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Hu C, Miccio JA, Dignam JJ, Paulus R, Liu C, Skinner HD, Tsakiridis T, Bradley JD, Machtay M. Progression-Free Survival as a Surrogate Endpoint of Overall Survival in Patients with Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy: Trial-Level Meta-Analysis and Individual-Level Analysis of NRG/RTOG 0617 and PROCLAIM. Int J Radiat Oncol Biol Phys 2023; 117:S128. [PMID: 37784328 DOI: 10.1016/j.ijrobp.2023.06.473] [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) Overall Survival (OS) is the gold standard endpoint in randomized clinical trials (RCTs) of Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC). Intermediate endpoints that can be observed at earlier time points and predict OS would improve trial efficiency and expedite the adoption of proven interventions. MATERIALS/METHODS Atrial-level meta-analysis was conducted using a weighted regression analysis to quantify the correlation between PFS and OS hazard ratios (HRs). Large (n≥ 100) contemporary RCTs in LA-NSCLC that used platinum-based chemoradiation were included. An individual-level surrogacy analysis based on Prentice criteria was performed to evaluate if PFS could reliably predict OS using NRG/RTOG 0617 (NCT00533949), a phase III RCT of dose escalated CRT. The individual-level correlation between PFS and OS was validated using PROCLAIM (NCT00686959) control arm. RESULTS Nineteen RCTs comprising a total of 5525 patients (pts) were included in the trial-level meta-analysis. A moderately high correlation was observed between PFS HR and OS HR (R2 = 0.68, 95% CI = 0.42-0.94). Individual-level analysis of NRG/RTOG 0617 showed that, as reported, RT dose was associated with OS (HR = 1.28, 95% CI = 1.04-1.58, p = 0.02) and PFS (HR = 1.21, 95% CI = 0.99-1.46, p = 0.06). Progressive disease (PD) was highly associated with OS, where pts having PD within 6mo or 12mo had a significantly higher mortality risk than those not having PD within 6mo or 12 mo, respectively, in landmark analysis (PD within 6mo: HR = 2.56, 95% CI = 1.82-3.59, p<0.0001; PD within 12mo: HR = 3.18, 95% CI = 2.45-4.12, p<0.0001). Accounting for PD moderately reduced RT dose effect on OS (HR = 1.21, 95% CI = 0.98-1.49), suggesting RT dose effect on OS may be mediated partially through PD. The association between OS and PD occurrence within 6mo or 12mo was similar in PROCLAIM control arm (PD within 6mo: HR = 2.06, 95% CI = 1.48-2.86, p<0.0001; PD within 12mo: HR = 2.02, 95% CI = 1.38-2.95, p<0.0001). CONCLUSION A moderately high trial-level surrogacy between PFS and OS was identified in trial-level meta-analysis. PD occurrence also reliably predicted OS at the individual patient level in both NRG/RTOG 0617 and PROCLAIM. These results support the use of PFS as a valid endpoint in clinical trials of LA-NSCLC.
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Affiliation(s)
- C Hu
- Johns Hopkins University School of Medicine, Baltimore, MD; NRG Oncology, Philadelphia, PA
| | - J A Miccio
- Penn State Cancer Institute, Hershey, PA
| | - J J Dignam
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA; University of Chicago, Department of Public Health Sciences, Chicago, IL
| | - R Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - C Liu
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD
| | - H D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - T Tsakiridis
- Juravinski Cancer Centre, McMaster University, Hamilton,ON, Canada
| | - J D Bradley
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - M Machtay
- Penn State University -Penn State Cancer Institute, Hershey, PA
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Kong F, Hu C, Machtay M, Matuszak M, Xiao Y, Ten Haken R, Hirsh V, Pryma D, Siegel B, Gelblum D, Hayman J, Robinson C, Loo B, Videtic G, Faria S, Ferguson C, Dunlap N, Kundapu V, Paulus R, Curran W, Bradley J. OA02.04 Randomized Phase Ⅱ Trial (RTOG1106) on Midtreatment PET/CT Guided Adaptive Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.277] [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: 10/21/2022]
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Hu C, Machtay M, Dignam J, Paulus R, Bradley J. MA05.09 PFS and Cardiac-Toxicity-Adjusted-PFS As Predictors of OS in Locally Advanced NSCLC Treated with Concurrent Chemoradiation. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.355] [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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Videtic G, Paulus R, Singh A, Chang J, Parker W, Olivier K, Timmerman R, Komaki R, Urbanic J, Stephans K, Yom S, Robinson C, Belani C, Iyengar P, Ajlouni M, Gopaul D, Lele S, Mcgarry R, Choy H, Bradley J. MA 13.08 Long Term Follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): a Randomized Phase II Study of 2 SBRT Schedules for Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.566] [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: 11/15/2022]
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Hitchcock K, Bradley J, Morris C, Hu C, Paulus R, Movsas B, Hoppe B. Quality of Survivorship Among Patients With Locally Advanced NSCLC Treated With Chemoradiation on RTOG 0617. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jin J, Hu C, Xiao Y, Zhang H, Ellsworth S, Schild S, Bogart J, Dobelbower M, Kavadi V, Narayan S, Iyengar P, Robinson C, Brufsky A, Koprowski C, Machtay M, Curran W, Paulus R, Choy H, Bradley J, Kong F. Higher Radiation Dose to Immune System is Correlated With Poorer Survival in Patients With Stage III Non–small Cell Lung Cancer: A Secondary Study of a Phase 3 Cooperative Group Trial (NRG Oncology RTOG 0617). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Videtic G, Paulus R, Singh A, Chang J, Parker W, Olivier K, Timmerman R, Komaki R, Urbanic J, Stephans K, Yom S, Robinson C, Belani C, Iyengar P, Ajlouni M, Gopaul D, Lele S, McGarry R, Choy H, Bradley J. Long-Term Follow-Up on NRG Oncology RTOG 0915 (NCCTG N0927): A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients with Stage I Peripheral Non–small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The onset of caries is characterized by demineralization of dental hard tissues. Optimal fluoridation with respective oral hygiene habits and diet may stop the progression of a lesion and even allow for its remineralization. The aim of modern dentistry must be a preventive approach rather than invasive repair of the disease. This is possible only with early detection and respective preventive measures. Some of today's diagnostic tools are not sensitive enough to detect this early onset of destruction. Tools based on fluorescence could have the possibility to overcome this problem. This overview will focus on today's knowledge of one possible tool, the DIAGNOdent.
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Affiliation(s)
- A Lussi
- Department of Operative, Preventive and Paediatric Dentistry, Klinik für Zahnerhaltung, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland.
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Bezjak A, Paulus R, Gaspar L, Timmerman R, Straube W, Ryan W, Garces Y, Pu A, Singh A, Videtic G, McGarry R, Iyengar P, Pantarotto J, Urbanic J, Sun A, Daly M, Grills I, Normolle D, Bradley J, Choy H. Efficacy and Toxicity Analysis of NRG Oncology/RTOG 0813 Trial of Stereotactic Body Radiation Therapy (SBRT) for Centrally Located Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Bezjak A, Paulus R, Gaspar L, Timmerman R, Straube W, Ryan W, Garces Y, Pu A, Singh A, Videtic G, McGarry R, Iyengar P, Pantarotto J, Urbanic J, Sun A, Daly M, Grills I, Normolle D, Bradley J, Choy H. OC-0136: Primary Study Endpoint Analysis of NRG Oncology/RTOG 0813 Trial of SBRT for centrally located NSCLC. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31385-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bezjak A, Paulus R, Gaspar L, Timmerman R, Straube W, Ryan W, Garces Y, Pu A, Singh A, Videtic G, McGarry R, Iyengar P, Pantarotto J, Urbanic J, Sun A, Daly M, Grills I, Normolle D, Bradley J, Choy H. Primary Study Endpoint Analysis for NRG Oncology/RTOG 0813 Trial of Stereotactic Body Radiation Therapy (SBRT) for Centrally Located Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.10.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee W, Dignam J, Amin M, Bruner D, Low D, Swanson G, Shah A, D'Souza D, Michalski J, Dayes I, Seaward S, Hall W, Nguyen P, Pisansky T, Faria S, Chen Y, Koontz B, Paulus R, Sandler H. NRG Oncology RTOG 0415: A Randomized Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.10.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gong Y, Gore E, Bar-Ad V, Wheatley M, Kong F, Yu J, Giaddui T, Chen W, Hu C, Paulus R, Xiao Y, Bradley J. Variation of Cardiac Contours Using Different Heart Definitions for NSCLC Patients Enrolled on RTOG 0617. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2150] [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: 10/24/2022]
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Movsas B, Hu C, Sloan J, Bradley J, Kavadi V, Narayan S, Robinson C, Johnson D, Paulus R, Choy H. Quality of Life (QOL) Analysis of the Randomized Radiation (RT) Dose-Escalation NSCLC Trial (RTOG 0617): The Rest of the Story. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Stanic S, Paulus R, Timmerman R, Michalski J, Barriger R, Bezjak A, Videtic G, Bradley J. No Clinically Significant Changes in Pulmonary Function Following Stereotactic Body Radiation Therapy (SBRT) Among Medically Inoperable Patients With Early Stage Peripheral Non-small Cell Lung Cancer: An Analysis of RTOG 0236. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.334] [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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Gore E, Paulus R, Wong S, Sun A, Videtic G, Dutta S, Suntharalingam M, Chen Y, Gaspar L, Choy H. Phase III Comparison of Prophylactic Cranial Irradiation Versus Observation in Patients with Locally Advanced Non-small Cell Lung Cancer -- An Updated Analysis of RTOG 0214. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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Hagan M, Bosch W, Moore M, Prestidge B, Paulus R, Galvin J, Sandler H, Winter K, Michalski J. Analysis Of Brachytherapy Plans For Regulatory Compliance: Application Of Expected Doses To Organs At Risk. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.619] [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: 10/16/2022]
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Bosch W, Paulus R, Michalski J, Galvin J, Followill D, Prestidge B, Bice W, Sandler H, Hagan M. Analysis of Brachytherapy Plans for Regulatory Compliance: Dosimetric Study of RTOG 0232 Plans to Quantify Expected Dose to Organs at Risk. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.603] [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: 10/16/2022]
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Efstathiou J, Paulus R, Smith M, Jones C, Leibenhaut M, Husain S, Rotman M, Souhami L, Sandler H, Shipley W. Cardiovascular Mortality following Short-term Androgen Deprivation in Clinically Localized Prostate Cancer: An Analysis of RTOG 94-08. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.084] [Citation(s) in RCA: 2] [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: 11/15/2022]
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Michiels S, Mauguen A, Fisher D, Burdett S, Paulus R, Mandrekar SJ, Belani CP, Shepherd FA, Eisen T, Pang H, Collette L, Le Pechoux C, Pignon J. Evaluation of disease-free survival as surrogate endpoint for overall survival using two individual patient data meta-analyses of adjuvant chemotherapy in operable non-small cell lung cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7004] [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: 11/20/2022] Open
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Gondi V, Paulus R, Bruner D, Meyers CA, Gore E, Wolfson AH, Werner-Wasik M, Choy H, Movsas B. Prognostic significance of QOL deterioration during early lung cancer survivorship: Secondary analysis of RTOG 0212 and 0214. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6061] [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: 11/20/2022] Open
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Gachet C, Paulus R, De Mourgues L, Durand C, Toulhoat H. Unsupported Ni-mo Sulfide Catalysts: Relation Between the HDS and Hydrogenation Activities and Some Structural Properties. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bscb.19840930809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Suntharalingam M, Paulus R, Edelman MJ, Krasna M, Burrows W, Gore E, Yom S, Choy H. RTOG 0229: A phase II trial of neoadjuvant therapy with concurrent chemotherapy and high-dose radiotherapy (XRT) followed by resection and consolidative therapy for LA-NSCLC. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, Fakiris A, Bezjak A, Videtic G, Choy H. Stereotactic Body Radiation Therapy for Medically Inoperable Early-stage Lung Cancer Patients: Analysis of RTOG 0236. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Komaki R, Paulus R, Ettinger DS, Videtic GM, Bradley JD, Glisson BS, Choy H. A phase II study of accelerated high-dose thoracic radiation therapy (AHTRT) with concurrent chemotherapy for limited small cell lung cancer: RTOG 0239. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
7527 Background: Inter-group(IG) study 0096 showed that hyperfractionated and accelerated radiotherapy (HFXART) and concurrent etoposide/cisplatin(EP) improved 5-yr survival (26 %) for patients (pts) with limited small cell lung cancer (LSCLC) compared to daily treatment (TRT) with EP (16%), (p=0.04), HFXART/ EP still had high local failure (LF 40 %) and acute severe esophagitis (ASE) rate (27%). Radiation Therapy Oncology Group (RTOG) 0239 was developed to improve local control (LC) and overall survival (OS) without increasing ASE.Methods: Eligibility included limited stage SCLC, age ≥ 18; P.S. 0–1, with adequate hematologic, hepatic, and renal function. RT was given to large field to 28.8 Gy: 1.8 Gy/ fraction (Fx), 5 days (d) / wk for 16 Fx followed by BID with AP/PA fields in AM @ 1.8 Gy /Fx; boost with 2nd treatment in PM @ 1.8 Gy/Fx on d: 23–26; then off-cord boost, 1.8 Gy, BID, x last 5 days for a total dose of 61.2 Gy in 5 wks. EP was started on day 1 of TRT with P, 60 mg/m2 i.v; E, 120 mg/m2 i.v.; E, 240 mg/m2 p.o. d 2 and 3 or E 120 mg/m2 i.v. / d on d 2 or 3. Repeat cycle every 3 wks x 2 cycles with RT, followed by adjuvant EP alone x 2 cycles. CR pts were asked to participate in the prophylactic cranial irradiation (PCI) study RTOG 0212. RTOG 0239 was designed to detect an improvement in the 2-year survival rate from 47% to 60% with less than 30% of ASE.Results: RTOG 0239 accrued 72 pts (71 eligible) from June 20, 2003 to May 23, 2006. The median follow-up time is 19.0 months for all pts, and 30.4 months for pts still alive. The median age was 63, 52% female, 58% Zubrod PS 0. The 2 -year survival rate was 37 % [95% CI: 25.6, 47.7]. 13 pts (18 %) experienced severe esophagitis. 2 treatment related deaths (2.8%) were reported. Response rates 2 months post RX showed CR 41%, PR 39%, SD 10% and PD 6%. Locoregional control rate at two years was 80%. RT compliance was 95 %.Conclusions: RTOG 0239, AHTRT/EP for LSCLC resulted in 37% 2-year OS, 80% 2 year LC and 18% ASE. Compliance with treatment was high and treatment-related death rate was similar to other chemoradiation regimens. Although 2-year OS did not achieve 60%, excellent LC and low ASE were achieved by RTOG 0239 which became one of 3 arms in an ongoing randomized trial of LSCLC RTOG0538/CALGB30610. [Table: see text]
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Affiliation(s)
- R. Komaki
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - R. Paulus
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - D. S. Ettinger
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - G. M. Videtic
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - J. D. Bradley
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - B. S. Glisson
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
| | - H. Choy
- UT M. D. Anderson Cancer Center, Houston, TX; ACR, Philadelphia, PA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Cleveland Clinic Foundation, Cleveland, OH; Washington University Physicans, St. Louis, MO; UT Southwestern Medical Center at Dallas, Dallas, TX
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Olsen CC, Paulus R, Komaki R, Varella-Garcia M, Dziadziuszko R, Curran WJ, Robert F, Choy H, Blumenschein GR, Hirsch FR. RTOG 0324: A phase II study of cetuximab (C225) in combination with chemoradiation (CRT) in patients with stage IIIA/B non-small cell lung cancer (NSCLC)—Association between EGFR gene copy number and patients’ outcome. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Blumenschein GR, Paulus R, Curran WJ, Robert F, Fossella FV, Werner-Wasik M, Doescher P, Choy H, Komaki R. A phase II study of cetuximab (C225) in combination with chemoradiation (CRT) in patients (PTS) with stage IIIA/B non-small cell lung cancer (NSCLC): A report of the 2 year and median survival (MS) for the RTOG 0324 trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7516] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Konski A, Bhargavan M, Owen J, Komaki R, Langer C, Byhardt R, Paulus R, Choy H, Bruner D, Curran W. “Less is not Always more”: An Economic Analysis of Radiation Therapy Oncology Group 94–10. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.329] [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: 10/22/2022]
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Sechet C, Sarmeo D, Mermoux M, Touzain P, Bonnetain L, Dumas D, Allard B, Paulus R. Sodium Reactivity With Anthracitic Carbons AT 700°C. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/10587259408051681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Sechet
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
| | - D. Sarmeo
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
| | - M. Mermoux
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
| | - Ph. Touzain
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
| | - L. Bonnetain
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
| | - D. Dumas
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
- b Société des Electrodes et Réfractaires Savoie Lre, CArbone Savoie , 10, rue de l'Industrie BP 16, F-69631 , Vénissieux Cedex
| | - B. Allard
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
- b Société des Electrodes et Réfractaires Savoie Lre, CArbone Savoie , 10, rue de l'Industrie BP 16, F-69631 , Vénissieux Cedex
| | - R. Paulus
- a Laboratoire Science des Surfaces et Matériaux Carbonés , URA CNRS n° 413 ENSEEG - INPG, BP 75 Domaine Universitaire, F-38402 , Saint-Martin d'Hères Cedex
- b Société des Electrodes et Réfractaires Savoie Lre, CArbone Savoie , 10, rue de l'Industrie BP 16, F-69631 , Vénissieux Cedex
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Konski AA, Bhargavan M, Owen J, Paulus R, Cooper J, Fu K, Ang K, Watkins-Bruner D. Altered fractionated radiotherapy is cost-effective in the treatment of locally advanced head and neck cancer: An economic analysis of Radiation Therapy Oncology Group (RTOG) 90–03. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6007] [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
6007 Background: RTOG 9003 compared altered fractionated radiotherapy (AIFX) to standard radiotherapy (SFX). Overall and disease-free survival was improved in the AIFX schedules but with increased toxicity. The specific aim of this study was to compare the cost-effectiveness of AIFX to SFX. Methods: Costs data included Medicare Part A and Part B costs from all providers—inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians and other Part B providers were obtained from the Centers for Medicare & Medicaid Services (CMS) for patients treated on RTOG 9003 from 1992–1996. Claims were restricted to those with a diagnosis of head and neck cancer. We calculated 56-month expected discounted costs for each arm of the trial in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Costs were discounted back to the time of entry onto the trial, using an annual discount rate of 3% and indexed to 1996 dollars using the Consumer Price Index. The analysis was performed from a payer’s perspective. Incremental cost-effective ratios were calculated comparing AIFX schedules to SFX. Results: Of the 1,130 patients entered, 1,073 patients were analyzable for outcomes and Medicare cost data and clinical outcomes were available for 130 patients. The expected mean 56-month cost and incremental cost-effectiveness ratios (ICER) compared to SFX are presented in the table . Sensitivity analysis and 95% confidence ellipses will be presented. Conclusions: Although more toxic altered fractionated radiotherapy schedules were found to be cost-effective using a willingness to pay of $50,000/life year in patients >65 years old. These results need to be confirmed in a cohort of younger patients. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. A. Konski
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - M. Bhargavan
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Owen
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - R. Paulus
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - J. Cooper
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - K. Fu
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - K. Ang
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
| | - D. Watkins-Bruner
- Fox Chase Cancer Center, Philadelphia, PA; American College of Radiology, Reston, VA; Radiation Therapy Oncology Group, Philadelphia, PA; Maimonides Medical Center, Maimonides, NY; University of California San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX
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Pilepich MV, Paulus R, St Clair W, Brasacchio RA, Rostock R, Miller RC. Phase III study of pentosanpolysulfate (PPS) in treatment of gastrointestinal tract sequelae of radiotherapy. Am J Clin Oncol 2006; 29:132-7. [PMID: 16601430 DOI: 10.1097/01.coc.0000203758.77490.fd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of pentosanpolysulfate (PPS) in the treatment of gastrointestinal tract sequelae of radiotherapy. METHODS Eligible patients were those with grade 1 to 3 radiation related proctitis, diarrhea and/or melena. At least 4 weeks had to elapse since the completion of the radiotherapy course. Patients with bleeding diathesis or ulcers, and patients receiving anticoagulants or chemotherapy were excluded. Stratification criteria included the type of sequelae (proctitis, diarrhea, melena), the severity grade and the onset (<3 months post-RT, >3 months post-RT). Patients were randomized to one of the following arms: 100 mg PPS 3 times per day (300 mg/day), 200 mg PPS 3 times per day (600 mg/day), or placebo 3 times per day. If there was no improvement in symptoms after 2 months, the protocol treatment was discontinued. If the symptoms improved or resolved, the protocol treatment was continued for additional 4 months. Patients under treatment were evaluated monthly, than every 2 to 3 months for the next 18 months. A symptom assessment questionnaire was used to measure quality of life endpoints. RESULTS From June 1999 to March 2001 180 patients were accessioned from 34 institutions. A total of 168 were analyzable. Neither the best observed response within 3 months for the entire population, nor the response rate within sequelae category or the quality of life measures differed significantly between the 3 arms of the study. CONCLUSION Administration of PPS has not been associated with an improvement in the clinical course of radiation related morbidity of the gastrointestinal tract.
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Pajak T, Trotti A, Gwede C, Paulus R, Cooper J, Ridge J, Fu K, Ang K. The TAME Risk Classification System: Acute Toxicity Burden and IPD Analysis of RTOG 90–03. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Machtay M, Swann S, Komaki R, Byhardt R, Paulus R, Sause W, Curran W, Albain K, Movas B. O-041 What is the meaning of local-regional control after chemoradiation for locally advanced NSCLC? An RTOG analysis. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Trotti A, Pajak TF, Gwede C, Paulus R, Cooper J, Forastiere A, Garden A, Ang K. The TAME adverse event summary and risk classification system: Analysis of the RTOG H&N Database. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Trotti
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - T. F. Pajak
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - C. Gwede
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - R. Paulus
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - J. Cooper
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - A. Forastiere
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - A. Garden
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
| | - K. Ang
- H. Lee Moffitt Cancer Ctr, Tampa, FL; Radiation Therapy Oncology Group, Philadelphia, PA; Mamonides Cancer Ctr, New York, NY; Johns Hopkins Sydney Kimmel Cancer Ctr, Baltimore, MD; MD Anderson Cancer Ctr, Houston, TX
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Scott C, Stern J, Asbell S, Osborne D, Peer J, Wasserman T, Hinrich S, Paulus R, Scarantino C, Bruner D. Age and marital status linked to quality of life of long term survivors of head and neck or prostate cancer: report from a survey of radiation therapy oncology group patients. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02004-1] [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: 11/29/2022]
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Langer CJ, Ruffer J, Rhodes H, Paulus R, Murray K, Movsas B, Curran W. Phase II radiation therapy oncology group trial of weekly paclitaxel and conventional external beam radiation therapy for supratentorial glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001; 51:113-9. [PMID: 11516860 DOI: 10.1016/s0360-3016(01)01597-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 10/18/2022]
Abstract
PURPOSE Fractionated external beam radiotherapy (EBRT) +/- carmustine (BCNU) is the standard of care for patients with glioblastoma multiforme (GBM), but survival results remain poor. Preclinical studies indicate synergy between RT and paclitaxel (TAX) in astrocytoma cell lines. Phase I studies in GBM have demonstrated a maximum tolerated dose for TAX of 225 mg/m(2)/3 h/week x 6, during EBRT, with no exacerbation of typical RT-induced toxicities. The Radiation Therapy Oncology Group (RTOG) therefore mounted a Phase II study to determine the feasibility and efficacy of conventional EBRT and concurrent weekly TAX at its MTD. PATIENTS AND METHODS Sixty-two patients with histologic diagnosis of GBM were enrolled from 8/16/96 through 3/21/97 in a multi-institutional Phase II trial of EBRT and TAX 225 mg/m(2)/3 h (1-3 h before EBRT), administered the first treatment day of each RT week. Total EBRT dose was 60 Gy (200 cGy/fraction), 5 days per week. A smaller treatment field, to include gross disease plus a margin only, was used after 46 Gy. RESULTS Sixty-one patients (98%) were evaluable. Median age was 55 years (range, 28-78). Seventy-four percent were > or = 50 years. Recursive partitioning analysis (RPA) Classes III, IV, V, VI included 10 (17%), 21 (34%), 25 (41%), and 5 (8%) patients, respectively. Gross total resection was performed in only 16%. There was no Grade 3 or 4 neutropenia or thrombocytopenia. Hypersensitivity reactions precluding further use of TAX occurred in 4 patients. There were 2 instances of late neurotoxicity (4% Grade 3 or 4). Ninety-one percent of patients received treatment per protocol. Seventy-seven percent completed prescribed treatment (6 weeks). Of 35 patients with measurable disease, CR/PR was observed in 23%, MR in 17%, and SD in 43%. Seventeen percent demonstrated progression at first follow-up. Median potential follow-up time is 20 months. Median survival is 9.7 months, with median survivals for RPA classes III, IV, V, and VI of 16.3, 10.2, 9.5, 2.5 months, respectively. Ten patients remain alive. CONCLUSION Concurrent full-dose EBRT and weekly high-dose TAX is feasible in the majority of GBM patients. Acute toxicity is acceptable; myelosuppression and peripheral sensory neuropathy are surprisingly modest, despite considerably higher overall dose intensity, compared to that achievable in other disease sites. Median survival by RPA class without prolonged adjuvant therapy is comparable to RTOG controls treated with standard EBRT and BCNU (1 year of BCNU).
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Affiliation(s)
- C J Langer
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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de Vroege R, Wagemakers M, te Velthuis H, Bulder E, Paulus R, Huybregts R, Wildevuur W, Eijsman L, van Oeveren W, Wildevuur C. Comparison of three commercially available hollow fiber oxygenators: gas transfer performance and biocompatibility. ASAIO J 2001; 47:37-44. [PMID: 11199313 DOI: 10.1097/00002480-200101000-00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/26/2022] Open
Abstract
The new generation of oxygenators have improved blood flow pathways that enable reduction in priming volume and, thus, hemodilution during cardiopulmonary bypass (CPB). We evaluated three oxygenators and two sizes of venous reservoirs in relation to priming volume, gas transfer, and blood activation. To compare priming volume, gas transfer, and biocompatibility of three hollow fiber oxygenators and two different size venous reservoirs, 60 patients were randomly allocated in groups to undergo cardiopulmonary bypass. In each group, an oxygenator with a different surface area and priming volume was used: 1.8 m2 and 220 ml (group 1, n = 23), 2.2 m2 and 290 ml (group 2, n = 20), and 2.5 m2 and 270 ml (group 3, n = 17). In groups 1 and 3, a large soft shell (1900 ml) venous reservoir was used, whereas in group 2, a smaller soft shell (600 ml) venous reservoir was used. Gas transfer was assessed by calculating the oxygen transfer rate for each group and per square meter for each oxygenator group. Partial arterial oxygen pressure (paO2) and partial arterial carbon dioxide pressure (paCO2) between the groups were assessed with forward stepwise regression analysis. Biocompatibility was evaluated through measurement of platelet numbers, complement activation products (C3b/c), coagulation (thrombin anti-thrombin III complex), and fibrinolysis (plasmin anti-plasmin complex). No differences were found in oxygen transfer rate per group. However, when correcting the oxygen transfer rate for surface area, group 1 demonstrated a higher oxygen transfer rate compared with group 2 (p < 0.05) at an FiO2 of 40 and 60% and compared with group 3 at an FiO2 of 60 and 70%. The regression analysis showed that the average arterial PO2 was the highest in group 3, i.e., 79.2 mm Hg higher than in group 1 (p < 0.001) and 73.5 mm Hg higher than in group 2 (p < 0.001). Group 3 also had the lowest average arterial pCO2, 0.57 mm Hg lower than in group 1 (p = 0.004) and 0.81 mm Hg lower than in group 2 (p < 0.001). During CPB, platelet numbers decreased significantly in all groups (p < 0.001), without differences between the groups. C3b/c levels increased in all groups during CPB. At cessation of CPB the C3b/c level in group 2 (398 nmol/L(-1)) was significantly higher compared to group 1(251 nmol/L(-1); p < 0.05) and group 3 (303 nmol/L(-1); p < 0.05). Thrombin anti-thrombin III complexes and plasmin anti-plasmin complex complexes increased during CPB to significantly high levels at cessation of CPB, but there were no differences between the groups. The oxygenator with the smallest surface area and lowest priming volume (group 1) had the highest oxygen transfer rate per square meter and showed the least blood damage, as depicted by complement activation. The oxygenator with the largest blood contact surface area and improved geometric configuration (group 3) showed the lowest oxygen transfer rate per square meter. However, this oxygenator elevated oxygen partial pressure the most and reduced carbon dioxide partial pressure the most. In group 2, where a smaller venous reservoir was used, the highest blood activation was observed.
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Affiliation(s)
- R de Vroege
- Department of Extracorporeal Circulation, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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Stäbler A, Paulus R, Steinborn M, Bosch R, Matzko M, Reiser M. [Spondylolysis in the developmental stage: diagnostic contribution of MRI]. ROFO-FORTSCHR RONTG 2000; 172:33-7. [PMID: 10719460 DOI: 10.1055/s-2000-278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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 assess the value of MR imaging in demonstrating ongoing spondylolysis in adolescents. METHODS MRI was performed in 9 juvenile patients (3 female, 6 male aged 8-16 years; mean 12.5 y) with pain during hyperextension. In 6 patients a CT scan and in 5 a plain film was available. RESULTS In all patients bone marrow edema was found in the pars interarticularis and the pedicle, which was bilateral in 4 patients. In 7/9 cases the L5 vertebra was affected, in 2/9 cases spondylolysis was found in L4. In 3 cases the edema reached the middle third of the vertebral body and a tumor was suspected. In all CT scans a bilateral incomplete or complete cleft in the pars inter-articularis was found. In 4/6 CT-scans a sclerosis was seen in the area of the bone marrow edema. Only in 1/5 plain films was there a suspicion for a spondylolysis, four examinations were completely normal. CONCLUSIONS To eliminate underlying causal conditions of spondylolysis and to install specific therapy, early diagnosis is mandatory. MR imaging should be the first and only imaging modality in young patients with low back pain during and after exercise and pain with hyperextension. Bone scans and CT scans should be avoided due to irradiation, plain films usually do not reveal pathological findings in developing sponylolysis.
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Affiliation(s)
- A Stäbler
- Institut für Radiologische Diagnostik, Ludwig-Maximilians-Universität München Grosshadern
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Abstract
Quality assurance in orthopaedics--as in any medical speciality--relies on precise medical records. Data quality is crucial for statistical evaluation; missing values cannot be avoided but must be minimized. The quality assurance system must be accessible from many locations within the clinic; given the complex and heterogeneous computing infrastructure this is a technological challenge. Intranet technology--the application of internet-tools in local networks--can help to solve the technical problems. A generic Intranet-based quality assurance system in orthopaedics was designed, implemented and evaluated. The basic concept is an intranet data entry form which is generated semi-automatically from the data definition. This form is adapted according to the individual needs of the doctors (intelligent data entry). By flexible data transformation the same data set is used for clinical reports as well as scientific evaluations. The first use was for ultrasound examinations of neonatal hips. A report form consisting of 56 items was designed. Within the first 9-month period 1303 cases have been documented.
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Affiliation(s)
- M Dugas
- Institute for Medical Informatics of the Ludwig-Maximilian-University Munich, Germany
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Jansen PG, te Velthuis H, Bulder ER, Paulus R, Scheltinga MR, Eijsman L, Wildevuur CR. Reduction in prime volume attenuates the hyperdynamic response after cardiopulmonary bypass. Ann Thorac Surg 1995; 60:544-9; discussion 549-50. [PMID: 7677478 DOI: 10.1016/0003-4975(95)00385-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [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: 01/26/2023]
Abstract
BACKGROUND A hyperdynamic response to cardiopulmonary bypass is characteristically observed in the post-operative course. To determine the effect of prime volume on the hemodynamic response, a database study was performed on patients who underwent elective coronary artery bypass grafting with an extracorporeal circuit with either a large prime volume (2,350-mL prime, n = 20) or a small prime volume (1,400-mL prime, n = 20). METHODS Measurements were carried out at fixed time points before and after cardiopulmonary bypass (until 18 hours postoperatively) and include hematocrit, colloid oncotic pressure, fluid balance, and hemodynamic profile (mean of three measurements). RESULTS The lower colloid oncotic pressure in the large prime group (16.2 +/- 0.6 mm Hg versus 19.1 +/- 1.1 mm Hg, p = 0.0002) was associated with a highly positive fluid balance (5.5 +/- 0.9 L versus 2.8 +/- 0.7 L, p = 0.0001). With the on-bypass hematocrit aimed at 22% to 23%, autologous blood was predonated by 16 patients in the small prime group but by none in the large prime group. Reinfusion of autologous blood resulted in a reduction in blood bank requirements (p = 0.03). Mean arterial pressure was 83 +/- 4 mm Hg for small prime versus 76 +/- 4 mm Hg for large prime (p = 0.01). Cardiac index was 2.9 +/- 0.2 L.min-1.m-2 for small prime versus 3.8 +/- 0.3 L.min-1.m-2 for large prime (p = 0.0001). Pulmonary vascular resistance index was 281 +/- 40 dyne.s.cm5.m-2 for small prime versus 188 +/- 22 dyne.s.cm5.m-2 for large prime (p = 0.0009). Oxygen delivery was 42 +/- 5 mL.min-1.m-2 for small prime versus 51 +/- 3 mL.min-1.m-2 for large prime (p = 0.004). Vasoactive medication was not different among groups. CONCLUSIONS Reduction in prime volume attenuates the hyperdynamic response after cardiopulmonary bypass. Furthermore, an important reduction in blood bank products can be obtained with small prime volumes.
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Affiliation(s)
- P G Jansen
- Center for Cardiopulmonary Surgery Amsterdam, Free University Hospital, The Netherlands
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Jansen PG, te Velthuis H, Huybregts RA, Paulus R, Bulder ER, van der Spoel HI, Bezemer PD, Slaats EH, Eijsman L, Wildevuur CR. Reduced complement activation and improved postoperative performance after cardiopulmonary bypass with heparin-coated circuits. J Thorac Cardiovasc Surg 1995; 110:829-34. [PMID: 7564452 DOI: 10.1016/s0022-5223(95)70117-6] [Citation(s) in RCA: 87] [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: 01/26/2023]
Abstract
A randomized controlled trial that involved 30 patients undergoing elective coronary artery bypass grafting was done to determine the effect of heparin-coated circuits and full heparinization on complement activation, neutrophil-mediated inflammatory response, and postoperative clinical recovery. Peak concentrations of terminal complement complex were 38% lower (p = 0.004) in 15 patients treated with heparin-coated circuits (median 775 micrograms/L, interquartile range 600 to 996) compared with those in 15 patients treated with uncoated circuits (median 1249 micrograms/L, interquartile range 988 to 1443). Although no significant intergroup differences in concentrations of polymorphonuclear neutrophil elastase were found, a positive correlation (rs = 0.74, p < 0.0007) was calculated between peak concentrations of terminal complement complex and polymorphonuclear neutrophil elastase. Differences in patient recovery were analyzed with use of a score composed of fluid balance, postoperative intubation time, and the difference between rectal temperature and skin temperature. The score was significantly lower in patients treated with heparin-coated circuits (p = 0.03), whereas its components showed no intergroup significance. We conclude that the use of heparin-coated circuits with full systemic heparinization results in improved biocompatibility, as assessed by complement activation, and leads to an improved postoperative recovery of the patient.
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Affiliation(s)
- P G Jansen
- Center for Cardiopulmonary Surgery Amsterdam, Free University Hospital, The Netherlands
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Lorenz J, Friedberg T, Paulus R, Oesch F, Ferlinz R. Oncogene overexpression in non-small-cell lung cancer tissue: prevalence and clinicopathological significance. Clin Investig 1994; 72:156-63. [PMID: 8186664 DOI: 10.1007/bf00184595] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In contrast to small-cell lung cancer, few data are available on the role of oncogene overexpression in non-small-cell lung cancers (NSCLC). To determine the prevalence and extent of the transcriptional activation of cancer genes in NSCLC we investigated the level of mRNA of the three important cellular oncogenes--erbB2, Ki-ras, and c-myc--in 39 surgically or endoscopically obtained tumor samples and 24 samples of normal bronchopulmonary tissue taken from the same patients. Tissue RNA was prepared and the specific mRNA analyzed by the highly sensitive nuclease S1 protection assay. Oncogene mRNA in the tumors was quantified by comparison with the homogeneously weak signals in normal lung tissue preparations with densitometry. The presence of two- to four-fold excess RNA was defined as moderate and a greater than fourfold RNA amount as strong gene overexpression. In contrast to normal tissue the oncogene mRNA amount varied considerably among tumors, showing increases up to 64-fold in erbB2, 13-fold in Ki-ras, and 57-fold in c-myc. Moderate and strong (in brackets) mRNA overexpression occurred with 33% (33%) in erbB2, 36% (18%) in Ki-ras, and 18% (23%) in c-myc. Simultaneous overexpression of two genes was observed with 41% and increased mRNA of all genes tested with 20% of the NSCLC samples. Augmented oncogene mRNA was observed most frequently in large-cell carcinoma. The c-myc overexpression was significantly more prevalent in large-cell cancer than in adenocarcinoma. Tumor differentiation was negatively correlated with c-myc mRNA amounts.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Lorenz
- III. Medizinische Klinik und Poliklinik, Johannes Gutenberg Universität, Mainz
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Juliá A, Bogaerts M, Paulus R, Crombez R, Domingo A, Ehrnström B, Hanson F, Johansson C, Soler J, Yosef H, Zachée N, Nilsson B. Prednimustine — clinical activity in low grade NHL refractory to chlorambucil and prednisolone. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91612-o] [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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Affiliation(s)
- C Rizo-Patron
- Division of Cardiology, Texas Heart Institute, Baylor College of Medicine, Houston 77030
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Garreau F, Toulhoat H, Kasztelan S, Paulus R. Low-temperature synthesis of mixed NiMo sulfides: structural, textural and catalytic properties. Polyhedron 1986. [DOI: 10.1016/s0277-5387(00)84911-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [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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Paulus R. [Immunoblastic lymphosarcoma "B". Clinical presentation of 8 cases]. Rev Med Liege 1983; 38:239-56. [PMID: 6603006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Neumann G, Paulus R. [Developmental trends in mortality]. Lebensversicher Med 1977; 29:73-7. [PMID: 17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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