarah Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Fiona Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | | | - Kevin N. Franks
- St James’ Institute of Oncology, University of Leeds, England, UK
| | | | - Gerard G. Hanna
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | | | - Stephen Harrow
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | | | | | - Samantha Hinsley
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
- Institute of Cancer Sciences, University of Glasgow, Scotland, UK
| | - Matthew Krebs
- Faculty of Biology, Medicine and Health, University of Manchester, England, UK
| | - Geraldine Murden
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Rachel Phillip
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Anderson J. Ryan
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England, UK
| | - Ahmed Salem
- The Christie NHS Foundation Trust/University of Manchester, Manchester, England, UK
| | | | - Paul Shaw
- Velindre University NHS Trust, Cardiff, Wales, UK
| | - Chris J. Twelves
- St James’ Institute of Oncology, University of Leeds, England, UK
| | - Katrina Walker
- Leeds Institute of Clinical Trials Research, University of Leeds, England, UK
| | - Robin J. Young
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, England, UK
| | - Corinne Faivre-Finn
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England, UK
| | | |
Collapse
|
36
|
Singh U, Walls GM, Hanna GG, Lynch TB, McAleese J. PET/CT features of lung SABR chest wall toxicity. J Med Imaging Radiat Oncol 2020; 65:92-94. [PMID: 33103346 DOI: 10.1111/1754-9485.13115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/15/2020] [Accepted: 09/20/2020] [Indexed: 12/25/2022]
Abstract
Stereotactic ablative radiotherapy offers a radical treatment approach for early stage lung cancers and an aggressive local therapy for pulmonary oligometastases from other tumour sites. Chest wall toxicity is one of the key dose-limiting toxicities for intrathoracic stereotactic treatments. The description of stereotactic radiotherapy chest wall toxicity using functional imaging has not been reported previously. A 56-year-old male received 60 Gy in 8 fractions delivered by volumetric modulated arc therapy for a T1bN0M0 clinical left upper lobe lung cancer. The past medical history included poorly controlled type 1 diabetes mellitus, severe peripheral vascular disease and obesity. The patient attended 9 months later with left-sided, slowly progressive chest pain. An 18 FDG PET/CT performed in order to investigate contralateral pulmonary lesions revealed FDG-avid focal thickening at the left superio-lateral thoracic wall with overlying inflammatory stranding in keeping with an indolent inflammatory process. Chest wall toxicity may present as pain, swelling, fracture and skin changes, and has the 18 FDG PET/CT chjmirocteristics of an inflammatory process. Patients with risk factors for chest wall toxicity, such as obesity, diabetes and smoking should be informed of their higher propensity for this clinically significant treatment side effect. For patients developing chest wall toxicity as demonstrated in this case with associated functional imaging findings, anti-inflammatory treatment should be promptly commenced.
Collapse
Affiliation(s)
- Urvashi Singh
- Cancer Centre Belfast City Hospital, Belfast, Northern Ireland
| | - Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast, Northern Ireland.,Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerard G Hanna
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tom B Lynch
- Cancer Centre Belfast City Hospital, Belfast, Northern Ireland
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast, Northern Ireland.,Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
37
|
Walls GM, O'Hare J, Hanna GG, Eakin RL, McAleese J. Re: Lewis et al. Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival? Clin Oncol (R Coll Radiol) 2020; 33:e100. [PMID: 33087297 DOI: 10.1016/j.clon.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G. Johnston Centre for Cancer Research, Queen's University of Belfast, Belfast, UK
| | - J O'Hare
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - G G Hanna
- Patrick G. Johnston Centre for Cancer Research, Queen's University of Belfast, Belfast, UK; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - R L Eakin
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| |
Collapse
|
38
|
Sogono P, Bressel M, David S, Shaw M, Chander S, Chu J, Plumridge N, Byrne K, Hardcastle N, Kron T, Wheeler G, Hanna GG, MacManus M, Ball D, Siva S. Safety, Efficacy, and Patterns of Failure After Single-Fraction Stereotactic Body Radiation Therapy (SBRT) for Oligometastases. Int J Radiat Oncol Biol Phys 2020; 109:756-763. [PMID: 33069796 PMCID: PMC7560377 DOI: 10.1016/j.ijrobp.2020.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/07/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022]
Abstract
Purpose Fewer attendances for radiation therapy results in increased efficiency and less foot traffic within a radiation therapy department. We investigated outcomes after single-fraction (SF) stereotactic body radiation therapy (SBRT) in patients with oligometastatic disease. Methods and Materials Between February 2010 and June 2019, patients who received SF SBRT to 1 to 5 sites of oligometastatic disease were included in this retrospective study. The primary objective was to describe patterns of first failure after SBRT. Secondary objectives included overall survival (OS), progression-free survival (PFS), high-grade treatment-related toxicity (Common Terminology Criteria for Adverse Events grade ≥3), and freedom from systemic therapy (FFST). Results In total, 371 patients with 494 extracranial oligometastases received SF SBRT ranging from 16 Gy to 28 Gy. The most common primary malignancies were prostate (n = 107), lung (n = 63), kidney (n = 52), gastrointestinal (n = 51), and breast cancers (n = 42). The median follow-up was 3.1 years. The 1-, 3-, and 5-year OS was 93%, 69%, and 55%, respectively; PFS was 48%, 19%, and 14%, respectively; and FFST was 70%, 43%, and 35%, respectively. Twelve patients (3%) developed grade 3 to 4 treatment-related toxicity, with no grade 5 toxicity. As the first site of failure, the cumulative incidence of local failure (irrespective of other failures) at 1, 3 and 5 years was 4%, 8%, and 8%, respectively; locoregional relapse at the primary was 10%, 18%, and 18%, respectively; and distant failure was 45%, 66%, and 70%, respectively. Conclusions SF SBRT is safe and effective, and a significant proportion of patients remain FFST for several years after therapy. This approach could be considered in resource-constrained or bundled-payment environments. Locoregional failure of the primary site is the second most common pattern of failure, suggesting a role for optimization of primary control during metastasis-directed therapy.
Collapse
Affiliation(s)
- Paolo Sogono
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steven David
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mark Shaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nikki Plumridge
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Keelan Byrne
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Greg Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| |
Collapse
|
39
|
Ahern V, Thwaites D, Gorayski P, Hanna GG, Kenny L, Sasso G, Le H, Penniment M. Particle Therapy in Australia: iacta alea est! J Med Imaging Radiat Oncol 2020; 64:679-681. [PMID: 32975366 DOI: 10.1111/1754-9485.13104] [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] [Received: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Verity Ahern
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Medicine, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - David Thwaites
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lizbeth Kenny
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Giuseppe Sasso
- Radiation Oncology Department, Auckland City Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michael Penniment
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
40
|
McNeil N, Gorayski P, Le H, Penniment M, Hanna GG, Thwaites D, Roos D, Kenny LM, Ahern V. Survey of clinician opinions on the role of proton beam therapy in Australia and New Zealand. J Med Imaging Radiat Oncol 2020; 64:689-696. [PMID: 32924305 DOI: 10.1111/1754-9485.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We surveyed the Australian and New Zealand (ANZ) radiation oncology community to assess their perceptions, understanding and experience of the current role of proton beam therapy (PBT) and the existing referral process to access PBT overseas, ahead of the development of the first PBT centre in Australia. METHODS The survey was conducted between September and October 2019 using a 17-question instrument, which was distributed by email to all 632 radiation oncology fellows and trainees listed in the Royal Australian and New Zealand College of Radiologists database. RESULTS One hundred and one respondents completed the survey, with an overall response rate of 16%. Most respondents were based in Australia (93%), with the majority working in public centres only (59%); 51% were > 10 years post fellowship and 17% were trainees. Most respondents (76%) reported moderate or high levels of confidence in the role of PBT. Only 28% had previously referred a patient for PBT overseas, with the most common referral indication being chordoma. Of those who had not previously referred a patient, 48% were not convinced about the rationale of PBT over current therapies available locally, 33% were not aware of the referral process, and 24% had concerns about the timeliness of a decision for government-funded PBT abroad. CONCLUSION This survey has demonstrated that, although there is reasonable confidence in the role of PBT among ANZ radiation oncologists, there are a number of important aspects of PBT awareness, education and access that need to be developed prior to commencement of PBT in Australia.
Collapse
Affiliation(s)
- Nicholas McNeil
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| | - Michael Penniment
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Thwaites
- Crown Princess Mary Cancer Centre in Westmead, Westmead Hospital, Westmead, New South Wales, Australia.,School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Roos
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Lizbeth M Kenny
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Centre in Westmead, Westmead Hospital, Westmead, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
41
|
Abstract
INTRODUCTION Radiotherapy technology and postgraduate medical training have both evolved significantly over the last 20 years. Clinical Oncology is a recognised craft specialty where the apprenticeship model of clinical training is applicable. The challenges of learning radiotherapy in the modern radiotherapy department workplace have not been comprehensively described and no optimal method has been identified. METHODS AND ANALYSIS Five Clinical Oncology trainers and five Clinical Oncology trainees at a regional cancer centre will be invited to undertake a semistructured interview regarding their personal accounts of learning radiotherapy. Both trainees and consultants will be treated as equal co-investors in the process of radiotherapy learning, with the common shared aim of passing radiotherapy skills from trainers to trainees. Interviews will last up to 40 min. After transcription, an interpretative phenomenological analysis will be performed. All trainees and trainers at the same centre (n=34) will then be invited to complete the same purpose-built questionnaire. Four trainers and three trainees have piloted the questionnaire, and input was sought from the national leads of the biennial UK Clinical Oncology training survey. Significance testing will be performed on predefined questions and thematic analysis on white space questions. ETHICS AND DISSEMINATION Medical education research is evolving in Clinical Oncology and Radiation Oncology but there are few studies comprehensively assessing this from the viewpoint of trainees and trainers. Pending the success of the proposed study, the approach detailed represents a novel method that could be used to identify the strengths and weaknesses of radiotherapy training in other centres and settings. Ethical and governance approvals have been granted by the University Research Ethics Committee and the Integrated Research Application System, respectively. This study has been funded by Friends of the Cancer Centre.
Collapse
Affiliation(s)
- Gerard Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, N. Ireland
- Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, N. Ireland
| | - James J McAleer
- Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, N. Ireland
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gerard G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, N. Ireland
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
42
|
Hwang EJ, Gorayski P, Le H, Hanna GG, Kenny L, Penniment M, Buck J, Thwaites D, Ahern V. Particle therapy toxicity outcomes: A systematic review. J Med Imaging Radiat Oncol 2020; 64:725-737. [PMID: 32421259 DOI: 10.1111/1754-9485.13036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/18/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023]
Abstract
Owing to its physical properties, particle therapy (PT), including proton beam therapy (PBT) and carbon ion therapy (CIT), can enhance the therapeutic ratio in radiation therapy. The major factor driving PT implementation is the reduction in exit and integral dose compared to photon plans, which is expected to translate to reduced toxicity and improved quality of life. This study extends the findings from a recent systematic review by the current authors which concentrated on tumour outcomes for PT, to now examine toxicity as a separate focus. Together, these reviews provide a comprehensive collation of the evidence relating to PT outcomes in clinical practice. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and seventy-nine studies were included. Most demonstrated acceptable and favourable toxicity results. Comparative evidence reported reduced morbidities and improvement in quality of life in head and neck, paediatrics, sarcomas, adult central nervous system, gastrointestinal, ocular and prostate cancers compared to photon radiotherapy. This suggestion for reduced morbidity must be counterbalanced by the overall low quality of evidence. A concerted effort in the design of appropriate comparative clinical trials is needed which takes into account integration of PT's pace of technological advancements, including evolving delivery techniques, image guidance availability and sophistication of planning algorithms.
Collapse
Affiliation(s)
- Eun Ji Hwang
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Medicine, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Liz Kenny
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Penniment
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jacqueline Buck
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - David Thwaites
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| |
Collapse
|
43
|
Abstract
BACKGROUND The last two decades have seen revolutionary developments in both radiotherapy technology and postgraduate medical training. Trainees are expected to attain competencies using a mix of experiential learning, formal postgraduate teaching, self-directed learning and peer education. Radiation (Clinical) Oncology is a recognised 'craft specialty' where the apprenticeship model of training is applicable. This scoping review examines the evidence in relation to how medical trainees learn radiotherapy. METHODS A systematic search of MEDINE and EMBASE was undertaken to identify studies of trainee and/or trainer experience of radiotherapy learning published 1999-2018. Results pertaining to Medical Oncology, workforce trends, undergraduate radiotherapy exposure, academic training, global health, non-medical staff, health service infrastructure and recruitment to training programmes were not included. RESULTS A total of 146 publications were included in the synthesis. Five themes were apparent through careful iterative analysis representing broadly inter-related issues. Most articles studied radiotherapy training from the perspective of the trainee doctor. Most literature reports results of observational, local or national surveys with a tightly defined scope. Considerable variation exists within hospitals, within countries, over time and between different curricular areas. CONCLUSIONS Medical education has not kept pace with changes in the field of radiotherapy and large differences are demonstrated in experience between trainees in different hospitals, countries and training stages. Interpersonal relationships, departmental organisation, and national curricula impact on training quality. Qualitative and quantitative research examining modern radiotherapy learning has been uncommon and uncoordinated, until recently. To date no single study has been designed to comprehensively assess a department's training scheme.
Collapse
Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland.
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland.
| | - Gerard G Hanna
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - James J McAleer
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
44
|
Hwang EJ, Gorayski P, Le H, Hanna GG, Kenny L, Penniment M, Buck J, Thwaites D, Ahern V. Particle therapy tumour outcomes: An updated systematic review. J Med Imaging Radiat Oncol 2020; 64:711-724. [PMID: 32270626 DOI: 10.1111/1754-9485.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/22/2019] [Revised: 12/20/2019] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
Particle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaide - the first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision-making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty-six studies were included, two-thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcomes compared to photon controls with the possibility of improved control in the case of carbon ion therapy. There is suggestion of reduced morbidities in a range of tumour sites, supporting the predictions from dosimetric modelling and the wide international acceptance of PT for specific indications based on this. Though promising, this needs to be counterbalanced by the overall low quality of evidence found, with 90% of studies of level IV (case series) evidence. Prospective comparative clinical trials, supplemented by database-derived outcome information, preferably conducted within international and national networks, are strongly recommended as PT is introduced into Australasia.
Collapse
Affiliation(s)
- Eun Ji Hwang
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Medicine, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Liz Kenny
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Penniment
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jacqueline Buck
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - David Thwaites
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Hanna CR, Lynskey DM, Wadsley J, Appleyard SE, Anwar S, Miles E, Gower J, Hall E, Coles CE, Hanna GG. Radiotherapy Trial Set-up in the UK: Identifying Inefficiencies and Potential Solutions. Clin Oncol (R Coll Radiol) 2020; 32:266-275. [PMID: 31685377 DOI: 10.1016/j.clon.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/17/2022]
Abstract
AIMS Radiotherapy clinical trials are integral to the development of new treatments to improve the outcomes of patients with cancer. A collaborative study by the National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group and the National Institute for Health Research was carried out to understand better if and why inefficiencies occur in the set-up of radiotherapy trials in the UK. MATERIALS AND METHODS Two online surveys collected information on the time taken for UK radiotherapy trials to reach key milestones during set-up and the research support currently being provided to radiotherapy centres to enable efficient clinical trial set-up. Semi-structured interviews with project managers and chief investigators identified better ways of working to improve trial set-up in the future. RESULTS The timelines for the set-up of 39 UK radiotherapy trials were captured in an online survey showing that the median time from grant approval to trial opening was 600 days (range 169-1172). There were 38 responses from radiotherapy centres to a survey asking about the current support provided for radiotherapy research. Most of these centres have more than one type of staff member dedicated to supporting radiotherapy research. The most frequent barrier to radiotherapy trial set-up identified was lack of physicists' time and lack of time for clinical oncologists to carry out research activities. Four main themes around trial set-up were identified from semi-structured interviews: the importance of communication and building relationships, the previous experience of the chief investigator and clinical trials units, a lack of resources and having the time and personnel required to produce trial documentation and to process trial approval requests. CONCLUSIONS This unique, collaborative project has provided up to date information about the current landscape of trial set-up and research support in the UK and identified several avenues on which to focus future efforts in order to support the excellent radiotherapy trial work carried out across the UK.
Collapse
Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK.
| | - D M Lynskey
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | | | - S Anwar
- National Institute for Health Research, Leeds, UK
| | - E Miles
- RTTQA Group, Mount Vernon Cancer Centre, Northwood, UK
| | - J Gower
- National Institute for Health Research, Leeds, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - G G Hanna
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| |
Collapse
|
46
|
Ong WL, Koh TL, Udovicich C, Hanna GG, Ball D, Millar J, Foroudi F. Radiation oncology trainee research requirements - re-thinking our intention and approach. J Med Imaging Radiat Oncol 2020; 64:462-463. [PMID: 32227448 DOI: 10.1111/1754-9485.13022] [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] [Received: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tze Lui Koh
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cristian Udovicich
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
47
|
Cho CKJ, Vellayappan BA, Dunne EM, Siva S, Liu M, Louie AV, Hanna GG, Lo SS. What is synchronous oligometastatic non-small cell lung cancer? J Thorac Dis 2020; 11:5666-5669. [PMID: 32030296 DOI: 10.21037/jtd.2019.12.44] [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: 11/06/2022]
Affiliation(s)
- Chan-Kyung Jane Cho
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Emma M Dunne
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, London, UK
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
48
|
McAleese J, Rooney CM, Baluch S, Drinkwater KJ, Hanna GG. Curative Radiotherapy for Lung Cancer in the UK: International Benchmarking. Clin Oncol (R Coll Radiol) 2019; 31:731. [PMID: 31466843 DOI: 10.1016/j.clon.2019.07.023] [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] [Received: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Affiliation(s)
- J McAleese
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - C M Rooney
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - S Baluch
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | | | - G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| |
Collapse
|
49
|
Konert T, Vogel WV, Paez D, Polo A, Fidarova E, Carvalho H, Duarte PS, Zuliani AC, Santos AO, Altuhhova D, Karusoo L, Kapoor R, Sood A, Khader J, Al-Ibraheem A, Numair Y, Abubaker S, Soydal C, Kütük T, Le TA, Canh NX, Bieu BQ, Ha LN, Belderbos JSA, MacManus MP, Thorwarth D, Hanna GG. Introducing FDG PET/CT-guided chemoradiotherapy for stage III NSCLC in low- and middle-income countries: preliminary results from the IAEA PERTAIN trial. Eur J Nucl Med Mol Imaging 2019; 46:2235-2243. [PMID: 31367906 PMCID: PMC6717604 DOI: 10.1007/s00259-019-04421-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/06/2019] [Accepted: 06/30/2019] [Indexed: 12/24/2022]
Abstract
Purpose Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. Methods The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan–Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. Results Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan–Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). Conclusion In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020. Electronic supplementary material The online version of this article (10.1007/s00259-019-04421-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- T Konert
- Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - W V Vogel
- Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - A Polo
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - E Fidarova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - H Carvalho
- Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil
| | - P S Duarte
- Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil
| | - A C Zuliani
- Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil
| | - A O Santos
- Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil
| | - D Altuhhova
- Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia
| | - L Karusoo
- Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia
| | - R Kapoor
- Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Sood
- Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J Khader
- Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan
| | - A Al-Ibraheem
- Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan
| | - Y Numair
- Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - S Abubaker
- Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - C Soydal
- Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey
| | - T Kütük
- Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey
| | - T A Le
- Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - N X Canh
- Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - B Q Bieu
- Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam
| | - L N Ha
- Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam
| | - J S A Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M P MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - G G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| |
Collapse
|
50
|
McAleese J, Taylor A, Walls GM, Hanna GG. Differential Relapse Patterns for Non-small Cell Lung Cancer Subtypes Adenocarcinoma and Squamous Cell Carcinoma: Implications for Radiation Oncology. Clin Oncol (R Coll Radiol) 2019; 31:711-719. [PMID: 31351746 DOI: 10.1016/j.clon.2019.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/27/2019] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022]
Abstract
AIMS Curative-intent (radical) radiotherapy aims to control local disease and cure non-small cell lung cancer (NSCLC). The predominant subtypes of NSCLC are adenocarcinoma and squamous cell carcinoma (SCC). The radiotherapy paradigm offered to patients does not differ according to these two subtypes. Relapse patterns and disease control rates for adenocarcinoma and SCC treated with radical radiotherapy were determined. MATERIALS AND METHODS A radical radiotherapy database covering the period from 2004 to June 2016 was examined to determine the first sites of relapse and the actuarial local and distant control rates. RESULTS In total, 537 patients with known pathological subtype were treated over the period. In 39 (7%), the site of first relapse was uncertain. Of the remainder, 203 (41%) had adenocarcinoma and 295 (59%) had SCC. At a median follow-up of 16.4 months, 58% had relapsed. There was a difference in relapse patterns (chi-squared test P < 0.0005), with a higher rate of first relapse locally in SCC (42% of all patients versus 24%) and a higher rate of first relapse in the brain for adenocarcinoma (14% versus 3%). The actuarial local control rate was worse for SCC (hazard ratio 0.6, 95% confidence interval 0.5-0.9, P = 0.002). The brain metastasis-free survival was worse for adenocarcinoma (hazard ratio 4.1, 95% confidence interval 2.2-7.5, P < 0.0001). CONCLUSION There is a difference in relapse patterns between NSCLC histological subtypes, indicating that these are distinct entities. This may have implications for follow-up policy and strategies to improve disease control.
Collapse
Affiliation(s)
- J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - A Taylor
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Centre for Cancer Research & Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Centre for Cancer Research & Cell Biology, Queen's University of Belfast, Belfast, UK
| |
Collapse
|