1
|
Lu S, Rakovitch E, Hannon B, Zimmermann C, Dharmarajan KV, Yan M, De Almeida JR, Yao CMKL, Gillespie EF, Chino F, Yerramilli D, Goonaratne E, Abdel-Rahman F, Othman H, Mheid S, Tsai CJ. Palliative Care as a Component of High-Value and Cost-Saving Care During Hospitalization for Metastatic Cancer. JCO Oncol Pract 2024:OP2300576. [PMID: 38442311 DOI: 10.1200/op.23.00576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/06/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
PURPOSE Randomized controlled trials have demonstrated that palliative care (PC) can improve quality of life and survival for outpatients with advanced cancer, but there are limited population-based data on the value of inpatient PC. We assessed PC as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer and identified hospitalization characteristics significantly associated with high costs. METHODS Hospitalizations of patients 18 years and older with a primary diagnosis of metastatic cancer from the National Inpatient Sample from 2010 to 2019 were analyzed. We used multivariable mixed-effects logistic regression to assess medical services, patient demographics, and hospital characteristics associated with higher charges billed to insurance and hospital costs. Generalized linear mixed-effects models were used to determine cost savings associated with provision of PC. RESULTS Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in US dollars (USD) to $56,098 USD, whereas the median hospital cost remained stable at $14,300 USD. Receipt of inpatient PC was associated with significantly lower charges (odds ratio [OR], 0.62 [95% CI, 0.61 to 0.64]; P < .001) and costs (OR, 0.59 [95% CI, 0.58 to 0.61]; P < .001). Factors associated with high charges were receipt of invasive medical ventilation (P < .001) or systemic therapy (P < .001), Hispanic patients (P < .001), young age (18-49 years, P < .001), and for-profit hospitals (P < .001). PC provision was associated with a $1,310 USD (-13.6%, P < .001) reduction in costs per hospitalization compared with no PC, independent of the receipt of invasive care and age. CONCLUSION Inpatient PC is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Integration of inpatient PC may de-escalate costs incurred through low-value inpatient interventions.
Collapse
Affiliation(s)
- Sifan Lu
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Eileen Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kavita V Dharmarajan
- Department of Radiation Oncology and the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Yan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John R De Almeida
- Department of Otolaryngology Head and Neck Surgery, University Health Network, Toronto, ON, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology Head and Neck Surgery, University Health Network, Toronto, ON, Canada
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Fadwa Abdel-Rahman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hiba Othman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sara Mheid
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Chiaojung Jillian Tsai
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
2
|
Mheid S, Allen S, Ng SSW, Hall WA, Sanford NN, Aguilera TA, Elamir AM, Bahij R, Intven MPW, Radhakrishna G, Mohamad I, De Leon J, Tan H, Lewis S, Gani C, Stanecu T, Dell’Acqua V, Hosni A. Local Control Following Stereotactic Body Radiation Therapy for Liver Oligometastases: Lessons from a Quarter Century. Curr Oncol 2023; 30:9230-9243. [PMID: 37887567 PMCID: PMC10605011 DOI: 10.3390/curroncol30100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
The utilization of stereotactic body radiation therapy for the treatment of liver metastasis has been widely studied and has demonstrated favorable local control outcomes. However, several predictive factors play a crucial role in the efficacy of stereotactic body radiation therapy, such as the number and size (volume) of metastatic liver lesions, the primary tumor site (histology), molecular biomarkers (e.g., KRAS and TP53 mutation), the use of systemic therapy prior to SBRT, the radiation dose, and the use of advanced technology and organ motion management during SBRT. These prognostic factors need to be considered when clinical trials are designed to evaluate the efficacy of SBRT for liver metastases.
Collapse
Affiliation(s)
- Sara Mheid
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Nova Scotia Health, Halifax, NS B3H 4R2, Canada;
| | - Sylvia S. W. Ng
- Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Todd A. Aguilera
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Ahmed M. Elamir
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75235, USA; (N.N.S.); (T.A.A.); (A.M.E.)
| | - Rana Bahij
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark;
| | - Martijn P. W. Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre, 3584 CX Utrecht, The Netherlands;
| | - Ganesh Radhakrishna
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | | | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, WA 6150, Australia;
- GenesisCare, Perth, WA 6150, Australia
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Teo Stanecu
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| | - Veronica Dell’Acqua
- Medical Affairs and Clinical Research, Linac-Based RT, Elekta Milan, 20864 Lombardy, Italy;
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (S.M.); (T.S.)
| |
Collapse
|
3
|
Lu S, Rakovitch E, Hannon B, Zimmermann C, Yan M, de Almeida J, Yao CM, Gillespie EF, Chino F, Yerramilli D, Abdel-Rahman F, Othman H, Mheid S, Tsai CJ. Palliative Care as a Component of High Value and Cost-Saving Care During Hospitalization for Metastatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e602-e603. [PMID: 37785818 DOI: 10.1016/j.ijrobp.2023.06.1967] [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) Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs. MATERIALS/METHODS This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with high charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care. RESULTS Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P <.001) and costs (OR, 0.59; 95% CI, 0.58-0.61; P<.001). Factors associated with high charges were receipt of invasive medical ventilation (P<.001) or systemic therapy (P<.001), Hispanic patients (P<.001), and young age (18-49 years, P<.001). For-profit hospitals were more likely to bill high charges (OR, 5.05; 95% CI, 4.78-5.33, P<.001) but less likely to incur high hospital costs (OR, 0.51; 95% CI, 0.48-0.54, P<.001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P<.001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019). CONCLUSION Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.
Collapse
Affiliation(s)
- S Lu
- SUNY Downstate College of Medicine, Brooklyn, NY
| | - E Rakovitch
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Hannon
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - C Zimmermann
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Yan
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C M Yao
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - E F Gillespie
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - F Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - H Othman
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - S Mheid
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - C J Tsai
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
4
|
Almasri H, Erjan A, Abudawaba H, Ashouri K, Mheid S, Alnsour A, Abdel-Razeq H. Clinical Characteristics and Survival Outcomes of Patients with De Novo Metastatic Breast Cancer. Breast Cancer (Dove Med Press) 2022; 14:363-373. [PMID: 36340331 PMCID: PMC9628702 DOI: 10.2147/bctt.s383874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
Purpose Though less than 5% of patients with breast cancer present with De Novo Metastasis (dnMBC) in Western societies, this percentage may reach 30% in developing countries. In this study, we present survival outcomes of patients diagnosed with dnMBC treated at a tertiary center in a developing country. Patients and Methods Using hospital-based database, consecutive patients with dnMBC diagnosed between 2013 and 2017 were identified. Demographic data, tumor characteristics, types of treatment, and survival data were retrospectively collected. Results A total of 435 patients were included; median age (range) at time of diagnosis was 51 (24-85) years. Most of the tumors expressed hormone receptors (81% Estrogen Receptor positive, 77% Progesterone Receptor positive). Human epidermal growth factor receptor-2 (HER2) overexpression was reported in 134 (30.9%) patients, while only 24 (5.5%) had Triple Negative (TN) disease. Bone, lung and liver were the most common sites of metastasis involved in 70.6%, 36.1%, and 32.0%, respectively. The median Overall Survival (OS) for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, high tumor grade, advanced T-stage, TN-disease and metastasis to multiple sites, but not HER2 status, were associated with poor OS. On multivariate analysis, high tumor grade (Hazard Ratio =1.6, p=0.002), advanced T-stage (Hazard Ratio=1.6, p=0.003), and triple negative status (Hazard Ratio= 2.1, p=0.008) predicted poor OS. Conclusion The overall survival of patients with dnMBC remains poor. Better understanding of the disease behavior and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients' outcomes.
Collapse
Affiliation(s)
- Hanan Almasri
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ayah Erjan
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hebah Abudawaba
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Khaled Ashouri
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Sara Mheid
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anoud Alnsour
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan,Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan,Correspondence: Hikmat Abdel-Razeq, Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan, Tel +96265300460, Email
| |
Collapse
|
5
|
Khader J, Glicksman RM, Mheid S, Mansour A, Giuliani ME, Gospodarowicz M, Almousa A, Abdel-Razeq H, Rodin D. Enhancing International Cancer Organization Collaborations: King Hussein Cancer Center and Princess Margaret Cancer Centre Model for Collaboration. J Cancer Educ 2022; 37:763-769. [PMID: 32926325 DOI: 10.1007/s13187-020-01878-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
Collaborative partnerships, which link two health organizations with shared characteristics to achieve common goals and to improve healthcare quality, are becoming increasingly common in oncology. The purpose of this study is to review the collaboration between King Hussein Cancer Center (KHCC) and Princess Margaret Cancer Centre (PM). The context, input, process, and product (CIPP) model, a quasi-experimental form of program evaluation, has been applied to the KHCC-PM collaboration. This model is well suited to evaluate complex collaborations as it does not assume linear relationships. Data sources include stakeholders' judgements of the collaboration, assessment of achievements, and informal interviews with key participants involved in the program. KHCC and PM are recognized as high-caliber comprehensive cancer centers, with a common goal of delivering high-quality care to patients. Through personal relationships among faculty in the centers and the perceived opportunities for mutual benefit, KHCC and PM signed a memorandum of understanding in 2013 to enter into a formal partnership. This partnership has been an evolving process that started with collaboration on education and grew to include clinical care. Research is an area for potential future collaboration. Enabling factors in the collaboration include dedication of individuals involved, trusting relationships amongst faculty, and the reciprocal nature of the relationship. Challenges have been financial, competing interests, and the absence of a successful collaborative model to follow. The KHCC and PM collaboration has been successful. A strategic plan is being developed and followed to guide areas of expansion.
Collapse
Affiliation(s)
- Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan
| | - Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sara Mheid
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan.
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Meredith E Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Mary Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Abdelatif Almousa
- Department of Radiation Oncology, King Hussein Cancer Center, P.O Box 1269, Amman, 11941, Jordan
| | | | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| |
Collapse
|
6
|
Almasri H, Erjan A, Abudawaba H, Ashouri K, Mheid S, Alnsour A, Abdel-Razeq H. Abstract P4-07-27: De novo metastatic breast cancer; clinical characteristics and treatment outcomes in a developing country. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-07-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Distant metastasis at the time of diagnosis of breast cancer is found in approximately 6% of new cases and much more in developing countries. Due to distinct biologic and molecular characteristics, de novo Metastatic Breast Cancer (dnMBC) is inherently different from recurrent metastatic breast cancer (rMBC). Data on de novo metastatic breast cancer is limited due to the heterogeneity of the disease and the lack of distinction between rMBC and dnMBC in most of the published literature. In this study, we aim to review the survival outcomes of patients diagnosed with dnMBC treated at a tertiary cancer center in a developing country and to identify factors that affect their outcome. Methods: Using hospital-based database, consecutive patients with pathologically proven dnMBC diagnosed between 2013 and 2017 inclusive were identified. Retrospective chart review was performed to collect demographic data, tumor characteristics, types of treatment, and dates of death/last follow-up. Overall survival (OS) was defined as the time from diagnosis to death from any cause or last follow-up. Survival was estimated using the Kaplan-Meier method and compared between subgroups using log-rank tests. Multivariate analysis was performed using cox regression method. Results: 435 patients (3 males) were included in the analysis. Median age (range) at time of diagnosis was 51 (24- 85) years, and 99 (22.8%) were younger than 40 years. Predominant histology was invasive ductal carcinoma (IDC) in 372 (75.2%) patients, followed by invasive lobular carcinoma (ILC) in 37 (8.5%) patients. Poor prognostic features of the primary tumor were present in majority of patients, including: high grade (n=201, 46%), advanced T-stage (T3/T4) (n=205, 47.2%), and lymph node involvement (n=322, 74%). Most of the tumors expressed hormone receptors (81% ER+, 77% PR+). HER-2neu overexpression was reported in 134 (30.9%) patients while only 24 (5.5%) had triple negative (TN) disease. The most common sites of distant metastases were bone (n=307, 70.6%) followed by lung (n=157, 36.1%) and liver (n=139, 32%). The median OS for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, factors associated with poor OS were: GIII (5-year OS: 45.8% in GI and II vs 19.1% in GIII), log rank p<0.001), advanced T-stage (5-year OS: 47% for T1/T2 vs 26.5% for T3/T4 tumors, log rank p<0.001), TN status (5-year OS 0 % in TN vs 35% in non-TN, log rank p<0.001), and metastasis to multiple sites (5-year OS: 50% for metastasis to a single site vs 24% for multiple sites (log rank p<0.001). No difference in OS was observed based on HER-2neu overexpression. On multivariate analysis, high tumor grade (Hazard ratio (HR) =1.6, p=0.002), advanced T-stage (HR=1.6, p=0.003) and triple negative status (HR= 2.1, p=0.008) predicted poor OS. Conclusions: The overall survival of patients with dnMBC remains poor. Better understanding of the disease behaviour and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients’ outcomes.
Citation Format: Hanan Almasri, Ayah Erjan, Hebah Abudawaba, Khaled Ashouri, Sara Mheid, Anoud Alnsour, Hikmat Abdel-Razeq. De novo metastatic breast cancer; clinical characteristics and treatment outcomes in a developing country [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-27.
Collapse
Affiliation(s)
| | - Ayah Erjan
- King Hussein Cancer Center, Amman, Jordan
| | | | | | - Sara Mheid
- King Hussein Cancer Center, Amman, Jordan
| | | | | |
Collapse
|
7
|
Dayyat A, Mheid S, Erjan A, AlHammadi A, Alnsoor A, Abdelrahman F, Al Masri H, Al-Rashdan A. Predictors of Recurrences in Stage II-III Breast Cancer in Patients Receiving Neoadjuvant Systemic Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.620] [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]
|
8
|
Abu-Hijlih R, Mheid S, Abuhijla F, Asha W, Mohamad I, Alrashdan A, Alheet S, Kana’an H, Abd Al-Raheem M, Almousa A. Adaptive radiotherapy in patients receiving neoadjuvant radiation for soft tissue sarcoma. Rep Pract Oncol Radiother 2019; 24:263-268. [PMID: 30936782 PMCID: PMC6426708 DOI: 10.1016/j.rpor.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/15/2018] [Accepted: 02/19/2019] [Indexed: 02/07/2023] Open
Abstract
AIM The aim of this study is to evaluate tumor volume changes during preoperative radiotherapy and to assess the role of adaptive radiation. BACKGROUND Contemporary neoadjuvant radiotherapy utilizes image guidance for precise treatment delivery. Moreover, it may depict changes in tumor size and shape. MATERIALS AND METHODS Between 2016 and 2018, 23 patients aged ≥18 years with soft tissue sarcoma were treated with neoadjuvant radiation followed by surgical resection. The tumor volumes (cc) were measured using the Pinnacle planning system prior to starting radiotherapy and during treatment, the changes in volume and absolute differences were estimated. Moreover, patient's position on the machine was evaluated to assess setup offsets. The triggers for plan adaptation were >1 cm expansion or unacceptable setup offsets. RESULTS The mean tumors volume at presentation was 810 cc (range, 55-4000). At last cone beam CT the tumor volume had changed in 14 patients (61%); it was stable in nine patients (39%). Disease regression was documented in eight patients (35%), with median shrinkage of -20.5% (range, -2 to -29%), while tumor progression was observed in six cases (26%), the median change was 12.5% (range, +10 to +25%).Adaptive radiation was required in four patients (17%). For the remaining 19 cases (83%), the dose distribution was adequate to cover target volumes. CONCLUSIONS Change in soft tissue sarcoma volume during radiation is not uncommon. Image guidance should be used to reduce setup errors and to detect differences in tumor volume. Image guidance and adaptive radiation are paramount to ensure optimal radiation delivery.
Collapse
Affiliation(s)
- Ramiz Abu-Hijlih
- Radiation Oncology Department, King Hussein Cancer Center, PO Box 1269, Amman 11941, Jordan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Khader J, Mheid S, AbuHijla F, AlKarmi N, Yousef Y, Othman Y. Choroidal Metastasis as an Unusual Initial Presentation of Transitional Cell Carcinoma of the Kidney. Case Rep Oncol 2016; 9:672-678. [PMID: 27920701 PMCID: PMC5118837 DOI: 10.1159/000452329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 02/05/2023] Open
Abstract
Metastases of transitional cell carcinoma (TCC) of the renal pelvis to the eye is a very rare event, as only one previous case has been described in the literature. We present a patient with choroidal metastasis secondary to TCC of the renal pelvis, with a review of the relevant literature. A 61-year-old male presented with sudden-onset loss of vision of the left eye. Upon evaluation and assessment, the patient was found to have unilateral choroidal metastasis secondary to TCC of the renal pelvis. He is currently on palliative chemotherapy with carboplatin and gemcitabine. External beam radiation therapy is a common mode of treatment and will be considered accordingly.
Collapse
Affiliation(s)
- Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
- *Jamal Khader, MD, Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman 11941 (Jordan), E-Mail
| | - Sara Mheid
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Fawzi AbuHijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nadi AlKarmi
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Yacoub Yousef
- Department of Surgery/Ophthalmology, King Hussein Cancer Center, Amman, Jordan
| | - Yazan Othman
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|