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Bendo GJ, Sturrock A, Hanks G, Plack CJ, Gowen E, Guest H. The diversity of speech-perception difficulties among autistic individuals. Autism Dev Lang Impair 2024; 9:23969415241227074. [PMID: 38283768 PMCID: PMC10822079 DOI: 10.1177/23969415241227074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Background & aims Communicative and sensory differences are core autistic traits, yet speech-perception abilities and difficulties among autistic individuals remain poorly understood. Laboratory studies have produced mixed and inconclusive results, in part because of the lack of input from autistic individuals in defining the hypotheses and shaping the methods used in this field of research. Little in-depth qualitative research on autistic experiences of speech perception has been published, yet such research could form the basis for better laboratory research, for improved understanding of autistic experiences, and for the development of interventions. Existing qualitative research describes widespread autistic listening differences with significant impacts, but these results rely on data gathered via oral interviews in a small sample. The present study addresses these limitations and employs a mixed-methods approach to explore autistic listening experiences. Methods We gathered survey data from 79 autistic individuals aged 18-55 without diagnosed hearing loss. The questionnaire included 20 closed-set questions on listening abilities and difficulties and three free-text questions on listening experiences. The free-text questions underwent deductive content analysis using a framework composed of themes from previous interview data on listening experiences (including auditory differences, contributing factors, impacts, and coping strategies). Concepts in the free-text data that were not part of the analysis framework were analyzed inductively. Results In the closed-set data, participants reported listening difficulties in most specified environments, but complex background sounds and particularly background voices caused the most difficulty. Those who reported listening difficulties expressed having substantially greater difficulties than other people the same age. Participants indicated multiple impacts from listening difficulties, most prominently in their social lives. Concepts in the free-text data strongly supported previous interview data on listening differences and factors that affect listening ability, especially the diversity of types of listening difficulties. Consistent with the closed-set data, background-sound complexity and concurrent voices were especially troubling. Some concepts in the free-text data were novel, particularly difficulties with remote, broadcast, and recorded audio, prompting the creation of new themes. Conclusions Both forms of data indicate widespread listening differences-predominantly listening difficulties-affecting most autistic adults. Diverse types of listening difficulty are evident, potentially indicating heterogeneous underlying mechanisms, and complexity of background noise is consistently identified as an important factor. Listening difficulties are said to have substantial and varied impacts. Autistic adults are keen to share coping strategies, which are varied and usually self-devised. Implications Based on both the quantitative and qualitative results, we provide recommendations to improve future research and support the autistic community. The data-revealing types of listening difficulties can guide better quantitative research into underlying mechanisms. Such research should take into account potential heterogeneity in listening difficulties. Suggestions for optimized collection of self-report data are also offered. Additionally, our results could be used to improve societal understanding of autistic listening differences and to create beneficial interventions for and with autistic individuals. Moreover, given the willingness of the autistic community to share coping strategies, systematic collation of these strategies could form the basis for self-help and clinical guidance.
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Affiliation(s)
- George J Bendo
- UK ALMA Regional Centre Node, Jodrell Bank Centre for Astrophysics, Department of Physics and Astronomy, The University of Manchester, Manchester, UK
| | - Alexandra Sturrock
- Division of Human Communication, Development and Hearing, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Graham Hanks
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Christopher J Plack
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Emma Gowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Hannah Guest
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
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Sturrock A, Guest H, Hanks G, Bendo G, Plack CJ, Gowen E. Chasing the conversation: Autistic experiences of speech perception. Autism Dev Lang Impair 2022; 7:23969415221077532. [PMID: 36382084 PMCID: PMC9620672 DOI: 10.1177/23969415221077532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical sensory reactivity and social communication difficulties are pervasive, yet the research literature lacks in-depth self-report data on speech perception in this population. The present study aimed to elicit detailed first-person accounts of autistic individuals' abilities and difficulties perceiving the spoken word. METHODS Semi-structured interviews were conducted with nine autistic adults. The interview schedule addressed interviewees' experiences of speech perception, factors influencing those experiences, and responses to those experiences. Resulting interview transcripts underwent thematic analysis. The six-person study team included two autistic researchers, to reduce risk of neurotypical 'overshadowing' of autistic voices. RESULTS Most interviewees reported pronounced difficulties perceiving speech in the presence of competing sounds. They emphasised that such listening difficulties are distinct from social difficulties, though the two can add and interact. Difficulties were of several varieties, ranging from powerful auditory distraction to drowning out of voices by continuous sounds. Contributing factors encompassed not only features of the soundscape but also non-acoustic factors such as multisensory processing and social cognition. Participants also identified compounding factors, such as lack of understanding of listening difficulties. Impacts were diverse and sometimes disabling, affecting socialising, emotions, fatigue, career, and self-image. A wide array of coping mechanisms was described. CONCLUSIONS The first in-depth qualitative investigation of autistic speech-perception experiences has revealed diverse and widespread listening difficulties. These can combine with other internal, interpersonal, and societal factors to induce profound impacts. Lack of understanding of such listening difficulties - by the self, by communication partners, by institutions, and especially by clinicians - appears to be a crucial exacerbating factor. Many autistic adults have developed coping strategies to lessen speech-perception difficulties or mitigate their effects, and these are generally self-taught due to lack of clinical support. IMPLICATIONS There is a need for carefully designed, adequately powered confirmatory research to verify, quantify, and disentangle the various forms of listening difficulty, preferably using large samples to explore heterogeneity. More immediate benefit might be obtained through development of self-help and clinical guidance materials, and by raising awareness of autistic listening experiences and needs, among the autistic community, communication partners, institutions, and clinicians.
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Affiliation(s)
| | - Hannah Guest
- Hannah Guest, Manchester Centre for
Audiology and Deafness, School of Health Sciences, The University of Manchester,
Oxford Road, Manchester M13 9PL, UK.
| | - Graham Hanks
- Department of Psychology, The University of
Sheffield, Sheffield, UK
| | - George Bendo
- Department of Physics and Astronomy, UK ALMA
Regional Centre Node, Jodrell Bank Centre for Astrophysics, The University of
Manchester, Manchester, UK
| | - Christopher J Plack
- Manchester Centre for Audiology and Deafness,
School of Health Sciences, The University of Manchester, Manchester,
UK
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Landberg T, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JC, Johansson KA, Möller T, Purdy J, Suntharalingam N, Svensson H. ICRU Reports. ACTA ACUST UNITED AC 2019. [DOI: 10.1093/jicru_os32.1.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- T. Landberg
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - J. Chavaudra
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - J. Dobbs
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - J. -P. Gerard
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - G. Hanks
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - J. -C. Horiot
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - K. -A. Johansson
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - T. Möller
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - J. Purdy
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - N. Suntharalingam
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
| | - H. Svensson
- Universitetssjukhuset Malmö, Sweden
- Institut Gustave-Roussy Villejuif, France
- St. Thomas' Hospital London, England
- Centre Hospitalier Lyon Sud Pierre-Benite, France
- Fox Chase Cancer Center Philadelphia, Pennsylvania, US.A
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Landberg T, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JC, Johansson KA, Möller T, Purdy J, Suntharalingam N, Svensson H. Report 62. ACTA ACUST UNITED AC 2016. [DOI: 10.1093/jicru/os32.1.report62] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kaasa S, Hanks G, Caraceni A. 189 INVITED How to Improve Cancer Pain Control Through European Guidelines for Opioid Treatment and Cancer Pain Diagnosis. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pigni A, Brunelli C, Gibbins J, Hanks G, Deconno F, Kaasa S, Klepstad P, Radbruch L, Caraceni A. Content development for EUROPEAN GUIDELINES on the use of opioids for cancer pain: a systematic review and Expert Consensus Study. Minerva Anestesiol 2010; 76:833-843. [PMID: 20935619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Workpackage 3.1 (WP 3.1), within the European Palliative Research Collaborative (EPCRC), was aimed at critically revising and updating the European Association for Palliative Care recommendations on cancer pain management. The aim of this paper is to report the results of the first phase in the revision process which consists of a literature review and an expert consensus about the contents to be considered relevant in the development of the new guidelines. A systematic literature search was carried out from 2001 to 2008 through various databases including Medline, Cinahl, Cochrane Database of Systematic Reviews, Embase and Google. Through this process, guideline quality was evaluated, content was compared with EAPC recommendations and a first set of key-points was developed. A modified two-round Delphi method was applied to choose the most relevant topics for future systematic literature reviews. Fourteen guidelines on cancer pain management, published or updated after 2000, were retrieved. A comparison of these guidelines with the EAPC recommendations led to the formulation of 37 key-points, which were submitted to a panel of experts through a Delphi method. Through the responses given by the experts (25 after the first round and 19 after the second) and after a revision by the WP 3.1 local and steering committees, a final list of 22 topics was generated to answer all identified key-points. Each of these topics will be the object of systematic literature reviews. The final version of the "Evidence-based guidelines for the use of opioid analgesics in the treatment of cancer pain: the EAPC recommendations" will be based on the results of the 22 systematic literature reviews.
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Affiliation(s)
- A Pigni
- Palliative Care, Pain Therapy and Rehabilitation Department, IRCCS Foundation National Cancer Institute, Milan, Italy.
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Rodrigues G, Bae K, Roach M, Lawton C, Donnelly B, Grignon D, Hanks G, Porter A, Lepor H, Sandler H. 66 IMPACT OF ULTRAHIGH BASELINE PSA LEVELS ON BIOCHEMICAL AND CLINICAL OUTCOMES IN TWO RADIATION THERAPY ONCOLOGY GROUP (RTOG) PROSTATE CANCER (PC) CLINICAL TRIALS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72453-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodrigues G, Bae K, Roach M, Lawton C, Donnelly B, Grignon D, Hanks G, Porter A, Lepor H, Sandler H. Impact of ultrahigh baseline PSA levels on biochemical and clinical outcomes in two Radiation Therapy Oncology Group (RTOG) prostate clinical trials. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5123 Background: Controversy exists regarding the outcomes of prostate cancer patients (PCP) presenting with ultra-high (UH; defined as PSA ≥ 50 ng/ml) PSA levels. The objectives of this study were to assess the outcome of this patient population compared to other high-risk patients and to identify predictors associated with biochemical/clinical outcomes. Methods: PCP from two phase III RTOG PC clinical trials (9202 and 9413) were divided into two groups; high-risk patients with and without UH baseline PSA level. Predictive variables included age, Gleason score, T stage, KPS, and treatment arm. Outcomes included overall survival (OS), distant metastasis (DM), and biochemical failure (BF) by Phoenix definition. A Cox proportional hazards regression model was used for OS, and Fine and Gray's regression model was used for DM and BF to test the hypotheses that a difference in each outcome exists between the two groups. Results: There are 401 PCP in the UH PSA and 1792 in the non-UH PSA cohort. Median age was 70 years and PCP were evenly distributed across the Gleason groups (2–6, 7, 8–10) for the non-UH (median PSA 22.4 ng/ml) and the UH PSA (median PSA 72.8ng/ml) cohort. The UH PSA cohort had a larger proportion of T1-T2 disease (p = 0.01) and a smaller proportion of Gleason 8 disease (p = 0.04) than the non-UH group. PCP with UH PSA was found to have inferior OS (HR 1.19, 95% CI 1.02–1.39), DM rate (HR 1.51, 95% CI 1.19–1.92), and BF rate (HR 1.50, 95% CI 1.29–1.73) when compared to other high-risk PCP in multivariable modeling. In the UH cohort, PSA level was found to model risk of DM (HR 1.01, 95% CI 1.001–1.02) but not OS and BF. Gleason grade 8–10 was found to consistently predict for poor OS, DM, and BF outcomes (with HR estimates ranging from 1.41 to 2.36) in both the overall and UH cohort multivariable analyses. Conclusions: UH PSA levels at diagnosis are related with detrimental changes in OS, DM, and BF. All three outcomes assessed in this investigation can be modeled by various combinations all predictive variables tested. Supported by RTOG U10 CA21661, CCOP U10 CA37422, and Stat U10 CA32115 grants from the NCI. This abstract's contents are the sole responsibility of the authors and do not necessarily represent the official views of the NCI. No significant financial relationships to disclose.
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Affiliation(s)
- G. Rodrigues
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - K. Bae
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Roach
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - C. Lawton
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - B. Donnelly
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. Grignon
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - G. Hanks
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - A. Porter
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - H. Lepor
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
| | - H. Sandler
- University of Western Ontario, London, ON, Canada; Radiation Therapy Oncology Group, Philadelphia, PA; University of California, San Francisco, San Francisco, CA; Medical College of Wisconsin, Milwaukee, WI; University of Calgary, Calgary, AB, Canada; Indiana Pathology Institute, Indianapolis, IN; Fox Chase Cancer Center, Philadelphia, PA; McGill University Health Centre, Montreal, QC, Canada; NYU Langone Medical Center, New York, NY; Cedars-Sinai Medical Center, Los Angeles, CA
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Chakravarti A, Desilvio M, Zhang M, Grignon D, Rosenthal S, Asbell S, Hanks G, Sandler H, Pollack A, Zhai G, Shipley W. The Prognostic Value of p16 Expression in Locally Advanced Prostate Cancer: A Study Based on RTOG 92-02. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Valicenti R, Desilvio M, Hanks G, Porter A, Brereton H, Shipley W, Sandler H. Surrogate endpoint for prostate cancer-specific survival: Validation from an analysis of Radiation Therapy Oncology Group Protocol 92–02. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Valicenti
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - M. Desilvio
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - G. Hanks
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - A. Porter
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - H. Brereton
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - W. Shipley
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - H. Sandler
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
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Konski AA, Feigenberg S, Raysor S, Eisenberg D, Mirchandani I, Uzzo RG, Greenberg R, Horwitz E, Pollack A, Hanks G, Watkins-Bruner D. Twenty-five percent positive biopsy rate in a high risk prostate cancer screening program with a PSA ≤ 2.5 ng/ml. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. A. Konski
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - S. Feigenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - S. Raysor
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - D. Eisenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - I. Mirchandani
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - R. G. Uzzo
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - R. Greenberg
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - E. Horwitz
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - A. Pollack
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - G. Hanks
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
| | - D. Watkins-Bruner
- Fox Chase Cancer Ctr, Philadelphia, PA; Jeanes Hosp, Temple Univ, Philadelphia, PA
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 4 general recommendations for prescribing, recording, and reporting external-beam therapy. J ICRU 2004; 4:49-55. [PMID: 24170791 DOI: 10.1093/jicru/ndh010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. Appendix: clinical examples. J ICRU 2004; 4:81-94. [PMID: 24170796 DOI: 10.1093/jicru/ndh015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. REFERENCES. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/jicru/ndh016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. List of abbreviations. J ICRU 2004; 4:15. [PMID: 24170785 DOI: 10.1093/jicru/ndh005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 3 PHYSICAL CHARACTERISTICS OF ELECTRON BEAMS. ACTA ACUST UNITED AC 2004; 4:39-48. [DOI: 10.1093/jicru/ndh009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 8 quantities, reference points, and volumes recommended for reporting electron beam therapy: summary. J ICRU 2004; 4:79. [PMID: 24170795 DOI: 10.1093/jicru/ndh014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. Executive summary. J ICRU 2004; 4:19-20. [PMID: 24170787 DOI: 10.1093/jicru/ndh017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 5 recommendations for reporting doses in electron beam therapy for different clinical situations. J ICRU 2004; 4:57-68. [PMID: 24170792 DOI: 10.1093/jicru/ndh011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 7 quality assurance. J ICRU 2004; 4:75-77. [PMID: 24170794 DOI: 10.1093/jicru/ndh013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 6 special techniques. J ICRU 2004; 4:69-73. [PMID: 24170793 DOI: 10.1093/jicru/ndh012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 1 introduction. J ICRU 2004; 4:21-24. [PMID: 24170788 DOI: 10.1093/jicru/ndh007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Gahbauer R, Landberg T, Chavaudra J, Dobbs J, Gupta N, Hanks G, Horiot JC, Johansson KA, Möller T, Naudy S, Purdy J, Santenac I, Suntharalingam N, Svensson H. 2 volumes. J ICRU 2004; 4:25-37. [PMID: 24170789 DOI: 10.1093/jicru/ndh008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Moore D, Hanlon A, Hanks G, Pollack A. Model-based prediction of biochemical failure in prostate cancer patients following radiation therapy. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Iles S, Catterall JR, Hanks G. Use of opioid analgesics in a patient with chronic abdominal pain. Int J Clin Pract 2002; 56:227-8. [PMID: 12018834] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Pethidine is the most commonly used opioid in hospitals in the UK, but it lacks potency, has a short duration of action and a narrow therapeutic index. These points are illustrated by a case history of a patient prescribed pethidine for chronic abdominal pain. Misplaced fears of the side-effects of morphine result in its underuse in the management of chronic pain with consequential restriction of patients' functional ability.
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Affiliation(s)
- S Iles
- Department of Respiratory Medicine, Bristol Royal Infirmary
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Sandler H, Shipley WU, Gomella L, Pienta K, Bard RH, Bruner D, Clark R, DeSilvio M, Gaspar L, Gillin M, Grignon D, Hammond E, Hanks G, Heydon KH, Kaufman DS, Lee WR, Michalski J, Mydlo J, Pisansky T, Pollack A, Porterfield H, Rifkin M, Roach M, Sanda M, True L, Vijayakumar S, Winter KA, Zeitman A. Radiation Therapy Oncology Group. Research Plan 2002-2006. Genitourinary Cancer Committee. Int J Radiat Oncol Biol Phys 2002; 51:28-38. [PMID: 11641012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Jani AB, Vaida F, Hanks G, Asbell S, Sartor O, Moul JW, Roach M, Brachman D, Kalokhe U, Muller-Runkel R, Ray P, Ignacio L, Awan A, Weichselbaum RR, Vijayakumar S. Changing face and different countenances of prostate cancer: racial and geographic differences in prostate-specific antigen (PSA), stage, and grade trends in the PSA era. Int J Cancer 2001; 96:363-71. [PMID: 11745507 DOI: 10.1002/ijc.1035] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this investigation was to examine changes in pretreatment prostate-specific antigen (PSA), stage, and grade over the past decade as a function of race and geographic region. A multiinstitutional database representing 6,790 patients (1,417 African-American, 5,373 white) diagnosed with nonmetastatic prostate cancer between 1988 and 1997 was constructed. PSA, stage, and grade data were tabulated by calendar year and region, and time trend analyses based on race and region were performed. There was an overall decline of PSA of 0.8%/year, which was significant (P = 0.0001), with a faster rate of decline in African-Americans (1.9%/year) than for whites (0.6%/year). The odds ratio (OR) for a stage shift was 1.09, which was significant (P < 0.0001), and this shift was greater in whites. The OR for an overall grade shift was 1.15, which was significant (P < 0.0001). Although grade and PSA trends were similar for the different regions, there were significant regional differences in stage trends. The implications are that the face of prostate cancer has changed over the past decade; i.e., the distributions of stage, grade, and PSA (the most important prognosticators) have changed. In addition, the countenances of that face are different for whites and African-Americans. For African-Americans, this is good news: the stage, grade, and PSA distributions are more favorable now than before. For whites, the trends are more complex and more dependent on region. These findings should be used for future clinical and health-policy decisions in the screening and treatment of prostate cancer.
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Affiliation(s)
- A B Jani
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
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Campbell T, Blasko J, Crawford ED, Forman J, Hanks G, Kuban D, Montie J, Moul J, Pollack A, Raghavan D, Ray P, Roach M, Steinberg G, Stone N, Thompson I, Vogelzang N, Vijayakumar S. Clinical staging of prostate cancer: reproducibility and clarification of issues. Int J Cancer 2001; 96:198-209. [PMID: 11410889 DOI: 10.1002/ijc.1017] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The American Joint Committee on Cancer (AJCC) staging system for prostate cancer adopted in 1992 is based on tumor-node-metastasis (TNM) designations. It has been widely accepted for use in local and advanced disease. The purpose of this study was to assess reproducibility of staging among observers and to help clarify staging issues. Twelve prostate cancer cases were sent to 20 physicians with special expertise in prostate cancer including eight urologists, eight radiation oncologists, and four medical oncologists. Physicians were asked to assign a stage based on the 1992 AJCC clinical staging. The most frequently reported stage assigned to each case was taken to be the consensus. Agreement was the percentage of physicians who reported that particular stage. Seventy-five percent of the physicians responded. The overall agreement for assignment of T stage was 63.9%. Differences were found by specialty for inclusion of available information in designating a T stage. The overall agreement for N stage was 73.8%. The most common designation was Nx regardless of availability of a computed tomography scan. The overall agreement for M stage was 76.6%. Without a bone scan the most common designation was Mx regardless of Gleason grade or prostate-specific antigen (PSA). A frequent comment was that PSA was more indicative of disease extent than current clinical staging. The reproducibility of the 1992 clinical AJCC staging is poor even among experts in the field. This problem arises primarily from disagreement regarding which studies are included in assigning a stage. Some of these difficulties are addressed in the 1997 revision. However, the clinical staging does not address the true biological significance of disease in many instances.
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Affiliation(s)
- T Campbell
- University of Chicago, Chicago, Illinois, USA
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Abstract
PURPOSE Five-year results from the 1989 patterns of care study (PCS) for prostate cancer are now ready for analysis. The PCS was initiated to determine national averages for treatments and examine outcomes prospectively; the 1989 prostate study is the first to have collected pre- and post-treatment serum PSA data. METHODS AND MATERIALS Six hundred patients treated with radiotherapy with curative intent for prostate cancer at 71 separate institutions in the year 1989 made up the study population. Three hundred ninety-one cases were fully analyzable. Pretreatment patient and tumor characteristics were as follows: of the 391 analyzable, 255 had pretreatment PSA values obtained, and 245 had a Gleason's sum (GS) reported. Three hundred fifty-eight were Caucasian, 24 African-American, and 3 Hispanic (also 6 unknown). One hundred three patients had PSA < 10, 60 had PSA 10-19, and 92 presented with PSA >20. Ninety-seven patients were from Radiation Therapy Oncology Group (RTOG), Community Cancer Centers (CCC), or teaching institutions; 141 patients were from other hospital-based, nonteaching institutions; and 153 were from freestanding radiation oncology facilities. Seventy-one patients were T1, 203 T2, and 100 T3/4. Twenty-four out of 391 patients also received neoadjuvant hormone therapy. Survival curves were constructed using Kaplan-Meier methods, and differences between groups were tested for significance using the log-rank test. For cumulative incidence curves, Gray's test was used to investigate failure distributions between groups. The variables entering Cox model for multivariate analysis included age, race, T stage, pretreatment PSA, and GS. A patient was considered a PSA failure if the treating radiation oncologist reported it as such. RESULTS With a median follow-up of 5.7 years, the 5-year biochemical no evidence of disease (bNED) and overall survival were 56% and 79% respectively for Stage T1, 52% and 81% for T2, and 36% and 63% for Stages T3 and T4 combined. As expected, higher pretreatment PSA, GS, and T stage were all prognostic of poorer outcome. On univariate analysis, bNED survival was adversely impacted by T stage (p = 0.009), pretreatment PSA (p = 0.0035), and by the GS (p = 0.0038). Cause-specific failure was significantly lower for higher T stage (p = 0.014), GS (p = 0.001), and also pretreatment PSA (p = 0.0004). Overall survival was significantly lower in patients with higher T stage (p = 0.047) or GS (p = 0.0191), but not pretreatment PSA (p = 0.284). On multivariate analysis, pretreatment PSA was found to be statistically significant in association with bNED survival, and GS was associated with overall survival, cause-specific survival, and distant metastasis. Few late complications were reported: 13/391 and 13/391 Grade 2-3 gastrointestinal (GI) and genitourinary (GU) complications respectively, with two patients having required surgery with or without a permanent colostomy. CONCLUSION For a representative cross-section of institutions in the United States, radiotherapy achieved high rates of bNED and CSS in selected groups of prostate cancer patients. When studied retrospectively, increased pretreatment PSA was a strong predictor of both biochemical failure and death due to prostate cancer. New strategies for patients with high-stage, high-grade tumors and/or pretreatment PSA >20 deserve testing.
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Affiliation(s)
- P J Chuba
- Department of Radiation Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA.
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Zietman A, Moughan J, Owen J, Hanks G. The Patterns of Care Survey of radiation therapy in localized prostate cancer: similarities between the practice nationally and in minority-rich areas. Int J Radiat Oncol Biol Phys 2001; 50:75-80. [PMID: 11316549 DOI: 10.1016/s0360-3016(00)01569-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Over the last two decades, the chance for the cure of localized prostate cancer by radiation has been improved by the widespread use of PSA for early detection and by a number of technical advances in treatment delivery. This study was designed to determine whether the stage of presentation and the quality of radiation treatment delivered are comparable between Caucasian and minority patients nationally and within minority-rich areas. METHODS AND MATERIALS A random survey conducted for the Patterns of Care Study in Radiation Oncology of 80 facilities treating patients with radiation in the USA. Of these, 67 comprise the "National Survey" and 13 a "Minority-Rich" survey (>40% of treated patients are minorities). Nine hundred twenty-six men with localized prostate cancer were treated in 1994. Five hundred ninety-five were in the national and 331 in the minority-rich survey. The main outcome measures were the clinical features of Caucasian and minority men at presentation and technical characteristics of the treatment delivered to them. RESULTS African-American men presented with more advanced disease (higher-presenting PSA and T-stage) than Caucasians in both the national and the minority-rich surveys. Hispanics also presented with later disease and could be grouped with African-American men rather than Caucasians. Overall the stage and PSA at presentation was earlier than seen in the previous Patterns of Care Study survey of 1989. The quality of treatment delivered has improved since 1989, with no distinction seen between those facilities sampled nationally and those within minority-rich areas. CONCLUSION African-American and Hispanic men with prostate cancer present for therapy at a later stage than Caucasian men, but when they do, the treatment received is of comparable quality.
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Affiliation(s)
- A Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Fiveash JB, Hanks G, Roach M, Wang S, Vigneault E, McLaughlin PW, Sandler HM. 3D conformal radiation therapy (3DCRT) for high grade prostate cancer: a multi-institutional review. Int J Radiat Oncol Biol Phys 2000; 47:335-42. [PMID: 10802357 DOI: 10.1016/s0360-3016(00)00441-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the results of 3DCRT and the effect of higher than traditional doses in patients with high grade prostate cancer, we compiled data from three institutions and analyzed the outcome of this relatively uncommon subset of prostate cancer patients. METHODS AND MATERIALS The 180 patients with Gleason score 8- 10 adenocarcinoma of the prostrate were treated with 3DCRT at the Univer sity of Michigan Health System, University of California-San Francisco, or Fox Chase Cancer. Eligible patients had T1-T4 NO or NX MO adenocarci noma with a pretreatment PSA. Pretreatment characteristics included: me dian age 72 years, 60.6% Gleason score 8 tumors, 57.6% T1-T2, and median pretreatment PSA 17.1 ng/ml (range 0.3-257.1). The total dose received was <70 Gy in 30%, 70-75 Gy in 37%, and >75 Gy in 33%, 27% received adju vant or neoadjuvant hormonal therapy. The median follow-up was 3.0 years for all patients and 16% of patients were followed up for at least 5 years. RESULTS The 5-year freedom from PSA failure was 62.5% for all patients and 79.3% in T1-T2 patients. Univariate analysis revealed that T-stage (T1-T2 vs. T3-T4), pretreatment PSA, and RT dose predicted for freedom from PSA failure. A 5-year overall survival for all patients was 67.3%. Only RT dose was predictive of 5-year overall survival on univariate analysis. Because a significant association was seen between T-stage and RT dose, the Cox proportional hazards model was performed separately for T1-T2 and T3-T4 tumors. None of the prognostic factors reached statistical significance for overall survival or freedom from PSA failure in T3-T4 patients or for overall survival in T1-T2 patients. Lower RT dose and higher pretreatment PSA predicted for PSA failure on multivariate analysis in T1-T2 patients. CONCLUSION This retrospective study from three institutions with experience in dose escalation suggests a dose effect for PSA control above 70 Gy in patients with T1-T2 high grade prostate cancer. These results are superior to surgery and emphasize the need for dose escalation in treating Gleason 8-10 prostate cancer.
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Affiliation(s)
- J B Fiveash
- Department of Radiation Oncology, University of Alabama-Birmingham Medical Center, Birmingham, AL 35233, USA.
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Hanks G. Palliative care: clinical approach to chronic pain and intestinal obstruction. Cleve Clin J Med 1999; 66:459-61. [PMID: 10486991 DOI: 10.3949/ccjm.66.8.459] [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] [Indexed: 11/14/2022]
Abstract
Many patients with terminal cancer receive inadequate treatment for pain and other symptoms. Yet, using oral medications in a simple stepwise approach, we should be able to control pain in up to 80% of patients.
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Bruner D, Ross E, Raysor S, Hanlon A, James J, Grumet S, Hanks G. 2296 Men treated with radiotherapy have better global quality of life outcomes despite decrements in site-specific quality of life domains than men at increased risk but without prostate cancer. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hardy J, Ling J, Mansi J, Isaacs R, Bliss J, A'Hern R, Blake P, Gore M, Shepherd J, Hanks G. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med 1998; 12:437-42. [PMID: 10621863 DOI: 10.1191/026921698666334766] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To determine the effect of dexamethasone when treating malignant bowel obstruction, 35 patients were randomized to receive intravenous dexamethasone or a placebo, crossing over to the alternate treatment arm if there had been no resolution of obstruction by day 5. This was done in two consecutive studies. Patients were stratified according to whether or not they had received specific anticancer therapy within 28 days of study. In trial 1, 15 out of 22 patients 'responded' (resolution of obstruction by day 5; 10 on dexamethasone, five on placebo). Eleven out of 15 patients were 'on treatment'. In trial 2, six out of 13 responded (three on dexamethasone, three on placebo); three out of six were 'on treatment'. When both studies are combined, 60% (21/35) patients responded (13 on dexamethasone, eight on placebo). Poor patient accrual terminated both studies. Numbers are too small to allow a combination of studies or formal statistical analysis. We are unable to make any conclusion as to the effectiveness of dexamethasone in the palliation of malignant bowel disease.
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Affiliation(s)
- J Hardy
- Department of Palliative Medicine, Royal Marsden NHS Trust, London, UK
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Minsky BD, Coia L, Haller DG, Hoffman J, John M, Landry J, Pisansky TM, Willett C, Mahon I, Owen J, Berkey B, Katz A, Hanks G. Radiation therapy for rectosigmoid and rectal cancer: results of the 1992-1994 Patterns of Care process survey. J Clin Oncol 1998; 16:2542-7. [PMID: 9667276 DOI: 10.1200/jco.1998.16.7.2542] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the US national practice standards for patients with adenocarcinoma of the rectum treated in radiation oncology facilities. MATERIALS AND METHODS A national survey of 57 institutions identified 507 eligible patients who received radiation therapy as a component of their treatment for rectal cancer. A stratified two-stage cluster sampling with simple random sampling at each stage for each stratum was used and on-site surveys were performed. RESULTS Of the 507 patients, 378 (75%) received postoperative therapy, 110 (22%) received preoperative therapy, 17 (2%) received both preoperative and postoperative therapy, and less than 0.5% received intraoperative radiation alone. To more accurately assess the utilization of modern radiation techniques as well as recommendations of the National Cancer Institute (NCI)-sponsored, randomized, postoperative, adjuvant combined modality therapy rectal cancer trials into current practice, the analysis was limited to the 243 (48%) patients with tumor, node, and metastasis staging system classification T3 and/or N1-2M0 disease who underwent conventional surgery with negative margins. Although only 7% were treated on a clinical trial, 90% received chemotherapy for a median of 21 weeks. Most were treated with modern radiation treatment techniques. In contrast, techniques to identify and help exclude the small bowel from the radiation field were not routinely used. CONCLUSION Despite the fact that only 7% of patients with T3 and/or N1-2M0 disease were treated on a clinical trial, such trials appear to have resulted in a positive influence on the standard of practice within the oncology community. Although there are still some deficiencies, the majority of these patients received combined modality therapy and were treated with modern radiation therapy techniques.
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Affiliation(s)
- B D Minsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Minsky BD, Coia L, Haller D, Hoffman J, John M, Landry J, Pisansky TM, Willett C, Mahon I, Owen J, Hanks G. Treatment systems guidelines for primary rectal cancer from the 1996 Patterns of Care Study. Int J Radiat Oncol Biol Phys 1998; 41:21-7. [PMID: 9588913 DOI: 10.1016/s0360-3016(98)00027-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The Patterns of Care Rectal Cancer Committee was formed to develop consensus recommendations for patients with adenocarcinoma of the rectum limited to the pelvis. METHODS AND MATERIALS The Committee was composed of a multidisciplinary group of oncologists, and clinical scenarios were chosen to address most of the major treatment controversies in the combined modality treatment of rectal cancer. A literature search was then conducted and the major articles were identified. A modified Delphi technique was used to arrive at consensus. Serial surveys were conducted by distributing questionnaires to the Committee members to consolidate expert opinion. Voting was conducted using a scoring system and opinions were unified to the highest degree possible. RESULTS Consensus voting was performed for 4 clinical scenarios. Acceptability ratings for treatment were grouped into 3 broad categories: not acceptable, acceptable, and most acceptable. Based on the treatment options, a decision tree was developed that reflects the consensus of the committee. CONCLUSION These options may help guide treatment decisions in rectal cancer.
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Affiliation(s)
- B D Minsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Bruner DW, Scott CB, McGowan D, Lawton C, Hanks G, Prestidge B, Gaspar L, Gore E, Asbell S. Validation of the sexual adjustment questionnaire (SAQ) in prostate cancer patients enrolled on radiation therapy oncology group (RTOG) studies 90-20 and 94-08. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80257-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shipley W, Thames H, Hanks G, Sandler H, Zietman A, Perez C, Kuban D, Hancock S, Smith C. PSA failure free survival following irradiation for stage T1–T2 prostate cancer patients: The results of an ASTRO sponsored pooled analysis. Int J Radiat Oncol Biol Phys 1998. [DOI: 10.1016/s0360-3016(98)80204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Herold D, Hanks G, Movsas B, Hanlon A. Postradiotherapy PSA nadirs fail to support dose escalation study in patients with pretreatment PSA values < 10 ng/ml. Radiat Oncol Investig 1997; 5:15-9. [PMID: 9303052 DOI: 10.1002/(sici)1520-6823(1997)5:1<15::aid-roi3>3.0.co;2-n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
With three-dimensional conformal therapy, doses > 75 Gy have been delivered to the prostate with acceptable levels of morbidity; however, higher doses do appear to increase late gastrointestinal (GI) and genitourinary (GU) morbidity. Because patients with pretreatment prostate-specific antigen (PSA) values < 10 ng/ml can achieve 3-year actuarial bNED control rates of 90% after treatment with external beam radiotherapy to doses < 71 Gy, one might question the need for further dose escalation in this population. In this report, we examined the relationship between dose and PSA nadir for 90 patients with pretreatment PSA values < 10 ng/ml entered into a dose escalation study from March 1987 to October 1992. We wanted to see if nadir response data would predict a different outcome from our 3-year bNED control reports. All patients were treated with external beam radiotherapy to ICRU reporting point doses of 6,598 cGy to 7,895 cGy (median of 7,068 cGy). Minimum follow-up was 36 months (median, 47 months). Seven hundred thirty-nine posttreatment PSA nadir values were analyzed, yielding an average of 8.2 values per patient. Estimates of rates of bNED control and time to reach a posttreatment PSA of 1.0 ng/ml were calculated using the Kaplan-Meier product limit method. The log-rank test was used to evaluate differences in rates according to dose levels. Linear regression and Cox proportional hazard modeling were used to relate dose to bNED control on a continuum. Escalating doses from 66 to 79 Gy failed to increase the percentage of patients achieving nadir values < 1 ng/ml and similarly failed to increase the 3-year actuarial bNED control. Linear regression (P = .81) and the chi-square test of association (P = .23) supported the lack of a dose effect on nadir continuously and categorically, respectively, and the Cox regression model supported the conclusion that dose on a continuum has no effect on bNED control (P = .34). Furthermore, time to reach a posttreatment PSA level of 1.0 ng/ml was not statistically dependent on dose level (P = .13). Based on this study and prior reports demonstrating a dose response for late GI/GU morbidity, we question whether further dose escalation in this subgroup of patients is justified.
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Affiliation(s)
- D Herold
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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Swenson EJ, DeHaven KE, Sebastianelli WJ, Hanks G, Kalenak A, Lynch JM. The effect of a pneumatic leg brace on return to play in athletes with tibial stress fractures. Am J Sports Med 1997; 25:322-8. [PMID: 9167811 DOI: 10.1177/036354659702500309] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A total of 18 competitive and recreational athletes were enrolled in a randomized, prospective study looking at the effect of pneumatic leg braces on the time to return to full activity after a tibial stress fracture. All patients had positive bone scans and 15 had positive radiographic findings by Week 12. There were two treatment groups. The traditional treatment group was treated with rest and, after 3 pain-free days, a gradual return to activity. The pneumatic leg brace (Aircast) group had the brace applied to the affected leg and then followed the same return to activity guidelines. The guidelines consisted of a detailed functional progression that allowed pain-free return to play. The brace group was able to resume light activity in 7 days (median) and the traditional group began light activity in 21 days (median). The brace group returned to full, unrestricted activity in 21 +/- 2 days, and the traditional group required 77 +/- 7 days to resume full activity. The Aircast pneumatic brace is effective in allowing athletes with tibial stress fractures to return to full, unrestricted, pain-free activity significantly sooner than traditional treatment.
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Affiliation(s)
- E J Swenson
- Department of Orthopaedics, University of Rochester, New York, USA
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Kline RW, Smith AR, Coia LR, Owen JB, Hanlon A, Wallace M, Hanks G. Treatment planning for adenocarcinoma of the rectum and sigmoid: a patterns of care study. PCS Committee. Int J Radiat Oncol Biol Phys 1997; 37:305-11. [PMID: 9069301 DOI: 10.1016/s0360-3016(96)00532-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To conduct a study of the process of treatment planning and treatment of adenocarcinoma of the rectum and sigmoid in the United States, and to compare survey results to consensus guidelines. METHODS AND MATERIALS A consensus committee developed guidelines for the radiotherapeutic management of adenocarcinoma of the rectum and sigmoid, and also developed a survey form that was used to gather data to evaluate the practice patterns for patients treated in 1989 and 1990 against the consensus guidelines. Seventy-three facilities were randomly selected for site visits from the 1321 radiation therapy facilities in the US: 21 academic, 26 hospital based, and 26 free standing. During the site visits, the radiotherapy records were examined by the surveyor physicist and radiation oncologist to extract and record the required data. Data collected included items related to treatment specific parameters, including treatment planning considerations. Analyses included stratification as to the types of institutions, academic, hospital based, or free standing. RESULTS For many treatment parameters there are discrepancies between the patterns of practice determined by the surveys and the consensus guidelines for radiotherapy treatment of adenocarcinoma of the rectum and sigmoid. Significant differences in practice among the stratified institution types were found in only a few parameters.
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Affiliation(s)
- R W Kline
- Mayo Clinic, Rochester, MN 55905, USA
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43
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Winter K, Grignon D, Pajak T, Pilepich M, Byhardt R, Lawton C, Gallagher M, Mesic J, Roach M, Hanks G, Coughlin C, Porter A. 1007 The need for central pathology tumor grading in prostate cancer using radiation therapy oncology group(RTOG) 8531. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80727-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baker LH, Hanks G, Gershenson D, Kantoff P, Lange P, Logothetis C, Sandler H, Walsh P. NCCN Prostate Cancer Practice Guidelines. The National Comprehensive Cancer Network. Oncology (Williston Park) 1996; 10:265-88. [PMID: 8953609] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L H Baker
- University of Michigan, Comprehensive Cancer Center, Ann Arbor, USA
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45
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Landberg T, Wambersie A, Akanuma A, Brahme A, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JC, Johansson KA, Naudy S, Möller T, Purdy J, Suntharalingam N, Svensson H. 249Margins in radiotherapy: Specification of electron beam treatment. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gerber RL, Smith AR, Owen J, Hanlon A, Wallace M, Hanks G. Patterns of care survey results: treatment planning for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 1995; 33:803-8. [PMID: 7591886 DOI: 10.1016/0360-3016(95)00278-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Treatment planning has been defined differently at various institutions to encompass tasks ranging from the initial evaluation of the patient to the delivery of the treatment as well as a more narrow view, focused primarily on isodose computation. To evaluate the impact of much of the new treatment-planning technology that has become available, it is necessary to define and develop recommended guidelines for the treatment-planning process. METHODS AND MATERIALS The 1989 Patterns of Care Study (PCS) included questionnaires to access treatment planning practices currently in use for the entire census of oncology facilities in the United States. These questionnaires were developed by a consensus committee consisting of both physicists and radiation oncologists whose charge was to formulate a description of current treatment-planning practices. The description was based on the committee's experience and knowledge of the treatment-planning process considered to be widely available and in general use, as well as a review of the literature. From the description of the treatment-planning process, a set of guidelines for treatment planning was developed for prostate as well as each of the other disease sites included in the PCS. Data from the study defined the general structure, methodology, process, and tools used by each institution involved in the Patterns of Care Survey Study. National averages for all of the variables were calculated with weighted averages, with the weights reflecting the sample design and number of patients in the different types of facilities. The data were stratified according to academic, hospital, or free-standing facility and were compared with the Consensus Guidelines for Treatment Planning of the Prostate. DISCUSSION Based on the consensus statement, the treatment-planning process was separated into the following categories: (a) Treatment-Planning Workup, (b) Treatment Plan Implementation, (c) Treatment Delivery, (d) Treatment Verification, and (e) Quality Assurance. The results from the survey were summarized for each category and compared with the consensus statement. CONCLUSIONS Although there is an increasing trend toward using computed tomography (CT) information to acquire individualized patient data, volume definition and localization are often completed in the simulator without the direct use of CT information (47%). As more sophisticated beam arrangements and blocking are used, one needs to look at the full three-dimensional (3D) volume to ensure that there are no marginal misses due to blocking and beam arrangement. Improved and more widespread use of immobilization devices is also required with conformal treatments and reduced margins. The results of the survey helped to identify and establish the standard of practice for treatment planning of the prostate as well as to provide documentation for better defining a complete description of the treatment planning process. Well-documented guidelines will provide more consistent treatment of patients, which should have an impact on outcome.
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Affiliation(s)
- R L Gerber
- Washington University School of Medicine, St. Louis, MO 63110, USA
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Landberg T, Wambersie A, Akanuma A, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JC, Johansson KA, Möller T, Purdy J, Suntharalingam N. ICRU definitions. Radiother Oncol 1995. [DOI: 10.1016/0167-8140(96)80499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ruderman JW, Schick JB, Sherman M, Reagan Y, Hanks G, Weitzman JJ. Use of a truss to maintain inguinal hernia reduction in a very low birth weight infant. J Perinatol 1995; 15:143-5. [PMID: 7595774] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Trusses are not usually used in management of inguinal hernia of the very low birth weight infant. A potential benefit of this therapy is maintenance of hernia reduction, thus delaying operative repair until the infant is larger and healthier. We designed a safe and effective truss with supplies found in most neonatal intensive care units.
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Affiliation(s)
- J W Ruderman
- UCI School of Medicine, Department of Neonatology, Tarzana Regional Medical Center 91356, USA
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Coia L, Hoffman J, Scher R, Weese J, Solin L, Weiner L, Eisenberg B, Paul A, Hanks G. Preoperative chemoradiation for adenocarcinoma of the pancreas and duodenum. Int J Radiat Oncol Biol Phys 1994; 30:161-7. [PMID: 8083109 DOI: 10.1016/0360-3016(94)90531-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE This study was designed to evaluate the effects of preoperative chemoradiation on resectability, response, local control, and survival in patients with local or local-regional involvement from carcinoma of the pancreas or cancer of the duodenum and to assess the associated toxicity of such treatment. METHODS AND MATERIALS This prospective pilot study of preoperative chemoradiation was initiated in 1986 for patients with clinical evidence of adenocarcinoma of the pancreas or duodenum without evidence of distant metastases. Radiation was given at 1.8 Gy per day to a total dose of 50.4 Gy. Two cycles of chemotherapy were given concurrent with radiation. On days 2-5 and 29-32, 5-fluorouracil (1 gm/m2/24 h x 4 days) was given, while mitomycin-C (10 mg/m2) was given on day 2 only. Surgical resection was 4-6 weeks following completion of chemoradiation. Thirty-one patients (17 male and 14 female) were entered on the protocol with a median potential follow-up of 4.5 years (range 6 months to 7.5 years). The median age was 64 years (range 32-73 years). Twenty-seven patients had pancreatic cancer (25 head, two body), while four patients had carcinoma arising from the duodenum. Twenty-one patients were initially judged to be unresectable and ten potentially resectable prior to chemoradiation. RESULTS Twenty-nine of 31 patients completed the entire course of radiation and both cycles of chemotherapy. Acute toxicity from chemoradiation consisted of nausea, vomiting, diarrhea, stomatitis, or hematologic suppression which was moderate to severe (Grade 3 or 4) in seven patients (23%). One patient died of sepsis following the first week of therapy. Seventeen patients (55%) underwent curative resection with subtotal or total pancreatectomy or Whipple resection (four duodenum, 13 pancreas) and two (2/17) had pathologic nodal involvement, while (0/17) none had involved margins. A complete pathologic response was seen in all four (4/4) patients with duodenal cancer and in none (0/13) with pancreatic cancer who underwent resection. The median postoperative hospitalization stay was 22 days (range 4-144 days). Of 17 patients who underwent curative resection, there were two postoperative mortalities (12%). Late complications have included abscess, one; and nonmalignant ascites, five. Ten of the 31 patients are alive. For patients with pancreatic cancer the median survival is 9 months, while survival at 1 year and 3 years are 36% and 19% overall and 60% and 43% at 1 and 3 years for those undergoing resection. Six of the 27 patients (22%) with pancreatic cancer are alive without recurrence. All four patients with duodenal cancer are alive without recurrence (12 months, 23 months, 35 months, 90 months). CONCLUSION Preoperative chemoradiation for cancer of the pancreas and duodenal region was relatively well-tolerated and enhanced resectability and downstaging of nodal metastases were suggested. The 3-year survival, particularly in patients who underwent resection, was high. For these reasons the applicability of this treatment regimen for pancreatic cancer is presently being studied in a group-wide multi-institutional Phase II trial. Chemoradiation for duodenal cancer has produced a complete pathologic response in all patients and survival has been excellent, suggesting efficacy of this regimen for duodenal cancer.
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Affiliation(s)
- L Coia
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111
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50
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Hanks G. European Journal of Palliative Care. Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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