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Grosinger AJ, Alcorn SR. An Update on the Management of Bone Metastases. Curr Oncol Rep 2024; 26:400-408. [PMID: 38539021 PMCID: PMC11021281 DOI: 10.1007/s11912-024-01515-8] [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] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW Increasing life expectancy among patients with advanced cancer has placed a greater emphasis on optimizing pain control and quality of life. Concurrently, significant advancements in radiotherapy for bone metastases have permitted for dose escalation strategies such as stereotactic radiotherapy. This review aims to provide updated information on the management of bone metastases in light of these developments. RECENT FINDINGS We reviewed recent studies regarding the role and details of external beam radiotherapy for bone metastases, with emphasis on differences by treatment site as well as intention (palliative versus ablative for oligometastases). Conventional palliative radiotherapy remains a mainstay of management. While stereotactic radiotherapy may augment durability of pain relief and even survival time, there are significant questions remaining regarding optimal dosing and patient selection. Radiotherapy for bone metastases continues to evolve, particularly with increasing use of stereotactic radiotherapy. Future studies are needed to clarify optimal dose, fractionation, modality, and patient selection criteria among different radiotherapy approaches.
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Affiliation(s)
- Alexander J Grosinger
- Department of Radiation Oncology, University of Minnesota Medical School, Mail Code 494, 420 Delaware St. SE, Minneapolis, MN, 55455-0110, USA
| | - Sara R Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Mail Code 494, 420 Delaware St. SE, Minneapolis, MN, 55455-0110, USA.
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Palm J, Ono M, Niedermaier C, Hörer J, Hoffmann G, Holdenrieder S, Klawonn F, Ewert P. Quantification of ventricular stress in univentricular hearts during early childhood using age-independent zlog-NT-proBNP. Int J Cardiol 2024:131983. [PMID: 38521506 DOI: 10.1016/j.ijcard.2024.131983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Children with univentricular hearts (UVH) undergo up to three palliative surgical procedures to achieve complete circulatory separation (Fontan circulation). As a marker of cardiac wall stress, NT-proBNP is a promising tool to assess systemic ventricular load in these patients. However, different reference intervals (RI) apply to each stage, as NT-proBNP is highly age-dependent. METHODS Children undergoing systemic-to-pulmonary (SP) shunt placement (stage 1), bidirectional cavopulmonary shunt (BCPS, stage 2) or total cavopulmonary connection (TCPC, stage 3) between 2011 and 2021 with NT-proBNP measurement within 7 days before surgery were included. Furthermore, outpatients after TCPC with NT-proBNP measurement were enrolled. Biomarker levels were evaluated using its age-adjusted z-score ("zlog-NT-proBNP"; age-independent RI, -1.96 to +1.96), allowing comparison between different stages and revealing changes in systemic ventricular load independent of the marked physiological decline in RI with age. RESULTS Overall, 289 children (227 before, 62 after TCPC) met the eligibility criteria. Median time between blood sampling and surgery (SP shunt/BCPS/TCPC) was 2 [1-3] days and 3.2 [2.0-4.5] years after TCPC. Age-adjusted zlog-NT-proBNP levels were 3.47 [2.79-3.93] in children with native UVH (before SP shunt), 3.10 [1.89-3.58] at stage 1 (before BCPS), 1.08 [0.51-1.88] at stage 2 (before TCPC), and 1.09 [0.72-1.75] at stage 3 (after TCPC/Fontan completion). Consequently, BCPS revealed the strongest decrease (median - 2.02 logarithmized standard deviations, p < 0.001). CONCLUSIONS In children with UVH undergoing staged Fontan palliation, zlog-NT-proBNP is a highly promising tool for course assessment of systemic ventricular load, independent of the age-related decline in physiological NT-proBNP concentration.
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Affiliation(s)
- Jonas Palm
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany.
| | - Masamichi Ono
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Carolin Niedermaier
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Jürgen Hörer
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Georg Hoffmann
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany; Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbuttel, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
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Waltenberger M, Vogel MME, Bernhardt D, Münch S, Dobiasch S, Redmond KJ, Lo SS, Acker G, Fehlings MG, Ringel F, Vajkoczy P, Meyer B, Combs SE. Radiotherapy concepts for spinal metastases-results from an online survey among radiation oncologists of the German Society for Radiation Oncology. Strahlenther Onkol 2024; 200:159-174. [PMID: 37272996 PMCID: PMC10805849 DOI: 10.1007/s00066-023-02082-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Spinal metastases (SM) are a common radiotherapy (RT) indication. There is limited level I data to drive decision making regarding dose regimen (DR) and target volume definition (TVD). We aim to depict the patterns of care for RT of SM among German Society for Radiation Oncology (DEGRO) members. METHODS An online survey on conventional RT and Stereotactic Body Radiation Therapy (SBRT) for SM, distributed via e‑mail to all DEGRO members, was completed by 80 radiation oncologists between February 24 and April 29, 2022. Participation was voluntary and anonymous. RESULTS A variety of DR was frequently used for conventional RT (primary: n = 15, adjuvant: n = 14). 30 Gy/10 fractions was reported most frequently. TVD in adjuvant RT was heterogenous, with a trend towards larger volumes. SBRT was offered in 65% (primary) and 21% (adjuvant) of participants' institutions. A variety of DR was reported (primary: n = 40, adjuvant: n = 27), most commonly 27 Gy/3 fractions and 30 Gy/5 fractions. 59% followed International Consensus Guidelines (ICG) for TVD. CONCLUSION We provide a representative depiction of RT practice for SM among DEGRO members. DR and TVD are heterogeneous. SBRT is not comprehensively practiced, especially in the adjuvant setting. Further research is needed to provide a solid data basis for detailed recommendations.
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Affiliation(s)
- Maria Waltenberger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Marco M E Vogel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | - Güliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
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Bögli SY, Stretti F, Utebay D, Hitz L, Hertler C, Brandi G. Limitation of life sustaining measures in neurocritical care: sex, timing, and advance directive. J Intensive Care 2024; 12:3. [PMID: 38225647 PMCID: PMC10790395 DOI: 10.1186/s40560-023-00714-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The limitation of life sustaining treatments (LLST) causes ethical dilemmas even in patients faced with poor prognosis, which applies to many patients admitted to a Neurocritical Care Unit (NCCU). The effects of social and cultural aspects on LLST in an NCCU population remain poorly studied. METHODS All NCCU patients between 01.2018 and 08.2021 were included. Medical records were reviewed for: demographics, diagnosis, severity of disease, and outcome. Advance directives (AD) and LLST discussions were reviewed evaluating timing, degree, and reason for LLST. Social/cultural factors (nationality, language spoken, religion, marital status, relationship to/sex of legal representative) were noted. Associations between these factors and the patients' sex, LLST timing, and presence of AD were evaluated. RESULTS Out of 2975 patients, 12% of men and 10.5% of women underwent LLST (p = 0.30). Women, compared to men, more commonly received withdrawal instead of withholding of life sustaining treatments (57.5 vs. 45.1%, p = 0.028) despite comparable disease severity. Women receiving LLST were older (73 ± 11.7 vs. 69 ± 14.9 years, p = 0.005) and often without a partner (43.8 vs. 25.8%, p = 0.001) compared to men. AD were associated with female sex and early LLST, but not with an increased in-hospital mortality (57.1 vs. 75.2% of patients with and without AD respectively). CONCLUSIONS In patients receiving LLST, the presence of an AD was associated with an increase of early LLST, but not with an increased in-hospital mortality. This supports the notion that the presence of an AD is primarily an expression of the patients' will but does not per se predestine the patient for an unfavorable outcome.
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Affiliation(s)
- Stefan Yu Bögli
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Federica Stretti
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Didar Utebay
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Ladina Hitz
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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Soliman YY, Kundranda M, Kachaamy T. Endoscopic Palliative Therapies for Esophageal Cancer. Gastrointest Endosc Clin N Am 2024; 34:91-109. [PMID: 37973233 DOI: 10.1016/j.giec.2023.07.003] [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] [Indexed: 11/19/2023]
Abstract
Endoscopic palliation of dysphagia for patients with inoperable esophageal cancer is complex, highly dependent on local expertise, and best done in a multidisciplinary fashion. Systemic therapy is the standard of care because it has been shown to improve survival. Esophageal stenting has traditionally been the most used endoscopic modality. Some modalities such as laser and photodynamic therapy are rarely used. There has been an increasing amount of data on cryotherapy, especially for patients with mild-to-moderate dysphagia on systemic chemotherapy. This article will discuss the latest evidence guiding the palliation of esophageal cancer.
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Affiliation(s)
- Youssef Y Soliman
- Gastroenterology, City of Hope Phoenix, 14200 W Celebrate Life Way, Goodyear, AZ 85338, USA
| | - Madappa Kundranda
- Gastrointestinal Oncology, Banner MD Anderson Cancer Center, Banner Gateway Medical Center, 2946 East Banner Gateway Drive, Gilbert, AZ 85324, USA
| | - Toufic Kachaamy
- Gastroenterology, City of Hope Phoenix, 14200 W Celebrate Life Way, Goodyear, AZ 85338, USA.
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Sezgin D, Geraghty J, Graham T, Blomberg K, Charnley K, Dobbs S, McElvaney A, Probst S, Beeckman D, Grocott P, Gethin G. Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce. J Tissue Viability 2023; 32:627-634. [PMID: 37482507 DOI: 10.1016/j.jtv.2023.07.002] [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: 03/07/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION A review protocol was developed but not registered.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - Jemell Geraghty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Tanya Graham
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care (AIIHPC), Dublin, Ireland
| | - Sharon Dobbs
- Wellington Hospital HCA Healthcare, London, United Kingdom
| | - Aideen McElvaney
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Sebastian Probst
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Geneva, Switzerland; University Hospital Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Sweden
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
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Stauder MC. Radiation for inflammatory breast cancer: Updates. Int Rev Cell Mol Biol 2023; 384:25-46. [PMID: 38637098 DOI: 10.1016/bs.ircmb.2023.10.004] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Inflammatory breast cancer (IBC) is a diagnosis based on a constellation of clinical features of edema (peau d'orange) of a third or more of the skin of the breast with a palpable border and a rapid onset of breast erythema. Incidence of IBC has increased over time, although it still makes up only 1-4% of all breast cancer diagnoses. Despite recent encouraging data on clinical outcomes, the published local-regional control rates remain consistently lower than the rates for non-IBC. In this review, we focus on radiotherapy, provide a framework for multi-disciplinary care for IBC, describe local-regional treatment techniques for IBC; highlight new directions in the management of patients with metastatic IBC and offer an introduction to future directions regarding the optimal treatment and management of IBC.
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Affiliation(s)
- Michael C Stauder
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Department of Breast Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Holcombe Blvd, Houston, TX, United States.
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Chandra A, Debnath A, Nongkynrih B. Palliative Care Need in India: A Systematic Review and Meta-analysis. Indian J Palliat Care 2023; 29:375-387. [PMID: 38058486 PMCID: PMC10696344 DOI: 10.25259/ijpc_140_2023] [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: 05/30/2023] [Accepted: 10/04/2023] [Indexed: 12/08/2023] Open
Abstract
Background To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India. Methods A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I2 test. Subgroup analyses were conducted based on the study site, urban-rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis. Results Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42-11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population. Conclusion This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.
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Affiliation(s)
- Ankit Chandra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aninda Debnath
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Yamamoto A, Ieki H, Shimamura M, Tsujiura M, Yokoe T, Sanuki N, Ojima E, Uchida K, Mohri Y. Symptom palliation with QUAD Shot radiation therapy to penile metastasis derived from descending colon cancer: a case report. Int Cancer Conf J 2023; 12:210-215. [PMID: 37251007 PMCID: PMC10212838 DOI: 10.1007/s13691-023-00604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
A 54-year-old man was diagnosed with descending colon cancer with metastases in the liver, para-aortic lymph nodes, and penis, and chemotherapy was introduced after construction of a colostomy. The patient reported only mild penile pain at the time of diagnosis; however, the pain gradually worsened and interfered with his daily life. Opioids did not provide sufficient analgesia, and the patient developed dysuria and priapism. Through construction of a cystostomy, palliative radiotherapy with QUAD Shot regimen (14 Gy in 4 fractions twice-daily on 2 days repeated every 4 weeks) to the penile metastasis was started for pain relief and tumor shrinkage. The radiation rapidly improved the penile symptoms, enabling opioid reduction and cystostomy removal. The patient remained pain-free and able to urinate on his own until his death. Metastatic penile tumors are rare, especially those derived from colon cancer. Penile metastases occur mainly in the late stages of cancer and may impair the patient's quality of life. In such cases, palliative radiotherapy, especially with QUAD Shot regimen, is useful with short treatment time, durable symptom control, and little adverse effect, maintaining quality of life.
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Affiliation(s)
- Akira Yamamoto
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507 Japan
| | - Hideharu Ieki
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Mai Shimamura
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Masahiro Tsujiura
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Takeshi Yokoe
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Naoko Sanuki
- Department of Radiation Oncology, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Eiki Ojima
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Keiichi Uchida
- Department of Pediatric Surgery, Mie Prefectural General Medical Center, 5450-132 Hinaga, Yokkaichi, Mie 514-8561 Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal and General Surgery, Mie Prefectural General Medical Center, 5450-132, Hinaga, Yokkaichi, Mie 514-8561 Japan
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Papalexis N, Peta G, Vara G, Spinnato P, Errani C, Martella C, Miceli M, Facchini G. Palliative Arterial Embolization for Metastases of the Sternum. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03459-1. [PMID: 37188897 DOI: 10.1007/s00270-023-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND To investigate the safety and efficacy of palliative arterial embolization for metastases of the sternum. MATERIALS AND METHODS This study included 10 consecutive patients (5 M, 5 F; mean age 58.1; range 37-70) with metastases of the sternum from different primary tumors, treated with palliative arterial embolization using NBCA-Lipiodol between January 2007 and June 2022. Four patients received a second embolization at the same site, for a total of 14 embolizations. Data on technical and clinical success, as well as changes in tumor size, were collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications. RESULTS Post-embolization angiography showed occlusion of more than 90% of the pathological feeding vessels in all procedures. Pain score and analgesic drug consumption were reduced by 50% in all 10 patients (100%, p < 0.05). The mean duration of pain relief was 9.5 months (range 8 to 12 months, p < 0.05). Metastatic tumor size was reduced from a mean of 71.5 cm3 (range 41.6 to 90.3 cm3) pre-embolization to a mean of 67.9 cm3 (range 38.5 to 86.1 cm3) at the 12-month follow-up (p < 0.05). None of the patients experienced embolization-related complications. CONCLUSION Arterial embolization is safe and effective as a palliative treatment for patients with metastases of the sternum who did not benefit from radiation therapy or experienced recurrence in symptoms.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Vara
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Martella
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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11
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Storandt MH, Tran N, Martin N, Jatoi A. Pembrolizumab near the end of life in patients with metastatic pancreatic cancer: a multi-site consecutive series to examine survival and patient treatment burden. Cancer Immunol Immunother 2023:10.1007/s00262-023-03397-4. [PMID: 36872382 DOI: 10.1007/s00262-023-03397-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/03/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Pembrolizumab confers minimal benefit to most patients with pancreas cancer. We explored survival and patient treatment burden (for example, death within 14 days of therapy) in a subgroup who had early access to pembrolizumab . METHODS This multisite study examined consecutive pancreas cancer patients, who received pembrolizumab from 2004 through 2022. Median overall survival of > 4 months was to be deemed favorable. Patient treatment burden and medical record quotations are presented descriptively. RESULTS Forty-one patients (median age 66 years; range 36, 84) are included. Fifteen (37%) had dMMR, MSI-H, TMB-H, or Lynch syndrome; and 23 (56%) received concurrent therapy. The median overall survival was 7.2 months (95% confidence interval (CI): 5.2, 12.7 months); 29 were deceased at the time of reporting. Patients with dMMR, MSI-H, TMB-H, or Lynch syndrome had a lower risk of death: hazard ratio (HR): 0.29 (95% CI: 0.12, 0.72); p = 0.008. Medical record phrases ("brilliant response") aligned with the above. One patient died within 14 days of therapy, and one was in an intensive care unit within 30 days of death. Fifteen patients enrolled in hospice; four of these died < 3 days later. CONCLUSIONS These unexpectedly favorable findings underscore the need for healthcare providers-including palliative care providers-to knowledgeably guide patients about cancer therapy even near the end of life.
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Affiliation(s)
| | - Nguyen Tran
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nichole Martin
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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12
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Robinson J, Forbess JM, Slack M, Moss J, Chaves A. Palliation of a Heterotaxy Single Ventricle Neonate with Pulmonary Atresia and Obstructed TAPVR. Pediatr Cardiol 2023:10.1007/s00246-023-03101-4. [PMID: 36869913 DOI: 10.1007/s00246-023-03101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 01/10/2023] [Indexed: 03/05/2023]
Abstract
Patients born with obstructed total anomalous pulmonary venous return have a high risk of morbidity and mortality in the neonatal period, which only increases when combined with single ventricle physiology and non-cardiac congenital anomalies such as heterotaxy syndrome. Despite advances in management of congenital heart disease, surgery within the first weeks of life to repair the pulmonary venous connection and establish pulmonary blood flow with a systemic-to-pulmonary shunt has historically led to disappointing outcomes. A multidisciplinary approach with pediatric interventional cardiology and cardiac surgery is required to reduce morbidity and mortality in this extremely high-risk patient population. Extending the time between birth and cardiac surgery can lessen postoperative complications and mortality risk, especially in patients with abnormal thoracoabdominal relationships. Our team was able to successfully utilize transcatheter stent placement in a vertical vein and patent ductus arteriosus to delay and stage cardiac surgeries in an infant born with obstructed total anomalous pulmonary venous return, unbalanced atrioventricular septal defect with pulmonary atresia and heterotaxy, thus reducing the morbidity and mortality associated with this diagnosis.
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Affiliation(s)
- Justin Robinson
- University of Maryland Heart and Vascular Center, Baltimore, MD, USA.
- Children's Heart Program, University of Maryland School of Medicine, Baltimore, MD, USA.
- , Baltimore, USA.
| | - Joseph M Forbess
- University of Maryland Heart and Vascular Center, Baltimore, MD, USA
- Children's Heart Program, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Slack
- University of Maryland Heart and Vascular Center, Baltimore, MD, USA
- Children's Heart Program, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julianne Moss
- University of Maryland Heart and Vascular Center, Baltimore, MD, USA
- Children's Heart Program, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alicia Chaves
- University of Maryland Heart and Vascular Center, Baltimore, MD, USA
- Children's Heart Program, University of Maryland School of Medicine, Baltimore, MD, USA
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13
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Oertel M, Schmidt R, Steike DR, Eich HT, Lenz P. Palliative care on the radiation oncology ward-improvements in clinical care through interdisciplinary ward rounds. Strahlenther Onkol 2023; 199:251-257. [PMID: 35951037 PMCID: PMC9938032 DOI: 10.1007/s00066-022-01989-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Palliative care is essential for patients with terminal diseases and aims at effective symptom control. This may stand in opposition to radiation treatment as an oncological treatment modality. The hereby presented work demonstrates the successful integration of a palliative care service in the radiation oncology ward. METHODS Since 2015, 1018 patients were seen by the palliative care service on the radiation oncology ward and have been analyzed in this single center study. To assess teaching efficacy of the consultation service, a survey was conducted among 15 radiation oncology residents. RESULTS Cooperation between the two departments proved to be efficient with rising patient numbers. Palliative care was able to guide appropriate postdischarge care with the number of patients dying on the radiation oncology ward decreasing significantly (p = 0.009). The main topics for consultation were pain medication (92.3%), organization of postdischarge care (92.3%), and psycho-oncological support (84.6%). Most residents had a positive image of the palliative care service and consented on adjectives like "enriching", "empathic", "collegial", "professionally founded", and a "low threshold for consultation". All participants agreed that cooperation deepened their knowledge on palliative care. CONCLUSION A synergistic cooperation between a palliative care consultation service and a radiation oncology department addresses patient symptoms on an individual level. It confers advanced knowledge on palliative care which is essential for resident education and patient treatment.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Renate Schmidt
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - David Rene Steike
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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14
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Arshad AM, Pandiyan APS, Ayub II, Chockalingam C, Thangaswamy D. Endovascular stenting for malignant superior vena cava syndrome - Case series and review of literature. Lung India 2023; 40:165-168. [PMID: 37006102 PMCID: PMC10174651 DOI: 10.4103/lungindia.lungindia_687_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 03/05/2023] Open
Abstract
The treatment of malignant superior vena cava syndrome (SVCS) revolves around radiotherapy and chemotherapy to relieve symptoms with surgery being ruled out due to the advanced stage of malignancy. Primary placement of endovascular stent for palliation of malignant SVCS is not commonly reported in the literature. Here, we present two cases of malignant superior vena cava syndrome with successful relief of symptoms after the placement of endo vascular stent.
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Affiliation(s)
- Abdul Majeed Arshad
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Irfan Ismail Ayub
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Chandrasekar Chockalingam
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhanasekar Thangaswamy
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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15
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Kawamoto T, Shikama N, Imano N, Kubota H, Kosugi T, Sekii S, Harada H, Yamada K, Naoi Y, Miyazawa K, Hirano Y, Wada Y, Tonari A, Saito T, Uchida N, Araki N, Nakamura N. Incidence of and risk factors for non-hematologic toxicity with combined radiotherapy and CDK4/6 inhibitors in metastatic breast cancer using dose-volume parameters analysis: a multicenter cohort study. Breast Cancer 2023; 30:282-92. [PMID: 36528759 DOI: 10.1007/s12282-022-01422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a lack of data on combined radiotherapy (RT) and cyclin-dependent kinase 4 and 6 inhibitor (CDK4/6i) risk factors and toxicity. This study aimed to assess the incidence of and risk factors for non-hematologic toxicities in patients treated with combined RT and CDK4/6i using dose-volume parameter analysis. METHODS We conducted a retrospective multicenter cohort study of patients with metastatic breast cancer receiving RT within 14 days of CDK4/6i use. The endpoint was non-hematologic toxicities. Patient characteristics and RT treatment planning data were compared between the moderate or higher toxicities (≥ grade 2) group and the non-moderate toxicities group. RESULTS Sixty patients were included in the study. CDK4/6i was provided at a median daily dose of 125 mg and 200 mg for palbociclib and abemaciclib, respectively. In patients who received concurrent RT and CDK4/6i (N = 29), the median concurrent prescribed duration of CDK4/6i was 14 days. The median delivered RT dose was 30 Gy and 10 fractions. The rate of grade 2 and 3 non-hematologic toxicities was 30% and 2%, respectively. There was no difference in toxicity between concurrent and sequential use of CDK4/6i. The moderate pneumonitis group had a larger lung V20 equivalent dose of 2 Gy per fraction and planning target volume than the non-moderate pneumonitis group. CONCLUSIONS Moderate toxicities are frequent with combined RT and CDK4/6i. Caution is necessary concerning the combined RT and CDK4/6i. Particularly, reducing the dose to normal organs is necessary for combined RT and CDK4/6i.
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16
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Gustafsson F, Damman K, Nalbantgil S, Van Laake LW, Tops LF, Thum T, Adamopoulos S, Bonios M, Coats AJ, Crespo-Leiro MG, Mehra MR, Filippatos G, Hill L, Metra M, Jankowska E, de Jonge N, Kaye D, Masetti M, Parissis J, Milicic D, Seferovic P, Rosano G, Ben Gal T. Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023; 25:457-468. [PMID: 36847113 DOI: 10.1002/ejhf.2814] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/01/2023] Open
Abstract
This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support).
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Affiliation(s)
- Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, København, Denmark
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanem Nalbantgil
- Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Linda W Van Laake
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Thum
- Institute of Molecular and Therapeutic Strategies (IMTTS), Hannover Medical School, and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | | | | | | | - Maria G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Marco Metra
- Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Ewa Jankowska
- Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David Kaye
- The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Ho BS, Nei WL. Treatment Response of Sacrococcygeal Chordoma to Palliative Stereotactic Body Radiotherapy: A Case Report. Case Rep Oncol 2023; 16:315-324. [PMID: 37187687 PMCID: PMC10176195 DOI: 10.1159/000530133] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
Chordomas are rare and locally aggressive tumours that arise from embryonic remnants of the notochord, with a predilection for the skull base, mobile spine, and sacrum. Sacral or sacrococcygeal chordomas can be particularly difficult to manage because of their large size at presentation and involvement of adjacent organs and neural structures. Although the recommended definitive therapy for such tumours is either en bloc resection with or without adjuvant radiotherapy (RT) or definitive fractionated RT with charged particle therapy, older and/or less-fit patients may not necessarily be accepting of said approaches due to the potential morbidities and challenging logistic requirements. Here, we report a case of a 79-year-old male presenting with intractable lower limb pain and neurologic deficits due to a large de novo sacrococcygeal chordoma. The patient was successfully treated with a 5-fraction course of stereotactic body radiotherapy (SBRT), given with palliative intent, with complete relief of his symptoms achieved approximately 21 months after RT and without the development of any iatrogenic toxicities. In view of this case, ultra-hypofractionated SBRT may be a suitable option for the palliation of large de novo sacrococcygeal chordomas for selected patients to reduce their symptom burden and improve their quality of life.
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Affiliation(s)
- Bryan Shihan Ho
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Long Nei
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
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18
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Egeland C, Bazancir LA, Bui NH, Baeksgaard L, Gehl J, Gögenur I, Achiam M. Palliation of dysphagia in patients with non-curable esophageal cancer - a retrospective Danish study from a highly specialized center. Support Care Cancer 2022; 30:9029-9038. [PMID: 35947208 DOI: 10.1007/s00520-022-07316-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/02/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE A majority of the patients with esophageal cancer (EC) suffer from dysphagia. Several endoscopic treatment options are available such as stent placement, argon plasma coagulation, and esophageal dilatation. This study aimed to map the use of endoscopic dysphagia relieving interventions and secondly investigate possible impact on survival. METHODS Data was collected at the Dept. of Surgery & Transplantation, Rigshospitalet, Denmark. Patients with non-curable EC referred from 2016 to 2019 were included. Type of dysphagia treatment, complications and the need for repeated treatments, and survival were registered. RESULTS In the study, 601 patients were included. Forty-five percent were treated with an endoscopic procedure due to dysphagia (82% had a stent placed). The median time from diagnosis to intervention was 24 days. The overall complication rate was 35% (38% in the stent group and 20% in the non-stent group, p = 0.03) and 13% of the patients were readmitted due to a complication. After 26% of the procedures, a repeated treatment was required. Patients having an endoscopic intervention had a worsened survival prognosis compared with the patients in the non-intervention group (HR: 2.17, 95% CI: 1.80-2.61, p < 0.001). In the sub analysis where only patients who had an intervention was included, a survival difference in favor of the non-stent group was found (HR: 0.61, 95% CI: 0.43-0.86, p = 0.005). CONCLUSION In this cohort, the incidence of endoscopic procedures was high, complication rates were considerable, and many the patients required a second treatment. A survival difference was seen, where the patients who had a stent placed seemed to have the worst survival outcomes. However, the causal relationship is yet to be determined why the results must be interpreted carefully. New interventions and tailored approaches that may positively affect functional and long-term oncological outcomes are highly warranted and this should preferably be investigated in randomized clinical trials.
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Affiliation(s)
- Charlotte Egeland
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Laser Arif Bazancir
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Nam Hai Bui
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Baeksgaard
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
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Kombathula SH, Cree A, Joshi PV, Akturk N, Barraclough LH, Haslett K, Choudhury A, Hoskin P. Palliative radiotherapy in cancers of female genital tract: Outcomes and prognostic factors. Radiother Oncol 2022; 175:42-46. [PMID: 35964765 DOI: 10.1016/j.radonc.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Metastatic and incurable cancers of the gynaecological tract (FGTC) represent a major global health burden. Systemic treatment has modest efficacy and radiotherapy is often used for local symptoms. This study combines experience from two large UK centres in palliative radiotherapy for gynaecological cancers. MATERIALS AND METHODS Pooled data from two major centres was analysed. Advanced FGTC patients who received at least one fraction of palliative radiotherapy to the pelvis between 2013 and 2018 were included. Data collected included demographic and tumour details, radiotherapy dose fractionation and details of previous and subsequent treatment. Response was defined in terms of toxicity, symptomatic response and survival. Comorbidities were recorded using a modified ACE 27 score which is adjusted for the presence of uncontrolled FGTC in all the patients. RESULTS A total of 184 patients were included for treatment response and toxicity; survival data was available for 165 patients. Subjective response in pre-radiotherapy symptoms was documented in 80.4%. Grade 3 or worse gastrointestinal, urinary and other (vomiting, fatigue, pain) toxicity incidence was 2.2%, 3.8%, and 2.7% respectively. No statistically significant correlation between the prescribed EQD210 and symptom control or toxicity was seen. 1 year overall survival was 25.1% (median 5.9 months). Absent distant metastases, completion of the intended course of radiotherapy, response to radiotherapy, and receipt of further lines of treatment were independent prognostic factors. CONCLUSION Palliative radiotherapy is effective for symptoms of advanced FGTC with low toxicity. The absence of a dose response argues for short low dose palliative radiotherapy schedules to be used.
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Affiliation(s)
| | - Anthea Cree
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; The Clatterbridge Cancer Centre, Clinical Oncology, Liverpool
| | - Priya V Joshi
- Mount Vernon Cancer Centre, Clinical Oncology, Northwood, United Kingdom
| | - Nesrin Akturk
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester
| | | | - Kate Haslett
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; Department of Cancer Sciences, University of Manchester
| | - Peter Hoskin
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; Department of Cancer Sciences, University of Manchester; Mount Vernon Cancer Centre, Clinical Oncology, Northwood, United Kingdom.
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20
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Qureshi AM, Caldarone CA, Wilder TJ. Transcatheter Approaches to Palliation for Tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:48-57. [PMID: 35835516 DOI: 10.1053/j.pcsu.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
Abstract
To this day, controversy still exists regarding the optimal method to treat symptomatic neonates and infants with Tetralogy of Fallot (TOF). Symptomatic (severely cyanotic or ductal dependent) infants with TOF can undergo either a staged repair approach (consisting of initial palliation followed by complete repair) or primary repair. Traditionally, initial palliative procedures have been surgical, for example placement of a Blalock-Taussig-Thomas (BTT) shunt. Recent advances in technology have facilitated the introduction of catheter-based procedures as palliative techniques, for example, patent ductus arteriosus (PDA) stenting and right ventricular outflow tract (RVOT) stenting as more durable solutions than balloon pulmonary valvuloplasty (BPV). In this article, we discuss the rationale for these procedures, technical aspects of these procedures and outcomes data compared to traditional surgical procedures. Recent data have suggested that RVOT and PDA stenting procedures offer many advantages over traditional surgical palliative procedures as palliative methods in this patient population. This comes at a cost of increased reintervention burden, which may be considered part of the overall treatment strategy in smaller neonates and can be minimized with a focus on technical aspects and overall treatment strategies. Advanced surgical techniques are required at the eventual complete repair to negotiate removal of stent material and pulmonary artery reconstruction in some instances. Further adoption of catheter based palliative procedures for infants with symptomatic TOF has the potential to tip the outcomes towards favoring a staged approach, particularly in high-risk infants.
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Affiliation(s)
- Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Christopher A Caldarone
- Congenital Heart Surgery, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Travis J Wilder
- Division of Congenital Heart Surgery, University Hospitals, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
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21
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Ehret CJ, Almodallal Y, Le-Rademacher JG, Martin NA, Moynagh MR, Rajotia A, Jatoi A. Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. BMC Cancer 2022; 22:659. [PMID: 35705907 DOI: 10.1186/s12885-022-09760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background To our knowledge, previous studies have not investigated hiccups in patients with cancer with detailed patient-level data with the goal of capturing a broad spectrum of hiccup symptomatology. Methods This multi-site, single institution study examined consecutive medical records to better understand hiccups in patients with cancer. Results A total of 320 patients are the focus of this report. The median age of patients when hiccups were first reported in the medical record was 63 years (range: 21, 97 years) with 284 (89%) men and 36 (11%) women. The most common diagnose was gastrointestinal cancer. Hiccups most frequently occurred daily, as seen in 194 patients (62%), and the most common duration was less than 1 week, as seen in 146 patients (47%). However, nine patients had had daily hiccups for greater than 6 weeks, and 5 had symptoms for years. Cited etiology was non-chemotherapy medications in 36 (11%) and cancer chemotherapy in 19 (6%). Complications occurred in approximately a third and included insomnia in 51 patients (16%); hospitalization or emergency department visit in 34 (11%); and musculoskeletal pain in 23 (7%). Baclofen was the single most prescribed agent for hiccup palliation, but 100 patients received more than one medication. Medical procedures, which included acupuncture, paracentesis, or phrenic nerve block, were performed in 5 patients. In 234 patients (73%), the medical record documented hiccup cessation. Conclusions Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches.
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Abstract
Pancreatobiliary malignancies have poor prognosis, and many patients are inoperable at the time of diagnosis. When surgical resection is impossible, systemic chemotherapy or radiotherapy is traditionally conducted with trial of immunotherapy or gene therapy lately. With the rapid development of endoscopic instruments and accessories in recent years, not only endoscopic early detection, characterization, and staging but also endoscopic palliative management of the pancreatobiliary malignancies is expanding the horizons. Endoscopic management is often preferred due to similar efficacy to surgical management with less morbidity. Here, we review the methodology and treatment outcome of various endoscopic management strategies in pancreatobiliary malignancies including endoscopic complication management, local palliative therapy, endoscopy-assisted therapy, and pain control utilizing endoscopic retrograde cholangiopancreatography or endoscopic ultrasound.
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Vreeland TJ, Bohan PMK, Newhook TE, Allen CJ, Prakash LR, Maxwell JE, Ikoma N, Kim MP, Lee JE, Katz MHG, Tzeng CWD. Contemporary Assessment of Need for Palliative Bypass After Aborted Pancreatoduodenectomy Following Neoadjuvant Therapy. J Gastrointest Surg 2022; 26:352-359. [PMID: 35064457 DOI: 10.1007/s11605-021-05224-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 11/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Planned pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) can be aborted due to intraoperative findings. There is little guidance regarding the need for prophylactic bypass following an aborted PD to prevent symptomatic biliary obstruction or gastric outlet obstruction (GOO) postoperatively. The aim of this study was to characterize postoperative interventions and postsurgical survival in patients following aborted PD. METHODS Patients with PDAC treated with neoadjuvant therapy and staging laparoscopy prior to planned PD between 2010 and 2015 were reviewed for aborted PDs. Data on postoperative biliary obstruction, GOO, procedural intervention, and postsurgical survival were analyzed. RESULTS Of 271 planned PDs, 47 (17.3%) were aborted. Thirty-six patients had ≥ 2 months of follow-up data and were included. Six patients underwent hepaticojejunostomy and nine patients underwent gastrojejunostomy at the time of the aborted PD. Sixteen of 30 patients (53%) without a surgical biliary bypass required endoscopic intervention, but none required palliative surgery. Ten of 27 patients (37%) without an operative gastrojejunostomy required intervention, but none required palliative surgery. Endoscopic or percutaneous therapy was required to treat 13/16 (81%) patients who presented with postoperative biliary obstructions and 6/10 (60%) of GOOs. Median survival following aborted PD was 13.3 months (CI 8.9-17.7). There were no differences in survival when comparing patients who developed a biliary obstruction (p = 0.92) or GOO (p = 0.90) to asymptomatic patients. CONCLUSIONS Following aborted PD, patients commonly develop obstructive symptoms. However, these symptoms can generally be managed without surgical intervention. In asymptomatic patients, preemptive surgical bypasses are not required at the time of aborted PD.
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Affiliation(s)
- Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr. Ft. Sam Houston, San Antonio, TX, 78234, USA.
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Phillip M Kemp Bohan
- Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr. Ft. Sam Houston, San Antonio, TX, 78234, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Casey J Allen
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jessica E Maxwell
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Erdoğan AP, Ekinci F, Yıldırım S, Özveren A, Göksel G. Palliative Biliary Drainage Has No Effect on Survival in Pancreatic Cancer: Medical Oncology Perspective. J Gastrointest Cancer 2021; 53:52-56. [PMID: 34767180 DOI: 10.1007/s12029-021-00754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Removal of obstructive jaundice in metastatic pancreatic cancer is an important part of palliative therapy. However, it is not known whether invasive procedures reduce cancer-related mortality. In this study, the effect of palliative biliary drainage on survival outcomes in pancreatic cancer patients was evaluated. METHODS Patients diagnosed with pancreatic cancer and undergoing biliary drainage in two different centers between 2010 and 2019 were evaluated retrospectively. RESULTS Biliary drainage was applied to 73 patients, constituting 20.6% of 355 patients included in the study. The median progression-free survival (PFS) of patients with biliary stent was 5 months, while the median PFS of patients without stenting was 5.5 months and the median overall survival (OS) was 11.1 and 11.5 months, respectively (p: 0.424, p: 0.802). CONCLUSIONS A positive effect of palliative biliary drainage on median PFS and OS could not be demonstrated in our study group. In pancreatic cancer, predictive markers are needed to select patients who can derive a survival benefit from biliary drainage.
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Affiliation(s)
- Atike Pınar Erdoğan
- Medical Faculty, Division of Medical Oncology, Department of Internal Medicine, Manisa Celal Bayar University, Manisa, Turkey.
| | - Ferhat Ekinci
- Medical Faculty, Division of Medical Oncology, Department of Internal Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Serkan Yıldırım
- Tatvan State Hospital Medical Oncology Clinic, Bitlis, Turkey
| | - Ahmet Özveren
- İzmir Kent Hospital Medical Oncology Clinic, İzmir, Turkey
| | - Gamze Göksel
- Medical Faculty, Division of Medical Oncology, Department of Internal Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Cuomo M, Purbojo A, Blumauer R, Schöber M, Wällisch W, Dittrich S, Cesnjevar RA. Repair of common arterial trunk: palliation and delayed correction as a viable alternative strategy in selected patients. Eur J Cardiothorac Surg 2021; 62:6414287. [PMID: 34718491 PMCID: PMC9257668 DOI: 10.1093/ejcts/ezab455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Primary repair of common arterial trunk (CAT) is burdened by high mortality rates, especially in the presence of multiple risk factors. Timing, possible palliative methods, optimal management of associated cardiac lesions and handling of a poor preoperative state are still under discussion. METHODS We retrospectively analysed all patients who underwent surgery for CAT in our institution between 2008 and November 2020. We included 22 patients, 11 of whom received primary correction (PC) and 11 of whom underwent initial palliation by partial repair, leaving the ventricular septal defect open and connecting the right ventricle to the pulmonary arteries with a small valveless right ventricle-to-pulmonary artery conduit. A delayed correction (DC) was performed after 11.5 ± 3.6 months. RESULTS The overall operative mortality was 4.5%; 1 patient (affected by severe truncal valve stenosis and presenting in a poor state preoperatively) in the DC group died after palliation. The incidence of postoperative pulmonary hypertensive crisis was significantly higher in the PC group (P = 0.027). No patient from either group required postoperative extracorporeal support. Survival rates after 6 years differed slightly (PC group, 90%; DC group, 70%; log-rank = 0.270). CONCLUSIONS PC of CAT remains an optimal surgical approach for patients with an expected low mortality. However, our data support palliation and DC as a suitable alternative strategy, especially in the presence of significant risk factors like interrupted aortic arch, poor preoperative condition or complex surgical anatomy.
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Affiliation(s)
- Michela Cuomo
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Robert Blumauer
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Martin Schöber
- Department of Pediatric Cardiology, University of Erlangen, Erlangen, Germany
| | - Wolfgang Wällisch
- Department of Pediatric Cardiology, University of Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University of Erlangen, Erlangen, Germany
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Kim KN, Shah P, Clark A, Freedman GM, Dastgheyb S, Barsky AR, Dreyfuss AD, Taunk NK. Safety of cyclin-dependent kinase4/6 inhibitor combined with palliative radiotherapy in patients with metastatic breast cancer. Breast 2021; 60:163-167. [PMID: 34653725 PMCID: PMC8527028 DOI: 10.1016/j.breast.2021.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Cyclin-dependent kinase (CDK)4/6 inhibitor is a first-line therapy for metastatic ER+/HER2-breast cancer. However, there are limited data on safety of combined radiotherapy (RT) and CDK4/6 inhibition. Methods We conducted a retrospective study of women with metastatic breast cancer who received palliative RT within 14 days of CDK4/6 inhibitor use. The primary endpoint was toxicity per Common Terminology Criteria for Adverse Events v5. Secondary endpoints were pain response and local control based on clinical assessment and imaging. Results Thirty patients underwent 36 RT courses with palbociclib (n = 34 courses, 94.4%) or abemaciclib (n = 2, 5.6%). RT was delivered before, concurrently or after CDK4/6 inhibitors in 7 (19.4%), 8 (22.2%), and 21 (58.3%) of cases with median 3.5 days from RT to closest CDK4/6 inhibitor administration. Median RT dose was 30Gy (range 8–40.05Gy). Treated sites included brain (n = 5, 11.6%), spine (n = 19, 44.2%), pelvis (n = 9, 20.9%), other bony sites (n = 6, 14.0%) and others (n = 4, 9.3%). No acute grade ≥3 non-hematologic toxicity occurred. No increased hematologic toxicity was attributable to RT with grade 3 hematologic toxicities rates 16.7%, 0%, and 6.7% before, during, and 2 weeks after RT completion. All but one patient (29/30) achieved symptom relief. Local control rates were 94.4%, 91.7% at 6 and 12 months. Conclusions The use of RT within 2 weeks of CDK4/6 inhibitors had low acceptable toxicity and high efficacy, suggesting that it is safe for palliation of metastatic breast cancer. CDK4/6 inhibitors with endocrine therapy is a preferred first line therapy for HR+, HER2-metastatic breast cancer. Limited data exists on safety of combined radiotherapy and CDK4/6 inhibition in patients with metastatic breast cancer. This retrospective cohort study included 30 patients who underwent palliative RT with combined CDK4/6 inhibitor use. RT within 2 weeks of CDK4/6 inhibitor had low toxicity and high efficacy, supporting its safety in metastatic breast cancer.
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Affiliation(s)
- Kristine N Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Payal Shah
- Department of Medicine, Division of Hematology Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Clark
- Department of Medicine, Division of Hematology Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sana Dastgheyb
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew R Barsky
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra D Dreyfuss
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neil K Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Cellini F, Di Franco R, Manfrida S, Borzillo V, Maranzano E, Pergolizzi S, Morganti AG, Fusco V, Deodato F, Santarelli M, Arcidiacono F, Rossi R, Reina S, Merlotti A, Jereczek-Fossa BA, Tozzi A, Siepe G, Cacciola A, Russi E, Gambacorta MA, Scorsetti M, Ricardi U, Corvò R, Donato V, Muto P, Valentini V. Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: the NORMALITY model. Radiol Med 2021. [PMID: 34570309 DOI: 10.1007/s11547-021-01414-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy.
This paper has two aims: (1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named “La Rete del Sollievo” (“The Net of Relief”)]. The proposed model, denoted “No cOmpRoMise on quality of life by pALliative radiotherapy” (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19).
Material and Methods First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups: palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed.
Results After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed: palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., “Normality model of PRT indications”) for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits. Conclusion We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.
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Federico JA, Martin JT. Surgeons' Role in Local Palliation of Esophageal Cancer. Surg Clin North Am 2021; 101:489-497. [PMID: 34048768 DOI: 10.1016/j.suc.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Esophageal cancer commonly presents in advanced stage, and many patients will require palliative intervention. Endoscopic stenting remains an excellent first-line therapy; however, this should be discussed in a multidisciplinary setting, considering expectations for long-term survival.
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Affiliation(s)
- John A Federico
- Kalispell Regional Healthcare, 1333 Surgical Services Drive, Kalispell, MT 59901, USA.
| | - Jeremiah T Martin
- Southern Ohio Medical Center, 1711 27th Street, Braunlin Building, Suite 206, Portsmouth, OH 45662, USA
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Hong D, Das LC, Daily E, Levine SK, Hahn OM, Liauw SL, Golden DW, Son CH. Goals of care discussions: perceptions of radiation and medical oncologists. Support Care Cancer 2021; 29:7279-7288. [PMID: 34031753 DOI: 10.1007/s00520-021-06258-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Goals of care discussions (GOCD) are essential when counseling patients with cancer. Respective roles of radiation oncologists (RO) and medical oncologists (MO) in GOCD can be unclear. This study aims to clarify the dynamics and barriers to GOCD. METHODS Five hundred and fifty-four ROs and 1604 MOs at NCI-designated comprehensive cancer centers were sent an anonymous electronic survey regarding demographics, opinions, training in GOCD, GOCD frequency, and three vignettes. Response formats were Yes/No, Likert-type, and free response. Chi-square and Wilcoxon rank-sum tests were performed. Likert-type scores were reported as median [interquartile range]. RESULTS There were 76 (13.7%) RO and 153 (9.5%) MO who completed surveys. Sixty-three percent of RO and 66% of MO reported GOCD with > 50% of patients (p = 0.90). GOCD were initiated for declining performance status (74%) and poor life expectancy (69%). More MO (42%) received formal GOCD training compared to RO (18%) (p < 0.01). MO were more comfortable conducting GOCD than RO (p < 0.01). RO-conducted GOCD were rated to be less important by MO compared to RO (p < 0.05). Thirty-six percent of MO reported being "not at all" or "somewhat" comfortable with RO-conducted GOCD. RO-initiated GOCD with new patients were rated less appropriate by RO compared to MO perceptions of RO-initiated GOCD (p < 0.01). CONCLUSIONS While MO and RO conduct GOCD with similar frequency, MO are more comfortable conducting GOCD and are more likely to have formal training. MO rate importance of RO involvement lower than RO. Further research is needed to understand interdisciplinary dynamics that may impact GOCD and subsequent patient care outcomes.
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Affiliation(s)
- Daniel Hong
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Ellen Daily
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Stacie K Levine
- Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
| | - Olwen M Hahn
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA
| | - Christina H Son
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA.
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Wright CM, Koroulakis AI, Baron JA, Chong EA, Tseng YD, Kurtz G, LaRiviere M, Venigalla S, Jones JA, Maity A, Mohindra P, Plastaras JP, Paydar I. Palliative Radiotherapy for Diffuse Large B-cell Lymphoma. Clin Lymphoma Myeloma Leuk 2021; 21:650-658. [PMID: 34127417 DOI: 10.1016/j.clml.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 11/17/2022]
Abstract
Recent improvements in chemoimmunotherapies, targeted agents, hematopoietic stem cell transplants, and cellular therapies have revolutionized treatment paradigms for patients with diffuse large B-cell lymphoma (DLBCL). Even in the relapsed or refractory setting, contemporary treatment options are delivered with curative intent and can lead to lasting remissions. Although such therapies have improved overall outcomes, they have increasingly led to a wide variety of presentations of recurrent tumors in need of palliation. Here, we review the use of radiotherapy (RT) in the palliation of DLBCL. We draw particular attention to the evolving role for hypofractionated RT and low-dose RT for DLBCL. We review the available literature on these topics and focus on commonly encountered clinical scenarios.
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Affiliation(s)
- Christopher M Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Antony I Koroulakis
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Jonathan A Baron
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sriram Venigalla
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ima Paydar
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Shawky Abdelgawaad A, Ezzati A, Krajnovic B, Seyed-Emadaldin S, Abdelrahman H. Radiofrequency ablation and balloon kyphoplasty for palliation of painful spinal metastases. Eur Spine J 2021; 30:2874-2880. [PMID: 33961090 DOI: 10.1007/s00586-021-06858-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/27/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE This study was designed with an aim to assess the safety and early postoperative outcomes of the combined Radiofrequency ablation (RFA) and Balloon Kyphoplasty (BKP) used for the treatment of painful neoplastic spinal lesions palliatively. PATIENTS AND METHODS Between December 2015 and December 2018, 60 patients (35 men and 25 women) with spinal metastases were operated using RFA and BKP at our institution. Transpedicular biopsy was performed in all cases. Patients' demographics, lesion characteristics, concurrent palliative therapies and complications were recorded. All patients were clinically (Pain score VAS 0-10) and radiologically evaluated pre- and postoperatively. Retrospective analysis of data for this cohort was performed. RESULTS Seventy-five painful spinal metastases (46 in the lumbar spine and 29 in the thoracic region) in 60 patients were operated [transpedicular RFA alone in 5 lesions, and in combination with BKP in 70 lesions (93%)]. The mean pre-procedure and post-procedure VAS for back pain was 7.2/10 and 2.7/10, respectively (p value = 0.0001). No neurological complications related to RFA were found and no cement extravasation into the spinal canal was observed. In two patients, asymptomatic leaks into the needle track, in two patients into draining veins and in one patient into the disk space were detected. CONCLUSION Combined RFA and BKP appears to be a safe, practical, effective and reproducible palliative treatment for painful spinal osteolytic metastasis. In carefully indicated cases, it relieves pain and maintains stability in a minimal invasive way without adding significant surgical trauma or complications.
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Affiliation(s)
- Ahmed Shawky Abdelgawaad
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany. .,Department of Orthopaedics, Assiut University Hospitals, Assiut, 71515, Egypt.
| | - Ali Ezzati
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Branko Krajnovic
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Sadat Seyed-Emadaldin
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
| | - Hamdan Abdelrahman
- Spine Center, Helios Hospitals Erfurt, Nordhaeuser Street 74, 99089, Erfurt, Germany
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Conio M, Savarese MF, Filiberti RA, Baron TH, Caruso A, Manta R, Marini M, De Luca L, De Ceglie A. Palliation of malignant esophageal obstruction using an anti-migration self-expandable metal stent: Results of a prospective multicenter study. Clin Res Hepatol Gastroenterol 2021; 45:101683. [PMID: 33848668 DOI: 10.1016/j.clinre.2021.101683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/23/2021] [Accepted: 03/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Self-expanding metal stents (SEMS) placement is primarily indicated to palliate dysphagia for patients with expected short-term survival. We aimed to assess the migration rate and other stent-related adverse events (AEs) of a fully covered SEMS with an anti-migration system (FCSEMS-AMS) for palliation of malignant dysphagia. METHODS This is a prospective study including patients with inoperable esophageal cancer that received a FCSEMS-AMS (Taewoong, Niti-S Beta™), in five tertiary-care endoscopic centers from January 2014 to February 2016. RESULTS Fifty-three consecutive patients were enrolled. Tumor location was proximal, mid and distal esophagus±esophago-gastric junction (EGJ) in 6, 14, and 33 cases, respectively. Overall, non-severe AEs were reported in 18 patients (34.0%), 13 of them required an additional endoscopic procedure. Migration occurred in 7 patients (13.2%): 3 from the upper and 4 from the lower esophagus and EGJ. Stent retrieval was necessary in one patient due to intolerable pain. Food bolus impaction and tumor overgrowth occurred in 2 patients (3.8%) and 4 (7.5%) patients respectively. Four patients complained of gastroesophageal reflux as late AEs. Median follow-up was 19.3 months. Dysphagia significantly improved until 3 and 6 months from stent insertion (median score before FCSEMS-AMS: 3, vs median score: 1). Median dysphagia-free time was 10 months. CONCLUSIONS Placement of the Taewoong, Niti-S Beta™ stent appeared to be a safe and effective treatment of malignant dysphagia. The anti-migration system reduced the overall migration rate, although it remained high in strictures located in the upper esophagus and when the stent was placed across the EGJ.
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Abstract
Loss of appetite is common among patients with advanced cancer. However, it remains controversial how, when, and if to palliate this symptom. Here, we provide an update on recent as well as past literature to address the question of whether loss of appetite should be palliated in patients with advanced cancer. In our opinion—and as discussed here—we believe that this symptom should be palliated, although perhaps not always with pharmacologic interventions.
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Affiliation(s)
| | - Aminah Jatoi
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Peters C, Vandewiele J, Lievens Y, van Eijkeren M, Fonteyne V, Boterberg T, Deseyne P, Veldeman L, De Neve W, Monten C, Braems S, Duprez F, Vandecasteele K, Ost P. Adoption of single fraction radiotherapy for uncomplicated bone metastases in a tertiary centre. Clin Transl Radiat Oncol 2021; 27:64-69. [PMID: 33532632 PMCID: PMC7829104 DOI: 10.1016/j.ctro.2021.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022] Open
Abstract
Single fraction radiotherapy is feasible for uncomplicated bone metastases. Four-week mortality was similar between single fraction and multiple fraction. Our paper has the highest rate of reported single fraction radiotherapy in literature. Re-irradiation were higher for single fraction radiotherapy in uncomplicated bone metastases.
Background Single-fraction radiotherapy (SFRT) offers equal pain relief for uncomplicated painful bone metastases as compared to multiple-fraction radiotherapy (MFRT). Despite this evidence, the adoption of SFRT has been poor with published rates of SFRT for uncomplicated bone metastases ranging from <10% to 70%. We aimed to evaluate the adoption of SFRT and its evolution over time following the more formal endorsement of the international guidelines in our centre starting from 2013. Materials and methods We performed a retrospective review of fractionation schedules at our centre for painful uncomplicated bone metastases from January 2013 until December 2017. Only patients treated with 1 × 8 Gy (SFRT-group) or 10 × 3 Gy (MFRT-group) were included. We excluded other fractionation schedules, primary cancer of the bone and post-operative radiotherapy. Uncomplicated was defined as painful but not associated with impending fracture, existing fracture or existing neurological compression. Temporal trends in SFRT/MFRT usage and overall survival were investigated. We performed a lesion-based patterns of care analysis and a patient-based survival analysis. Mann-Whitney U and Chi-square test were used to assess differences between fractionation schedules and temporal trends in prescription, with Kaplan-Meier estimates used for survival analysis (p-value <0.05 considered significant). Results Overall, 352 patients and 594 uncomplicated bone metastases met inclusion criteria. Patient characteristics were comparable between SFRT and MFRT, except for age. Overall, SFRT was used in 92% of all metastases compared to 8% for MFRT. SFRT rates increased throughout the study period from 85% in 2013 to 95% in 2017 (p = 0.06). Re-irradiation rates were higher in patients treated with SFRT (14%) as compared to MFRT (4%) (p = 0.046). Four-week mortality and median overall survival did not differ significantly between SFRT and MFRT (17% vs 18%, p = 0.8 and 25 weeks vs 38 weeks, p = 0.97, respectively). Conclusions Adherence to the international guidelines for SFRT for uncomplicated bone metastasis was high and increased over time to 95%, which is the highest reported rate in literature.
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Affiliation(s)
- Cedric Peters
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Julie Vandewiele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Marc van Eijkeren
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Sabine Braems
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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Weismüller TJ. Role of Intraductal RFA: A Novel Tool in the Palliative Care of Perihilar Cholangiocarcinoma. Visc Med 2021; 37:39-47. [PMID: 33718482 DOI: 10.1159/000513970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Background Patients with irresectable perihilar cholangiocarcinoma (PHC) have a limited prognosis with median survival times still less than 1 year. In addition to the current standard first-line systemic chemotherapy (gemcitabine and a platinum derivate), endoscopic treatment aims to ensure adequate drainage of the biliary system by placing biliary plastic or metal stents. Local ablative procedures like intraluminal biliary brachytherapy (ILBT) or photodynamic therapy (PDT) are used to improve local tumor control and to optimize the stent patency. Summary Intraductal radiofrequency ablation (RFA) is another promising tool in the therapeutic armamentarium for the endoscopic management and tumor ablation of extrahepatic cholangiocarcinoma (eCCA). By applying thermal energy to the tissue through high-frequency alternating current, RFA induces coagulative necrosis and causes local destruction of the tumor. It is established as a first line percutaneous treatment of solid liver tumors, and since 2011 an endoscopic catheter is available that allows intraductal RFA in the biliary or pancreatic ducts. While the first pilot studies primarily evaluated this new method in patients with distal eCCA, there is now evidence accumulating also for PHC. Two retrospective and two prospective studies demonstrated a significantly improved overall survival and a longer stent patency with intraductal RFA, which overall had a favorable safety profile and was not associated with a significant increase in adverse events. However, prospective studies comparing the efficacy and safety of intraductal RFA, PDT, and/or ILBT are lacking. Key Messages Recent studies suggest that intraductal RFA is an effective and well-tolerated additional treatment option with regard to stent patency but also overall survival. Since RFA has fewer systemic side effects and requires less logistical effort when compared to ILBT and PDT, intraductal RFA should be considered as another safe and feasible adjuvant method for the palliative care of patients with advanced PHC. Since comparative studies are lacking, the choice of the local ablative method remains in each case an individual decision.
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Li D, Zhou X, Li M. Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis. BMC Cardiovasc Disord 2021; 21:9. [PMID: 33407150 PMCID: PMC7789398 DOI: 10.1186/s12872-020-01817-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs). RESULTS In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups. CONCLUSION Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt. TRIAL REGISTRATION CRD42019147672.
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MESH Headings
- Blalock-Taussig Procedure/adverse effects
- Blalock-Taussig Procedure/mortality
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/instrumentation
- Cardiac Catheterization/mortality
- Child
- Child, Preschool
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/physiopathology
- Ductus Arteriosus, Patent/therapy
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Hemodynamics
- Humans
- Infant
- Infant, Newborn
- Length of Stay
- Male
- Palliative Care
- Pulmonary Artery/abnormalities
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/growth & development
- Pulmonary Artery/surgery
- Pulmonary Circulation
- Recovery of Function
- Stents
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Xu Zhou
- Evidence-Based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China
| | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Abstract
The hypoplasia of left-sided heart structures shows great variability and complexity. What the many variants have in common is that their heart structures are neither fully developed before nor after birth. Fetuses and newborns require an individual therapy depending on anatomy and function of the heart. Fetal interventions focus on improving left heart structures by catheter-based interventions and maternal hyperoxygenation which promotes growth as the left ventricular preload and blood flow within the cavity increase. Stage-I management of newborns with single ventricle physiology is usually based on the Norwood/Sano surgery or the Hybrid approach. Two more steps are required to ultimately achieve a Fontan circulation. Some centers also use the Hybrid approach for subsequent Norwood operation beyond the neonatal period. After the Hybrid approach, a comprehensive stage-II or corrective surgery is performed, the latter if a bi-ventricular circulation is possible. With progressively improved catheter-based interventions, particularly ductal stenting and manipulations of the atrial septum, the next advance is to develop a bespoke flow restrictor that can be easily inserted into the branches of the pulmonary artery. The main goal is to avoid complex heart operations under general anesthesia, followed by substantial intensive care in the neonatal period, especially for patients with complex heart defects. Based on the current state of the art of surgical treatment of hypoplastic left heart syndrome and variants with the Norwood surgery or the Hybrid approach, our main focus is on an alternative percutaneous transcatheter technique in the sense of a completely non-surgical stage-I approach.
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Ferro M, Macchia G, Re A, Buwenge M, Ferro M, Boccardi M, Picardi V, Ianiro A, Arena E, Zamagni A, Farina E, Cilla S, Valentini V, Morganti AG, Deodato F. Advanced head and neck cancer in older adults: Results of a short course accelerated radiotherapy trial. J Geriatr Oncol 2021; 12:441-5. [PMID: 33097457 DOI: 10.1016/j.jgo.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/01/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the feasibility and safety of a repeated SHort course Accelerated RadiatiON therapy (SHARON) regimen in the palliative setting of Head and Neck (H&N) cancer in older adults. MATERIAL AND METHODS Patients with histological confirmed H&N cancers, age ≥ 80 years, expected survival >3 months, and Eastern Cooperative Oncology Group (ECOG) performance status of ≤3 were enrolled. Patients were treated in cohorts of six patients: a total dose of 20 Gy was delivered in 2 consecutive days with a twice-daily fractionation (5 Gy per fraction) and at least 8-h interval. If no Grade 3 toxicity was registered, a second enrollment started with another cohort of six patients to whom were administered two cycles (total dose of 40 Gy). The primary endpoint was to evaluate the feasibility of the two cycles of treatment. Secondary endpoints were evaluation of symptoms control rate, symptoms-free survival (SFS), and Quality of Life (QoL) scores. RESULTS Seventeen consecutive patients (median age: 85 years) were treated. Nine patients were treated with one cycle and 8 patients with two cycles. No G3 toxicity was reported in either cohort. With a median follow-up time of 4 months, 3-month SFS in the first and second cohorts was 83.3%, and 87.5%, respectively. The overall palliative response rate was 88%. Among 13 patients reporting pain, 8 (61.5%) showed an improvement or resolution of their pain. CONCLUSION Repeated short course accelerated radiotherapy in a palliative setting of H&N cancers is safe and well-tolerated in older adults.
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van Rossum PSN, Jeene PM, Rozema T, Braam PM, Lips IM, Muller K, van Kampen D, Vermeulen BD, Homs MYV, Oppedijk V, Berbée M, Hulshof MCCM, Siersema PD, El Sharouni SY. Patient-reported outcomes after external beam radiotherapy versus brachytherapy for palliation of dysphagia in esophageal cancer: A matched comparison of two prospective trials. Radiother Oncol 2020; 155:73-79. [PMID: 33065190 DOI: 10.1016/j.radonc.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE A matched comparison of external beam radiotherapy (EBRT) versus brachytherapy recently demonstrated that EBRT appears at least as effective for palliating dysphagia in patients with incurable esophageal cancer. The aim of this analysis was to compare patient-reported outcomes (PROs) after EBRT versus brachytherapy. MATERIALS AND METHODS In a multicenter prospective cohort study, patients with incurable esophageal cancer requiring palliation of dysphagia were included to undergo EBRT (20 Gy in 5 fractions). This EBRT cohort was compared to the single-dose 12 Gy brachytherapy cohort of the previously reported SIREC-trial. Propensity score matching was applied to adjust for baseline imbalances. The primary endpoint of dysphagia improvement was reported previously. PROs were secondary outcomes and assessed at baseline and 3 months after treatment using EORTC QLQ-C30 and QLQ-OES18 questionnaires. RESULTS A total of 115 enrolled EBRT patients and 93 brachytherapy patients were eligible. After matching, 69 well-balanced pairs remained. At follow-up, significant deteriorations in functioning (i.e. physical, role, social), pain, appetite loss, and trouble with taste were observed after brachytherapy. In the EBRT group, such deterioration was observed only for role functioning, while significant improvements in trouble with eating and pain were found. Between-group comparison showed mostly comparable PRO changes, but significantly favored EBRT with regard to nausea, vomiting, pain, and appetite loss. CONCLUSION Short course EBRT results in similar or better PROs at 3 months after treatment compared to single-dose brachytherapy for the palliation of malignant dysphagia. These findings further support its use and inclusion in clinical practice guidelines.
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Affiliation(s)
- Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
| | - Paul M Jeene
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Radiotherapiegroep, location Deventer, The Netherlands.
| | - Tom Rozema
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Pètra M Braam
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene M Lips
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Muller
- Radiotherapiegroep, location Deventer, The Netherlands
| | - Daphne van Kampen
- Zuidwest Radiotherapeutisch Instituut, Vlissingen and Roosendaal, The Netherlands
| | - Bram D Vermeulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolein Y V Homs
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Vera Oppedijk
- Radiotherapeutisch Instituut Friesland, Leeuwarden, The Netherlands
| | - Maaike Berbée
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sherif Y El Sharouni
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, Komici K, Mazzarella G, Parrella R, Bianco A. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res 2020; 32:1599-1608. [PMID: 32557332 PMCID: PMC7298699 DOI: 10.1007/s40520-020-01631-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.
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Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Grazia Mazzeo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| | - Matilde Boccia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Gennaro Mazzarella
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Roberto Parrella
- COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
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Kronborg-White S, Andersen CU, Kohberg C, Hilberg O, Bendstrup E. Palliation of chronic breathlessness with morphine in patients with fibrotic interstitial lung disease - a randomised placebo-controlled trial. Respir Res 2020; 21:195. [PMID: 32703194 PMCID: PMC7376842 DOI: 10.1186/s12931-020-01452-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patients suffering from fibrotic interstitial lung diseases (fILD) have a poor prognosis and a high symptom burden. Palliative treatment includes relief of symptoms such as breathlessness. There is no evidence-based treatment for chronic breathlessness but opioids are often used despite concerns due to the hypothetical risk of respiratory depression. This study investigated the effect of oral morphine drops in patients with fILD on chronic breathlessness and safety. Methods In a double-blinded placebo-controlled study, 36 patients with fILD were randomised to either four daily doses of 5 mg of oral morphine drops or placebo for 1 week. Endpoints and safety parameters were obtained at baseline, at follow-up after 1 h and 1 week. Results The primary endpoint, the visual analogue score (VAS) of dyspnea was reduced by 1.1 ± 0.33 cm in the morphine group at follow-up compared to baseline (P < 0.01), whereas the reduction was 0.35 ± 0.47 cm in the placebo group. However, the difference between the two groups was not statistically significant (p = 0.2). Oral morphine drops did not affect respiratory frequency, pulse rate, blood pressure, peripheral saturation or the 6-min walk test. More patients treated with morphine reported constipation, nausea and confusion. Conclusion Oral administration of morphine drops, 20 mg a day, in patients with fILD did not significantly reduce dyspnea VAS score during 1 week compared to placebo. Oral morphine did not induce respiratory depression, but was related to an increased risk of constipation, nausea and confusion. Trial registration The trial is registered in clinicaltrials.gov (Identifier: NCT02622022). Registered 4 December 2015.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,Department of Internal Medicine, Viborg Regional Hospital, 8800, Viborg, Denmark.
| | | | - Charlotte Kohberg
- Department of Oncology, Odense University Hospital, Odense, 5000, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, 7100, Vejle, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200, Aarhus N, Denmark
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Han TM, Bondarev S, Keller EJ, Vogelzang RL, Resnick SA. Efficacy of endovascular Z-configuration stenting for malignant versus nonmalignant caval obstruction. J Vasc Surg Venous Lymphat Disord 2020; 8:939-944. [PMID: 32414673 DOI: 10.1016/j.jvsv.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to assess factors associated with symptom resolution after endovascular stenting for superior or inferior vena cava syndrome. METHODS Eighty-six consecutive vena cava Z-configuration stent placements in 82 patients (53 ± 14 years old) at a single institution were reviewed for patient demographics, comorbidities, and durability of stent patency (also evaluated were persistent or recurrent symptoms, stent occlusion, and need for repeated stenting). Logistic regression was used to identify independent factors associated with stent patency, and Φ coefficients and analysis of variance were used to compare cases subdivided by lesion location (superior vena cava, inferior vena cava) and the presence or absence of malignant disease. RESULTS Clinical follow-up was available in 77 of 86 (90%) cases. Technical success with clinical failure (persistent symptoms) occurred in 40% of these cases with a median follow-up of 67 (interquartile range, 14-570) days and mortality rate of 63% during this period. Malignant obstructions had a significantly higher clinical failure rate of 54% compared with 15% for nonmalignant obstructions (Φ = 0.34; P = .002). However, only metastatic disease was independently associated with clinical failure when controlling for demographics, other comorbidities, and differential follow-up (adjusted odds ratio, 8.27; 95% confidence interval, 2.79-24.50). CONCLUSIONS Vena cava Z-stenting effectively resolves symptoms in 85% of nonmalignant obstructions compared with only 46% of malignant obstructions. Patients should be counseled accordingly, and those with malignant obstructions may require closer follow-up to evaluate the need for reintervention and goals of care.
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Affiliation(s)
- Timothy M Han
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Sergey Bondarev
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill
| | - Eric J Keller
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert L Vogelzang
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Scott A Resnick
- Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Quist M, Langer SW, Lillelund C, Winther L, Laursen JH, Christensen KB, Rørth M, Adamsen L. Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial. Lung Cancer 2020; 145:76-82. [PMID: 32416432 DOI: 10.1016/j.lungcan.2020.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 05/02/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Exercise can improve treatment-related side effects, quality of life, and function in patients with various types of cancer; however, more evidence is needed for patients with advanced inoperable lung cancer. MATERIAL AND METHODS We randomized 218 patients with advanced inoperable lung cancer to a 12-week supervised, structured exercise training program (aerobic, strength, and relaxation training) twice weekly versus usual care. Primary outcome was change in maximal oxygen uptake (VO2 peak). Secondary outcomes were muscle strength, functional capacity, forced expiratory volume in 1 s, health-related quality of life, anxiety, and depression. RESULTS There was no significant difference between the intervention and control groups in VO2 peak. There was a significant improvement in muscle strength. There was also a significant difference between the two for social well-being (Functional Assessment of Cancer Therapy-Lung, FACT-L), anxiety, and depression. CONCLUSION There was a significant reduction in the level of anxiety and depression and a significant increase in all muscle strength outcomes in the intervention group compared to patients randomized to usual care. There was a significant difference between the groups for social well-being. The primary outcome did not show a significant improvement in VO2 peak. Based on our results, future patients with advanced inoperable lung cancer should be considered for supervised exercise during the course of their disease.
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Pencovich N, Orbach L, Lessing Y, Elazar A, Barnes S, Berman P, Blachar A, Nachmany I, Sagie B. Palliative bypass surgery for patients with advanced pancreatic adenocarcinoma: experience from a tertiary center. World J Surg Oncol 2020; 18:63. [PMID: 32238149 PMCID: PMC7114792 DOI: 10.1186/s12957-020-01828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background As advances in oncological treatment continue to prolong the survival of patients with non-resectable pancreatic ductal adenocarcinoma (PDAC), decision-making regarding palliative surgical bypass in patients with a heavy disease burden turns challenging. Here we present the results of a pancreatic surgery referral center. Methods Patients that underwent palliative gastrojejunostomy and/or hepaticojejunostomy for advanced, non-resectable PDAC between January 2010 and November 2018 were retrospectively assessed. All patients were taken to a purely palliative surgery with no curative intent. The postoperative course as well as short and long-term outcomes was evaluated in relation to preoperative parameters. Results Forty-two patients (19 females) underwent palliative bypass. Thirty-one underwent only gastrojejunostomy (22 laparoscopic) and 11 underwent both gastrojejunostomy and hepaticojejunostomy (all by an open approach). Although 34 patients (80.9%) were able to return temporarily to oral intake during the index admission, 15 (35.7%) suffered from a major postoperative complication. Seven patients (16.6%) died from surgery and another seven within the following month. Nine patients (21.4%) never left the hospital following the surgery. Mean length of hospital stay was 18 ± 17 days (range 3–88 days). Mean overall survival was 172.8 ± 179.2 and median survival was 94.5 days. Age, preoperative hypoalbuminemia, sarcopenia, and disseminated disease were associated with palliation failure, defined as inability to regain oral intake, leave the hospital, or early mortality. Conclusions Although palliative gastrojejunostomy and hepaticojejunostomy may be beneficial for specific patients, severe postoperative morbidity and high mortality rates are still common. Patient selection remains crucial for achieving acceptable outcomes.
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Affiliation(s)
- Niv Pencovich
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel.
| | - Lior Orbach
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yonatan Lessing
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Amit Elazar
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Sophie Barnes
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Phillip Berman
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Boaz Sagie
- Department of General Surgery B, Division of Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel
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Massaccesi M, Boldrini L, Piras A, Stimato G, Quaranta F, Azario L, Mattiucci GC, Valentini V. Spatially fractionated radiotherapy (SFRT) targeting the hypoxic tumor segment for the intentional induction of non-targeted effects: An in silico study to exploit a new treatment paradigm. Tech Innov Patient Support Radiat Oncol 2020; 14:11-14. [PMID: 32154394 PMCID: PMC7052565 DOI: 10.1016/j.tipsro.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/30/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The possibility of intentionally triggering non targeted effects (NTEs) using spatially fractionated radiotherapy (SFRT) alone or combined with immunotherapy is an intriguing and fascinating area of research. Among different techniques for SFRT, stereotactic body radiotherapy targeting exclusively the central hypoxic segment of bulky tumors, (SBRT-PATHY) might trigger immunogenic cell death more efficiently. This in silico study aims to identify the best possible dosimetric trade-off for prescribing SFRT with volumetric modulated arc (VMAT) based stereotactic radiotherapy (SRT). Material and methods Eight spherical volumes defined "Gross Tumor Volumes" (GTVs) were generated with diameters of 3-10 cm (with incremental steps of 1 cm), simulating tumor lesions. The inner third part of each GTV (GTVcentral) was selected to simulate the central hypoxic area and a ring structure was derived around it to simulate the tumor periphery (GTVperipheral). Volumetric modulated arc radiation treatment (VMAT) plans were calculated to deliver a single fraction of 10 Gy to each GTVcentral with different dose prescription methods: target mean and isodose driven (40, 50, 60, 70, 80 and 90%).The volume of GTVperipheral receiving less than 2 Gy was recorded as dosimetric performance indicator. Results 56 possible dosimetric scenarios were analyzed. The largest percentage of GTVperipheral spared from the dose of 2 Gy was achieved with dose prescription methods to the 70% isodose line for lesions smaller than 6 cm (range 42.9-48.4%) and to the target mean for larger ones (range 52.9-64.5%). Conclusions Optimizing the dose prescription method may reduce the dose to tumor periphery in VMAT-based SFRT, thus potentially sparing tumor infiltrating immune cells. The optimal method may vary according to the size of the lesion. This should be taken into account when designing prospective trials using SFRT.
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Affiliation(s)
- M Massaccesi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - L Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - A Piras
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - G Stimato
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - F Quaranta
- Università Cattolica del Sacro Cuore, Istituto di Fisica, Roma, Italy
| | - L Azario
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Fisica Sanitaria, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Fisica, Roma, Italy
| | - G C Mattiucci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
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Bossé D, Lin X, Simantov R, Lalani AA, Derweesh I, Chang SL, Choueiri TK, McKay RR. Response of Primary Renal Cell Carcinoma to Systemic Therapy. Eur Urol 2019; 76:852-60. [PMID: 31594707 DOI: 10.1016/j.eururo.2019.08.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Upfront cytoreductive nephrectomy (CRN) in renal cell carcinoma (RCC) has come into question in recent prospective clinical trials. OBJECTIVE We investigated the effect of systemic therapies on primary tumor response in patients with metastatic RCC. DESIGN, SETTING, AND PARTICIPANTS A pooled analysis of 12 phase II/III clinical trials of metastatic RCC patients treated with systemic therapy between 2003 and 2013 was performed. Patients with one target lesion in the kidney and no prior nephrectomy were identified as having their primary tumor in place. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The objective response rate (ORR) of the primary tumor was defined as per the Response Evaluation Criteria in Solid Tumors (RECIST). ORR was assessed in the overall population and patient subsets based on prior treatment and International Metastatic RCC Database Consortium (IMDC) risk group. Cox's models adjusting for baseline characteristics, treatment, line of therapy, and site of metastases were used for survival analyses. RESULTS AND LIMITATIONS In total, 4736 patients were identified, of whom 565 had their primary tumor in place: 461 (82%) were treatment naïve, 283 (50%) received first-line vascular endothelial growth factor (VEGF)-targeted therapy, and 222 (39%) were IMDC poor risk. The ORRs of the primary tumor were 19% (95% confidence interval 16-23) in patients treated with first-line therapy (any type), 28% (22-33) in those treated with first-line VEGF-targeted therapy, and 23% (19-28) in those treated with VEGF-targeted therapy (any line). The ORRs were 9% (5-13) and 20% (15-27) in IMDC poor- and intermediate-risk patients, respectively. CONCLUSIONS Systemic therapy reduces primary tumor size in patients with metastatic RCC. Responses in primary tumors treated with VEGF-targeted therapy were observed in upward of 28% of patients. Selection of patients for immediate CRN requires careful consideration of patient and disease characteristics. PATIENT SUMMARY Antiangiogenic therapy meaningfully decreases the size of primary kidney tumor. Hence, for patients with metastatic disease who are not undergoing upfront cytoreductive nephrectomy, systemic therapy can palliate both primary tumor and metastases.
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Metwally IH, Hamdy O, Elbalka SS, Elbadrawy M, Elsaid DM. Oophorectomy as a Hormonal Ablation Therapy in Metastatic and Recurrent Breast Cancer: Current Indications and Results. Indian J Surg Oncol 2019; 10:542-546. [PMID: 31496608 DOI: 10.1007/s13193-019-00938-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022] Open
Abstract
Breast cancer is the commonest malignancy affecting females. Hormone-positive cancers carry a better prognosis. Many adjuvant and palliative endocrine therapies are in use, including surgical ablation. We retrospectively studied seventy-four patients who did bilateral salpingo-oophorectomy (BSO)/bilateral oophorectomy (BO) for factors affecting survival and prognosis. BSO was superior in overall and progression-free survival. Incidental ovarian metastasis carried a grave prognosis. Surgical hormonal ablation is a viable option with laparoscopic BSO as the approach of choice.
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Affiliation(s)
- Islam H Metwally
- 1Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Gehan Street, Mansoura City, Dakahlia Governorate 35516 Egypt
| | - Omar Hamdy
- 1Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Gehan Street, Mansoura City, Dakahlia Governorate 35516 Egypt
| | - Saleh S Elbalka
- 1Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Gehan Street, Mansoura City, Dakahlia Governorate 35516 Egypt
| | - Mohamed Elbadrawy
- 1Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Gehan Street, Mansoura City, Dakahlia Governorate 35516 Egypt
| | - Dina M Elsaid
- 2Obstetrics and Gynecology Department, Mansoura University Hospital (MUH), Mansoura, Egypt
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Abstract
Primary liver tumors are most commonly hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Although surgical resection offers a chance for cure, these tumors generally present at a late, inoperable stage, necessitating an understanding of noncurative and palliative treatment options. These options include ablative therapies, including radiofrequency ablation; intra-arterial therapies, including transcatheter chemoembolization; biliary decompression; radiotherapy; systemic therapies, including traditional chemotherapeutic agents; and molecular therapies, such as sorafenib. Selection of nonoperative treatment depends on patient and tumor factors as well as institutional resources and expertise.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB-425, Boston, MA 02114, USA
| | - Akhil Chawla
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 4-460, Boston, MA 02114, USA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 4-460, Boston, MA 02114, USA.
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Minervini A, Lauro A, Pagano N, Vaccari S, D'Andrea V, Marino IR, Cervellera M, Tonini V. The Great View Forward: The Use of a Colonoscope for Distal Duodenal Stent Placement. Dig Dis Sci 2019; 64:2445-2448. [PMID: 31410750 DOI: 10.1007/s10620-019-05768-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Stent placement in the distal duodenum can be difficult. We describe a case report of a 94-year-old man with metastatic pancreatic head cancer compressing the third and fourth portions of the duodenum, treated by endoscopic stent placement using a colonoscope. AREAS COVERED A literature review highlighted two possible procedures for stent placement in the distal duodenum, namely forward-viewing and side-viewing endoscopies. Gastroscopes, duodenoscopes, enteroscopes, and colonoscopes have all been suggested for the purpose. For distal lesions, especially when the duodenal wall is stiffened due to compression or infiltration by neoplastic lesions, a conventional upper endoscope can be too short to reach the narrowed site in "push mode," necessitating the use of a longer endoscope. EXPERT COMMENTARY A colonoscope can be safely and effectively used to accomplish distal duodenal stent placement.
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Affiliation(s)
- A Minervini
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy.
| | - N Pagano
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
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Boškoski I, Tringali A, Familiari P, Bove V, Landi R, Attili F, Perri V, Onder G, Mutignani M, Costamagna G. A 17 years retrospective study on multiple metal stents for complex malignant hilar biliary strictures: Survival, stents patency and outcomes of re-interventions for occluded metal stents. Dig Liver Dis 2019; 51:1287-1293. [PMID: 31036471 DOI: 10.1016/j.dld.2019.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic placement of SEMSs for malignant hilar biliary strictures (MHBS) is well-established palliative treatment for inoperable patients. Objectives of this study were evaluation of survival and stents patency after placement of multiple SEMS for palliation of complex MHBS. METHODS Retrospective review of patients with MHBS that underwent ERCP with insertion of multiple SEMSs for palliation. Survival-associated factors and stents patency were analyzed by Cox multivariate analysis. RESULTS Between January 1998 and January 2015, 740 patients with nonoperable MHBS that underwent ERCP were identified and only 18.2% of these received multiple SEMSs. Complications were observed in 7.5% of the patients with no procedure-related mortality. Palliative therapies (chemotherapy, external beam radiotherapy and high dose rate brachytherapy) were done in some patients, and outcomes were evaluated. Overall mean survival of the 134 patients was 323 days. Of these, 59% did not had stents malfunction while 41% patients had episodes of SEMSs malfunction and mean survival after re-interventions was 502.9 days. Survival was not influenced by type of tumor, sex or age. CONCLUSIONS Endoscopic multiple SEMSs placement is safe and effective in patients with complex MHBS. Survival is independent from the type and complexity of MHBS while is prolonged in patients undergoing HDR brachytherapy. Prompt recognition of SEMSs malfunction is fundamental for survival.
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Affiliation(s)
- Ivo Boškoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy.
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Pietro Familiari
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Vincenzo Bove
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Rosario Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Fabia Attili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Vincenzo Perri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
| | | | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
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