1
|
Manion K, Muñoz-Grajales C, Kim M, Atenafu E, Faheem Z, Gladman DD, Urowitz M, Touma Z, Wither JE. Different Immunologic Profiles Are Associated With Distinct Clinical Phenotypes in Longitudinally Observed Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2024; 76:726-738. [PMID: 38073017 DOI: 10.1002/art.42776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The aim of this study was to determine the immunologic profile associated with disease flares in patients with systemic lupus erythematosus (SLE) and to investigate the clinical significance of any differences observed between patients during and following a flare. METHODS Multiparameter flow cytometry was used to examine 47 immune populations within the peripheral blood of 16 healthy controls, 25 patients with clinically quiescent SLE, and 46 patients with SLE experiencing a flare at baseline and at 6- and 12-month follow-up visits. Unsupervised clustering was used to identify patients with similar immune profiles and to track changes over time. Parametric or nonparametric statistics were used when appropriate to assess the association of cellular phenotypes with clinical and laboratory parameters. RESULTS Five clusters of patients were identified that variably contained patients with active and quiescent SLE, and that had distinct clinical phenotypes. Patients characterized by increased T peripheral helper, activated B, and age-associated B cells were the most likely to be flaring at baseline, as well as the most likely to remain active or flare over the subsequent year if they acquired or retained this phenotype at follow-up. In contrast, patients who had increased T helper (Th) cells in the absence of B cell changes, or who had increased Th1 cells and innate immune populations, mostly developed quiescent SLE on follow-up. A significant proportion of patients with SLE had depletion of many immune populations at flare and only showed increases in these populations post-flare. CONCLUSION Cellular phenotyping of patients with SLE reveals several distinct immunologic profiles that may help to stratify patients with regard to prognosis and treatment.
Collapse
Affiliation(s)
- Kieran Manion
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Carolina Muñoz-Grajales
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael Kim
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Eshetu Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zoha Faheem
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | - Murray Urowitz
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | - Zahi Touma
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | - Joan E Wither
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Remalante-Rayco P, Espiritu AI, Daghistani Y, Chim T, Atenafu E, Keshavarzi S, Jha M, Gladman DD, Oh J, Haroon N, Inman RD. Incidence and predictors of demyelinating disease in spondyloarthritis: data from a longitudinal cohort study. Rheumatology (Oxford) 2023:kead527. [PMID: 37792508 DOI: 10.1093/rheumatology/kead527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/13/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES To investigate the incidence of demyelinating disease (DD) among spondyloarthritis (SpA) patients and identify risk factors that predict DD in this patient population. METHODS Axial SpA (axSpA) and psoriatic arthritis (PsA) patients were identified from a longitudinal cohort database. Each group was analysed according to the presence or absence of DD. Incidence rates (IR) of DD were obtained with competing risk analysis. Cox regression analysis with Fine and Grey's method was used to evaluate predictors of DD development. RESULTS Among 2260 patients with follow-up data, we identified 18 DD events corresponding to an average IR of 31 per 100 000 persons per year for SpA. The IR of DD at 20 years was higher in axSpA than in PsA (1.30% vs 0.13%, p= 0.01). The risk factors retained in the best predictive model for DD development included ever- (versus never-) smoking (HR 2.918, 95% CI 1.037-8.214, p= 0.0426), axSpA (versus PsA) (HR 8.790, 95% CI 1.242-62.182, p= 0.0294), and presence (versus absence) of IBD (HR 5.698, 95% CI 2.083-15.589, p= 0.0007). History of TNFi therapy was not a predictor of DD. CONCLUSION The overall incidence of DD in this SpA cohort was low. Incident DD was higher in axSpA than in PsA. A diagnosis of axSpA, the presence of IBD, and ever-smoking predicted the development of DD. History of TNFi use was not found to be a predictor of DD in this cohort.
Collapse
Affiliation(s)
- Patricia Remalante-Rayco
- Schroeder Arthritis Institute, Toronto Western Hospital, Spondylitis Program, University Health Network, Toronto, Ontario, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Adrian I Espiritu
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yassir Daghistani
- Schroeder Arthritis Institute, Toronto Western Hospital, Spondylitis Program, University Health Network, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Tina Chim
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sareh Keshavarzi
- Biostatistics Division, University of Toronto, Toronto, Ontario, Canada
| | - Mayank Jha
- Schroeder Arthritis Institute, Toronto Western Hospital, Spondylitis Program, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Schroeder Arthritis Institute, Toronto Western Hospital, Spondylitis Program, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, Toronto Western Hospital, Spondylitis Program, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Thomsen B, Vesprini D, Zeng L, Myrehaug SD, Tseng CL, Detsky J, Chen H, Zhang B, Jerzak K, Atenafu E, Maralani P, Soliman H, Sahgal A. Stereotactic Body Radiotherapy (SBRT) for Breast Cancer Spinal Metastases is Associated with Low Rates of Long-Term Local Failure (LF) and Vertebral Compression Fracture (VCF) Independent of Molecular Status. Int J Radiat Oncol Biol Phys 2023; 117:e153. [PMID: 37784740 DOI: 10.1016/j.ijrobp.2023.06.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is limited outcome data specific to breast cancer spinal metastases following spine SBRT. This study aims to report outcomes specific to breast cancer spinal metastases receiving spine SBRT and determine the implication of biomarker status. MATERIALS/METHODS We have been maintaining a prospective database since the inception of the spine SBRT program. A retrospective review identified 168 breast cancer patients with 409 spinal segments treated with spine SBRT between January 2008 and January 2023. Molecular subtypes were grouped based on luminal A, luminal B, basal, and HER2 enriched. Patients were followed with q3-monthly full-spine MRI and a clinical assessment. The primary endpoint was MRI-based local failure (LF), and secondary endpoints were overall survival (OS) and vertebral compression fracture (VCF). RESULTS The median follow-up was 33 months (range, 3.3-123 months). Amongst the 168 patients, the majority were ECOG 0 or 1 (95%), neurologically intact (94%), polymetastatic (74%), and either luminal A (71%) or luminal B (8%). A total of 17% of patients were HER2+ve versus 83% HER2-ve. Of 409 treated segments the majority (76%) had no prior radiation or surgery (de novo), were SINS stable (60%), had either no or low-grade epidural disease (86%) and treated with 24-28 Gy in 2 fractions (73%). The LF and OS rates at 1, 3, and 5 years were 5%, 11%, and 14%, respectively, and 91%, 65%, and 45%, respectively, independent of molecular subtype on univariate analyses. The cumulative risk of VCF at 2 and 5 years was 7% and 10%, respectively. CONCLUSION We observe, in the largest breast cancer spine cohort to date, excellent long-term local control rates independent of molecular sub-group, and acceptable VCF rates.
Collapse
Affiliation(s)
- B Thomsen
- University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - K Jerzak
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Ong WL, Zeng L, Soliman H, Myrehaug SD, Detsky J, Chen H, Ruschin ME, Atenafu E, Larouche J, Maralani P, Sahgal A, Tseng CL. Outcomes Specific to Spinal Metastases with Paraspinal Disease Extension Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e142-e143. [PMID: 37784717 DOI: 10.1016/j.ijrobp.2023.06.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spinal metastases with paraspinal disease (PD) extension are known to have worse outcomes following stereotactic body radiotherapy (SBRT). Characteristics of the PD itself have not been investigated to determine the impact on outcomes such as local control, which is the purpose of this study. MATERIALS/METHODS We retrospectively reviewed those patients who had SBRT for spinal metastases with PD disease, identified from a prospectively maintained database. Spinal metastases previously irradiated or surgical resected were excluded. The extent of PD was classified as involving the rib, neuroforamina, and muscle invasion. The gross tumor volume of PD (GTV_PD) and the clinical target volume of PD (CTV_PD) were segregated from the bony compartments based on the treatment plan contours. The outcomes of interest included the cumulative risk of local failure (LF), re-irradiation rates (ReRT), and overall survival (OS). LF and ReRT were estimated for each treated sites using the competing risk model (death as the competing risk), while OS was evaluated per patient using the Kaplan Meier method. RESULTS A total of 86 patients with 96 spinal metastases sites with PD were included. Of the 96 treated sites, 65% (62/96), 29% (28/96) and 6% (6/96) of PD spanned 1, 2, and 3 vertebral levels respectively. The median follow-up was 12.4months (range: 0.6-100months). The 6- and 12-month OS for the cohort was 81% and 51%, respectively. 33/86 (38%) patients had radioresistant cancer (gastrointestinal, renal cell carcinoma, thyroid, sarcoma, or melanoma). Involvement of rib, neuroforamina and muscle invasion were observed in 39% (37/96), 65% (62/96) and 21% (20/96) of the treated sites, respectively. Epidural disease was present in 57% (55/96) of treated sites. The median GTV_PD volume was 7cc (range: 0.3-114cc), and the median CTV_PD volume was 24cc (range: 0.4-248cc). The prescribed doses were 24 Gy/2 fractions (fx) (80%), 28 Gy/2 fx (10%) and 30 Gy/4 fx (10%). There were 84 treated sites with at least one post-treatment MRI available for LF assessment. The crude LF risk was 32% (27/84), and the 6- and 12-month cumulative LF rates were 12% and 28%, respectively. There was a trend towards an increased risk of LF when PD involved the rib (35% vs 24% at 1 year respectively, P = 0.07) and muscle (67% vs 20% at 1 year respectively; P = 0.06), but no difference in LF for neuroforamina involvement (26% vs 34% at 1 year respectively, P = 0.5). There were no differences in LF based on cancer radioresistance (P = 0.6), GTV_PD volume (P = 0.3) or CTV_PD volume (P = 0.4). Of the 96 treated sites, 14% (14/96) were re-irradiated (9 with repeat SBRT and 5 with conventional EBRT) at a median of 15 months (range: 4.7-59 months) post initial SBRT. The cumulative incidence of ReRT at 6- and 12-months were 1.2% and 7.3%, respectively. CONCLUSION PD involving adjacent rib and muscle may be associated with worse LF following SBRT. Further expansion of the cohort and dosimetric analyses are ongoing.
Collapse
Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Zeng KL, Soliman H, Myrehaug SD, Tseng CL, Detsky J, Chen H, Lim-Fat MJ, Ruschin ME, Atenafu E, Keith J, Lipsman N, Heyn C, Maralani P, Das S, Pirouzmand F, Sahgal A. Outcomes Following Dose Escalated Radiotherapy for High Grade Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e161. [PMID: 37784757 DOI: 10.1016/j.ijrobp.2023.06.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Conventionally fractionated radiotherapy (RT) is a defined treatment following surgery for atypical and malignant meningioma. However, the optimal radiotherapeutic approach is not well defined. We present the results of our dose-escalation strategy. MATERIALS/METHODS Consecutive patients with a histopathologic grade 2 or 3 meningioma treated with RT were retrospectively reviewed. The primary outcome was progression-free survival (PFS), and secondary outcomes included cause-specific survival (CSS), overall survival (OS), local failure and incidence of radiation necrosis. We specifically compared the dose-escalation cohort, defined as those treated with ≥66 Gy EQD2 (equivalent dose in 2 Gy fractions, a/b = 10), to the standard dose cohort receiving <66 Gy EQD2. We defined adjuvant as RT delivered within 6 months of surgery otherwise the treatment was salvage. RESULTS A total of 118 patients with Grade 2 (111/118) or 3 (7/118) meningioma were identified. 54/118 (45.8%) received dose-escalation and 64/118 (54.2%) standard dosing. 34/54 (63.0%) dose-escalated and 45/64 (70.3%) standardly dosed were treated adjuvantly. The median follow-up was 45.4 months (IQR: 24.0-80.0 months) and median OS was 9.7 years. Post-operative residual disease was present in all dose-escalated patients, as compared to 65.6% in the standard dose cohort. PFS at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 78.9%, 72.2% and 64.6% vs. 57.2%, 49.1% and 40.8%, respectively, (p = 0.030). On multivariable (MVA) analysis, dose-escalation (HR: 0.544, 95% CI: 0.303-0.977, p = 0.042) was associated with improved PFS, whereas ≥2 surgeries (HR: 1.989, 95% CI: 1.049-3.773, p = 0.035) and older age (HR: 1.035, 95% CI:1.015-1.056, p<0.001) associated with worse PFS. The cumulative risk of local failure at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 16.9%, 23.8% and 31.8% vs. 39.6%, 45.6% and 53.9%, respectively, favoring dose-escalation (p = 0.016). MVA confirmed dose-escalation as predictive of a lower risk of LF (HR: 0.483, 95% CI: 0.263-0.887, p = 0.019), while ≥2 surgeries prior to RT predicted for greater LF rates (HR:2.145, 95% CI:1.220-3.771, p = 0.008). A trend was observed for prolonged CSS and OS in the dose escalation cohort (p = <0.1). Seven patients (5.9%) developed symptomatic radiation necrosis (RN) with no significant difference between the two cohorts. CONCLUSION Dose-escalated radiotherapy for high grade meningioma to at least 66 Gy is associated with significantly improved rates of local control and PFS with an acceptable risk of RN.
Collapse
Affiliation(s)
- K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M J Lim-Fat
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Keith
- Department of Neuropathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - C Heyn
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - F Pirouzmand
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Shor D, Zeng KL, Chen H, Louie AV, Menjak I, Atenafu E, Tseng CL, Detsky J, Larouche J, Zhang B, Soliman H, Maralani P, Myrehaug SD, Sahgal A. Molecular Status Predicts for Local Control in Patients with Non-Small Cell Lung Cancer Spinal Metastases Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e57-e58. [PMID: 37785740 DOI: 10.1016/j.ijrobp.2023.06.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report outcomes after spine stereotactic body radiotherapy (SBRT) in patients with metastatic non-small cell lung cancer (NSCLC), to determine the significance of programmed death-ligand 1 (PD-L1) status and epidermal growth factor (EGFR) mutation on local failure (LF) rate. MATERIALS/METHODS A total of 165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary outcomes included overall survival (OS) and vertebral compression fracture (VCF) rates. OS was estimated using the Kaplan-Meier method. Cumulative LF and VCF rates were calculated using competing risk analysis method. Multivariable analysis (MVA) evaluated factors predictive of LF and VCF. RESULTS Median follow-up was 13 months (range, 0.5-95 months). Median OS was 18.4 months (95% CI 11.4-24.6). Median age was 67 years (range, 28.2-89.9). 52% were female, 76% had an adenocarcinoma histology and 61% had a smoking history. 49/165 (29%) had an EGFR mutation. PD-L1 status was analyzed in 109/165 (66%) patients with 16% PD-L1 ≥ 50%, 20% PD-L1 1-49% and 35% PD-L1 <1%. Of 389 segments, 79% were de novo and 21% were previously radiated. At baseline, 35% had a VCF, 27% had epidural disease, 27% had paraspinal extension, and 49% were Spinal Instability in Neoplasia Score (SINS) stable. 239/389 (61%) were treated with either 24 or 28 Gy in 2 SBRT fractions. Within 1 month of SBRT, 39/165 (24%) had a tyrosine kinase inhibitor, 27/165 (16%) immunotherapy (IO) with or without chemotherapy, and 31/165 (19%) chemotherapy alone. LF cumulative incidence at 1- and 2-years was 16.3% (95% CI 12.8-20.3%) and 25.4% (95% CI 20.9%-30%), respectively. EGFR positivity (p<0.0001), PD-L1≥50% (p = 0.013) and treatment with IO within 1 month of SBRT (p = 0.004) predicted for improved local control on MVA. The 1- and 2-year LF rate in EGFR-positive vs. negative patients were 12.9% vs. 16.6% and 17.7% vs. 28.8%, respectively, and in those PD-L1 ≥50% vs PD-L1<50% were 7.8% vs. 19.6% and 7.8% vs. 38.1% respectively. Cumulative incidence of VCF at 1- and 2-years were 6.6% (95% CI 4.4-9.4%) and 8.8% (95% CI 6.1-12.0%). MVA identified prior SBRT to the same treated segment (P<0.0001) and a baseline VCF (p<0.0001) as significant predictors. 18/389 (4.6%) had radiation-induced radiculopathy and no radiation myelopathy events detected. CONCLUSION We identify the predictive utility of EGFR mutation and PD-L1 ≥50% status on local control in NSCLC patients with spinal metastases treated with spine SBRT, and a therapeutic benefit with peri-SBRT IO.
Collapse
Affiliation(s)
- D Shor
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Menjak
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Ong WL, Stewart J, Sahgal A, Soliman H, Tseng CL, Detsky J, Ho L, Das S, Maralani P, Lipsman N, Stanisz G, Perry J, Chen H, Atenafu E, Lau A, Ruschin ME, Myrehaug SD. Predictors of Tumor Dynamics during a 6-Week Course of Chemoradiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e142. [PMID: 37784716 DOI: 10.1016/j.ijrobp.2023.06.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Our prior imaging studies have shown geometrically meaningful inter-fraction tumor dynamics specific to glioblastoma (GBM). We aim to identify predictors associated with tumor dynamics during a 6-week course of concurrent chemoradiotherapy (CRT) for GBM. MATERIALS/METHODS Patients enrolled in a prospective serial magnetic resonance imaging (MRI) study were reviewed. All patients were treated with 54-60 Gy in 30 fractions. The gross tumor volume (GTV) included the surgical cavity and T1c enhanced residual tumor; clinical tumor volume (CTV) included GTV with a 15mm isotropic expansion, respecting anatomical boundaries; planning target volume (PTV) was 4mm expansion. MRIs were obtained at RT planning (F0), fraction 10 (F10), and fraction 20 (F20). Tumor dynamic metrics (relative to F0) assessed included the GTV volume (Vrel), Hausdorff distance (dH) and migration distance (dM). dH is the average distance between two datasets in metric space. dM is the maximum linear displacement of the GTV in any direction. Factors to be determined associated with tumor dynamics included: age, sex, corpus callosum (CC) involvement, extent of surgery (gross total resection (GTR), subtotal resection (STR) or biopsy alone (Bx)), MGMT methylation and IDH mutation status. RESULTS A total of 129 patients were reviewed. Median GTV was 20.9cc at F0, 17.6cc at F10 (Vrel 0.85), and 16.1cc at F20 (Vrel 0.78). Patients without CC involvement had more marked GTV volume reduction: Vrel 0.82 vs 1.02 with CC involvement at F10 (P = 0.05), and Vrel 0.77 vs 0.88 with CC involvement at F20 (P = 0.03). Patients with GTR (vs STR vs Bx) had more marked GTV volume reduction across all time points: Vrel 0.78, 0.85 and 1.07 respectively at F10 (P = 0.001), and Vrel 0.69, 0.80, 1.04 respectively at F20 (P = 0.001). The median dH was 8.1mm at F10 and 9.2mm at F20. Patients with CC involvement (vs without CC involvement) had a larger dH: 54% vs 25% had dH>10mm respectively at F10 (P = 0.03), and 73% vs 28% had dH>10mm respectively at F20 (P<0.005). Patients with a GTR had smaller dH at both F10 (P = 0.02) and F20 (P = 0.006). At F20, 20%, 47% and 37% of patients with GTR, STR and Bx had dH>10mm (P = 0.04). The median dM were 4.7mm at F10 and 4.7mm at F20. Patients with CC involvement (vs without CC involvement) had larger dM: 41% vs 12% had dM >10mm respectively at F10 (P = 0.01), and 45% vs 9% had dM >10mm respectively at F20 (P<0.001). Patients with GTR had smaller dM at F10 (P = 0.03) and F20 (P0.002). At F20, 0%, 25% and 19% of patients with GTR, STR and Bx had dM>10mm (P = 0.002). Age, sex, MGMT methylation and IDH mutation status were not associated with Vrel, dH and dM at F10 and F20. CONCLUSION We identified CC involvement and extent of surgery to be associated with tumor dynamics at F10 and F20 over the course of CRT for GBM. This offers opportunities to better select patients who may benefit from earlier/ more frequent RT replan/ adaptation to ensure adequate tumor coverage, or to reduce RT toxicities.
Collapse
Affiliation(s)
- W L Ong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia
| | - J Stewart
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Ho
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - G Stanisz
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - J Perry
- Department of Neurooncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - A Lau
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
8
|
Palhares DM, Zeng KL, Myrehaug SD, Tseng CL, Soliman H, Chen H, Maralani P, Larouche J, Wilson J, Ruschin ME, Zhang B, Atenafu E, Sahgal A, Detsky J. Stereotactic Body Radiotherapy (SBRT) for Sacral Metastases: Deviation from Recommended Target Volume Delineation Predicts Higher Risk of Local Failure. Int J Radiat Oncol Biol Phys 2023; 117:e143-e144. [PMID: 37784719 DOI: 10.1016/j.ijrobp.2023.06.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A international consensus recommendation was published to guide target volume delineation specific to sacral stereotactic body radiotherapy (SBRT). We report outcomes after sacrum SBRT, focusing on the impact of contouring deviation on local failure (LF) risk, with an aim to validate this guideline. MATERIALS/METHODS All patients who underwent SBRT to any level between S1 and S5 from 2010 to 2021 were identified from a prospectively maintained institutional database. The primary outcome was magnetic resonance-based LF. Secondary outcomes included vertebral compression fracture (VCF) and overall survival (OS). Cumulative LF and VCF rates were calculated per segment using the competing risk analysis method. Kaplan Meier analysis was used to estimate OS per patient. Cox proportional hazards model was used to assess predictive factors of LF, VCF, and OS. RESULTS A total of 215 treated sacral segments in 112 patients were retrospectively reviewed. The median follow-up was 13 months (range, 0.4-116.9). The median age was 64 years (range, 18-86), and 56% were male. Most patients (52%) had treatment to a single segment. The median clinical target volume (CTV) was 129.2 cc (range, 5.8-753.5). Most segments were treated with 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Thirty-one percent of segments were of radioresistant histology (gastrointestinal, kidney, melanoma, sarcoma, or thyroid primary), and 51% had extraosseous disease. Sixteen percent of segments were under-contoured per consensus guidelines, with incomplete coverage of the involved sector (71%), omission of the adjacent uninvolved sector (17%), or both (11%) as the causes for deviation. The cumulative incidence of LF was 18.4% (95% CI 13.5-24.0) at 12-months and 23.1% (95% CI 17.6-29.0) at 24-months. On multivariate analysis (MVA), under-contouring (HR 2.4, 95% CI 1.3-4.7, p = 0.008), radioresistant histology (HR 2.4, 95% CI 1,4-4.1, p = 0.001), and extraosseous extension (HR 2.5, 95% CI 1.3-4.7, p = 0.005) were predictors of increased risk of LF. The LF rates at 12/24-months were 15.1%/18.8% for segments contoured per guideline versus 31.4%/40.0% for those under-contoured. The cumulative incidence of VCF was 7.1% (95% CI 4.1-11.1) at 12-months and 12.3% (95% CI 8.2-17.2) at 24-months. On MVA, female gender was the only risk factor for VCF (HR 2.3, 95% CI 1.1-5.2, p = 0.04). The median OS was 29.5 months (95% CI 17.5-59.2). On MVA, primary kidney (HR 4.7, 95% CI 1.7-12.5, p = 0.002) or lung histology (HR 3.4, 95% CI 1.3-8.5, p = 0.010), the presence of liver (HR 2.8, 95% CI 1.2-6.4, p = 0.016) or lung (HR 2.5, 95% CI 1.3-5.1, p = 0.008) metastases, ECOG performance status 2 or 3 (HR 3.3, 95% CI 1.2-8.2, p = 0.013), and the presence of sensory or motor deficit (HR 2.6, 95% CI 1.2-5.4, p = 0.012) were prognostic for worse OS. CONCLUSION Sacral SBRT is associated with high rates of efficacy and an acceptable VCF risk. Adherence to target volume delineation consensus guidelines reduces the risk of LF.
Collapse
Affiliation(s)
- D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - K L Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Larouche
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Wilson
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - M E Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
9
|
Diaz Mejia NM, Stecca C, Jiang DM, Fallah-Rad N, Bedard PL, Kumar V, Abdeljalil O, Zahralliyali A, Alqaisi H, Al-Ezzi EM, Choy V, Banwait P, Atenafu E, Sridhar SS. A retrospective review of primary prophylaxis with granulocyte-colony stimulating factor (G-CSF) for patients with genitourinary malignancies receiving chemotherapy during the COVID-19 pandemic and implications for the future. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
115 Background: To mitigate the risks of chemotherapy associated neutropenia, during the COVID-19 pandemic, all genitourinary (GU) cancer patients treated with chemotherapy at the Princess Margaret Cancer Centre (PMCC) were offered primary prophylaxis with GCSF. We hypothesize that this reduced rates of febrile neutropenia, hospitalizations, healthcare costs and improved overall outcomes, compared to GU cancer patients treated with chemotherapy without GCSF in the 2 years prior to the pandemic. Methods: We performed a retrospective review of GU cancer patients, receiving curative or palliative intent chemotherapy, with or without primary GCSF prophylaxis between January 2018 and June 2022. GCSF was given either as a single dose or as consecutive doses post chemotherapy. Main outcomes were incidence of febrile neutropenia, hospitalization, health care expenditures as well as disease specific outcomes. Results: Overall, 248 patients with prostate cancer (44%), urothelial cancers (33%) germ cell (21%), and rare GU cancers (4%) were identified. Median age was 70 (range 19-91), 92% were male, 65% were ECOG 0/1. Treatment intent was neoadjuvant (13%), adjuvant (20%), or palliative (67%). Main regimens used were docetaxel, cabazitaxel, carboplatin, cisplatin/etoposide, gemcitabine/cisplatin and BEP. Median follow-up was 10.5 months (0.23-52.3 months). A total of 206/248 received primary GCSF prophylaxis. During chemotherapy, the median white blood cell levels were higher in the GCSF group compared to the non-GCSF group (14.1*10*9/L vs 2.90*10*9/L, p<0.0001); and neutropenia rates were markedly lower (2% vs. 93%, P=<0.0001). Hospital admission rates were significantly lower in G-CSF users compared to non-users (19% vs. 69%, P<0.0001). Symptomatic disease progression 13% was the leading cause of admission in the G-CSF group. Infectious causes such as UTI, pneumonia, COVID-19, and sepsis were seen in only 12% of the G-CSF group compared to 31% in the non-users. G-CSF was generally well tolerated with just 0.97% discontinuing G-CSF. Conclusions: During the COVID-19 pandemic, primary prophylactic G-CSF use in GU cancer patients, undergoing chemotherapy significantly lowered rates of both febrile neutropenia and hospitalizations and could be a cost-effective strategy in this patient population that warrants further study.
Collapse
Affiliation(s)
- Nely Mercy Diaz Mejia
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Carlos Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Vikaash Kumar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Osama Abdeljalil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Amer Zahralliyali
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Esmail Mutahar Al-Ezzi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Vivian Choy
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Parmvir Banwait
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Eshetu Atenafu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| | - Srikala S. Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON., Toronto, ON, Canada
| |
Collapse
|
10
|
Al Nabhani I, Andrews C, Sibai J, Atenafu E, Young T, Chan SM, Gupta V, Maze D, Schimmer AD, Schuh AC, Yee K, Sibai H. Safety of re-challenging adults with acute lymphoblastic leukemia with PEG-asparaginase-induced severe hypertriglyceridemia when treated with a pediatric-inspired regimen. EJHaem 2023; 4:232-235. [PMID: 36819167 PMCID: PMC9928666 DOI: 10.1002/jha2.607] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 06/18/2023]
Abstract
PEG-asparaginase is used as a treatment for Philadelphia-negative acute lymphoblastic leukemia. In pediatric studies, triglycerides (TGs) were affected more by PEG-asparaginase than by native L-asparaginase (10.0% vs. 5.5%). We conducted a retrospective study to determine the safety of re-challenging adult patients with PEG-asparaginase after experiencing an episode of severe hypertriglyceridemia (>1000 mg/dl or 11.4 mmol/L). The incidence of hypertriglyceridemia associated with PEG-asparaginase in adult patients was high (67.5%). Therefore, checking TGs at baseline and monitoring levels while receiving PEG-asparaginase need to be considered and studied in prospective studies. However, in patients with hypertriglyceridemia not complicated by acute pancreatitis, re-challenging is safe once TG levels normalize.
Collapse
Affiliation(s)
- Ibrahim Al Nabhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Claire Andrews
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Jad Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Eshetu Atenafu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Taylor Young
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Steven M. Chan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Vikas Gupta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Dawn Maze
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Aaron D. Schimmer
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Andre C. Schuh
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Karen Yee
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Hassan Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| |
Collapse
|
11
|
Zhao D, Eladl E, Zarif M, Capo‐Chichi J, Schuh A, Atenafu E, Minden M, Chang H. Molecular characterization of
AML‐MRC
reveals
TP53
mutation as an adverse prognostic factor irrespective of
MRC
‐defining criteria,
TP53
allelic state, or
TP53
variant allele frequency. Cancer Med 2022; 12:6511-6522. [PMID: 36394085 PMCID: PMC10067127 DOI: 10.1002/cam4.5421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/30/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) generally confers poor prognosis, however, patient outcomes are heterogeneous. The impact of TP53 allelic state and variant allele frequency (VAF) in AML-MRC remains poorly defined. METHODS We retrospectively evaluated 266 AML-MRC patients who had NGS testing at our institution from 2014 to 2020 and analyzed their clinical outcomes based on clinicopathological features. RESULTS TP53 mutations were associated with cytogenetic abnormalities in 5q, 7q, 17p, and complex karyotype. Prognostic evaluation of TP53MUT AML-MRC revealed no difference in outcome between TP53 double/multi-hit state and single-hit state. Patients with high TP53MUT variant allele frequency (VAF) had inferior outcomes compared to patients with low TP53MUT VAF. When compared to TP53WT patients, TP53MUT patients had inferior outcomes regardless of MRC-defining criteria, TP53 allelic state, or VAF. TP53 mutations and elevated serum LDH were independent predictors for inferior OS and EFS, while PHF6 mutations and transplantation were independent predictors for favorable OS and EFS. NRAS mutation was an independent predictor for favorable EFS. CONCLUSIONS Our study suggests that TP53MUT AML-MRC defines a very-high-risk subentity of AML in which novel therapies should be explored.
Collapse
Affiliation(s)
- Davidson Zhao
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| | - Entsar Eladl
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
- Department of Pathology, Faculty of Medicine Mansoura University Mansoura Egypt
| | - Mojgan Zarif
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| | - José‐Mario Capo‐Chichi
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| | - Andre Schuh
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| | - Eshetu Atenafu
- Department of Biostatistics University Health Network Toronto Ontario Canada
| | - Mark Minden
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| | - Hong Chang
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Department of Hematology and Medical Oncology University Health Network Toronto Ontario Canada
| |
Collapse
|
12
|
Zeng K, Abugarib A, Soliman H, Myrehaug S, Husain Z, Detsky J, Ruschin M, Karotki A, Atenafu E, Maralani P, Sahgal A, Tseng C. Dose-Escalated Two-Fraction Spine Stereotactic Body Radiotherapy: 28 Gy vs. 24 Gy in 2 Daily Fractions. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Zeng K, Myrehaug S, Soliman H, Husain Z, Tseng C, Detsky J, Ruschin M, Atenafu E, Witiw C, Larouche J, da Costa L, Maralani P, Parulekar W, Sahgal A. Mature Local Control and Reirradiation Rates Comparing Spine Stereotactic Body Radiotherapy to Conventional Palliative External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Zeng KL, Myrehaug S, Soliman H, Husain ZA, Tseng CL, Detsky J, Ruschin M, Atenafu E, Witiw C, Larouche J, da Costa L, Maralani PJ, Parulekar W, Sahgal A. 47: Mature Local Control and Reirradiation Rates Comparing Spine Stereotactic Body Radiotherapy to Conventional Palliative External Beam Radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Zeng KL, Abugharib A, Soliman H, Myrehaug S, Husain Z, Detsky J, Ruschin M, Karotki A, Atenafu E, Maralani P, Sahgal A, Tseng CL. 83: Dose-Escalated Two-Fraction Spine Stereotactic Body Radiotherapy: 28 GY Versus 24 GY in 2 Daily Fractions. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
16
|
Piedimonte S, Kim SR, Clark M, Lheureux S, May T, Bernardini M, Atenafu E. The modeled CA-125 elimination rate constant k (KELIM) score as a predictor of treatment response in patients with advanced high grade serous ovarian cancer (190). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Zhao D, Zarif M, Eladl E, Capo-Chichi JM, CSmith A, Atenafu E, Tierens A, Minden M, Schuh A, Chang H. NPM1-mutated AML-MRC diagnosed on the basis of history of MDS or MDS/MPN frequently harbours secondary-type mutations and confers inferior outcome compared to AML with mutated NPM1. Leuk Res 2022; 118:106869. [DOI: 10.1016/j.leukres.2022.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
|
18
|
Padayachee J, Sanmamed N, Lee J, Liu Z, Berlin A, Craig T, Lao B, Rink A, Bayley A, Catton C, Sundaramurthy A, Foltz W, McPartlin A, Ghai S, Atenafu E, Gospodarowicz M, Warde P, Helou J, Raman S, Menard C, Chung P. Local Control in Tumor-Targeted Dose Escalation for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Wang M, Kim A, Ruschin M, Tan H, Soliman H, Myrehaug S, Detsky J, Husain Z, Atenafu E, Keller B, Sahgal A, Tseng C. Dosimetric Comparison in Malignant Glioma Patients Clinically Treated on Hybrid Magnetic Resonance Imaging (MRI)-Linac (MRL) vs. Conventional Linac. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Chen H, Atenafu E, Erler D, Poon I, Dagan R, Redmond K, Foote M, Badellino S, Biswas T, Ricardi U, Sahgal A, Louie A. A Prognostic Model for Patients With Oligometastatic Disease Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Cherniawsky HM, Kukreti V, Reece D, Masih-Khan E, McCurdy A, Jimenez-Zepeda VH, Sebag M, Song K, White D, Stakiw J, LeBlanc R, Reiman A, Aslam M, Louzada M, Kotb R, Gul E, Atenafu E, Venner CP. The survival impact of maintenance lenalidomide: an analysis of real-world data from the Canadian Myeloma Research Group national database. Haematologica 2021; 106:1733-1736. [PMID: 33054120 PMCID: PMC8168484 DOI: 10.3324/haematol.2020.259093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Vishal Kukreti
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - Donna Reece
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - Esther Masih-Khan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Canadian Myeloma Research Group, Toronto, Ontario.
| | | | | | - Michael Sebag
- Department of Oncology, Division of Hematology, McGill University, Montreal, QC
| | - Kevin Song
- BC Cancer, Vancouver General Hospital, British Columbia
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre. Dalhousie University, Halifax, Nova Scotia
| | - Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec
| | - Anthony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, NB
| | | | | | - Rami Kotb
- Cancer Care Manitoba, Winnipeg, Manitoba
| | - Engin Gul
- Canadian Myeloma Research Group, Toronto, Ontario
| | | | | |
Collapse
|
22
|
Cherniawsky HM, Kukreti V, Reece D, Masih-Khan E, McCurdy A, Jimenez-Zepeda VH, Sebag M, Song K, White D, Stakiw J, LeBlanc R, Reiman A, Louzada M, Aslam M, Kotb R, Gul E, Atenafu E, Venner CP. The impact of lenalidomide maintenance on second-line chemotherapy in transplant eligible patients with multiple myeloma. Eur J Haematol 2021; 106:673-681. [PMID: 33539037 DOI: 10.1111/ejh.13596] [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: 09/24/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To understand the impact of therapy sequencing on progression-free (PFS) and overall survival (OS) for the treatment of multiple myeloma (MM). The use of daily, low-dose, lenalidomide maintenance (LM) has raised concern for fostering resistance, preventing its use in the relapsed setting. METHODS We conducted a retrospective analysis of survival outcomes from the Canadian Myeloma Research Group Database. Patients were grouped based on receipt of LM after autologous stem cell transplant and receipt of lenalidomide in second-line therapy, 575 patients were included. RESULTS Patients treated with LM had statistically similar 2nd PFS when re-exposed to lenalidomide in second-line therapy compared to those receiving non-lenalidomide-containing regimens (10.2 vs 14.0 months, P =.53). This cohort also had the longest 2nd OS, 18 months longer than patients treated with LM who did not receive lenalidomide at relapse (55.3 vs 37 months, P =.004). Patients treated with LM also demonstrated deeper responses to second-line therapy than their non-LM counterparts. CONCLUSION Our data suggest that patients progressing on LM who receive lenalidomide-containing therapy at first relapse have comparable 2nd PFS and better 2nd OS compared to non-lenalidomide-containing second-line regimens. Identification of patients mostly likely to benefit from further lenalidomide-containing therapy is paramount.
Collapse
Affiliation(s)
| | - Vishal Kukreti
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Donna Reece
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Esther Masih-Khan
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Canadian Myeloma Research Group, Toronto, ON, Canada
| | - Arleigh McCurdy
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Michael Sebag
- Departments of Medicine and Oncology, Division of Hematology, McGill University, Montreal, QC, Canada
| | - Kevin Song
- BC Cancer Agency, Vancouver General Hospital, Vancouver, BC, Canada
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre. Dalhousie University, Halifax, NS, Canada
| | - Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Anthony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | | | | | - Rami Kotb
- Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Engin Gul
- Canadian Myeloma Research Group, Toronto, ON, Canada
| | | | | |
Collapse
|
23
|
Zeng K, Husain Z, Soliman H, Myrehaug S, Tseng C, Detsky J, Lee Y, Campbell M, Foster M, Atenafu E, Maralani P, Sahgal A. Imaging-Based Local Control Rates For “Radioresistant” Spinal Metastases Following Spine Stereotactic Body Radiotherapy Using Prostate Cancer As The “Radiosensitive” Reference. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
Detsky JS, Nguyen TK, Lee Y, Atenafu E, Maralani P, Husain Z, Tseng CL, Myrehaug S, Soliman H, Sahgal A. Mature Imaging-Based Outcomes Supporting Local Control for Complex Reirradiation Salvage Spine Stereotactic Body Radiotherapy. Neurosurgery 2020; 87:816-822. [PMID: 32374852 DOI: 10.1093/neuros/nyaa109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Upon progression after upfront radiotherapy to spinal metastases, low-dose re-irradiation conventional external beam radiation (cEBRT) provides limited clinical benefit. Spine stereotactic body radiotherapy (SBRT) allows for dose escalation in the salvage setting with the potential for improved local control. OBJECTIVE To report mature clinical and imaging-based outcomes for salvage SBRT. METHODS A retrospective review was undertaken of consecutive patients with spinal metastases treated with re-irradiation spine SBRT having failed either cEBRT (n = 60 with 1 prior course and n = 17 with 2 or more prior cEBRT courses), or prior SBRT (n = 6) to the same spinal segment. The primary outcome was local failure (LF), and secondary outcomes included overall survival (OS) and the rate of vertebral compression fracture (VCF). RESULTS A total of 43 patients with 83 spinal segments treated with salvage SBRT were reviewed. The crude risk of LF was 18%, and actuarial LF rates at 6, 12, and 24 mo were 7%, 14%, and 19%, respectively. The presence of extensive paraspinal disease (hazard ratio [HR] = 7.1, 95% CI 1.5-34) significantly predicted for LF. The median OS was 13.2 (95% CI 6.1-16.3) mo, and the presence of neurological deficits (HR = 4.7, 95% CI 1.8-12.1) and brain metastases (HR = 2.6, 95% CI 1.1-6.3) were significant prognostic factors. The crude risk of VCF was 4%, and radiation myelopathy was not observed. CONCLUSION These data support the safety and efficacy of spinal re-irradiation with SBRT including patients with prior SBRT and multiple courses of prior cEBRT.
Collapse
Affiliation(s)
- Jay S Detsky
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario
| | - Young Lee
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Eshetu Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario
| | - Pejman Maralani
- Medical Imaging, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario
| |
Collapse
|
25
|
Zeng KL, Husain Z, Soliman H, Myrehaug S, Tseng CL, Detsky J, Lee Y, Campbell M, Foster M, Atenafu E, Maralani P, Sahgal A. 35: Imaging-Based Local Control Rates for “Radioresistant” Spinal Metastases Following Spine Stereotactic Body Radiotherapy Using Prostate Cancer as The “Radiosensitive” Reference. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
26
|
Erler D, Sahgal A, Dagan R, Redmond KJ, Foote M, Badellino S, Biswas T, Atenafu E, Louie A, Lee Y, Ricardi U, Poon I. Survival Outcomes and Prognostic Factors for >1000 Patients Treated Curatively with Stereotactic Body Radiation Therapy (SBRT) for Oligometastases. J Med Imaging Radiat Sci 2020. [DOI: 10.1016/j.jmir.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Faruqi S, Ruschin M, Soliman H, Myrehaug S, Zeng KL, Husain Z, Atenafu E, Tseng CL, Das S, Perry J, Maralani P, Heyn C, Mainprize T, Sahgal A. Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases. Int J Radiat Oncol Biol Phys 2020; 106:772-779. [DOI: 10.1016/j.ijrobp.2019.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/05/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022]
|
28
|
Andrews C, Atenafu E, Murphy T, Al-Shaibani Z, Chan S, Gupta V, Kim DD, Kumar R, Lam W, Lipton JH, Mattson J, Maze D, Michelis FV, McNamara C, Schimmer A, Schuh AC, Sibai H, Viswabandya A, Yee K, Minden M, Law AD. Allogeneic Stem Cell Transplantation Has Limited Benefit in Older Patients with Mixed Phenotype Acute Leukemia. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
Lieberman L, Nixon S, Doherty M, Murray C, Wolfe A, Brandys D, Rowland S, Atenafu E, Lechner B, Maze D. Clinical outcomes and management following intracranial hemorrhage in acute leukemia. Transfus Med Rev 2020. [DOI: 10.1016/j.tmrv.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Barrera M, Atenafu E, Nathan PC, Schulte F, Hancock K. Depression and Quality of Life in Siblings of Children With Cancer After Group Intervention Participation: A Randomized Control Trial. J Pediatr Psychol 2019; 43:1093-1103. [PMID: 29893947 DOI: 10.1093/jpepsy/jsy040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 05/16/2018] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of this study was to (1) assess the effects of a group intervention called Siblings Coping Together on siblings' psychosocial adjustment compared with controls; (2) explore the potential moderating effect of siblings' gender; and (3) investigate whether the intervention was more effective for siblings with more depressive symptoms at baseline. Methods This was a repeated measure, parallel randomized controlled trial (RCT) with two groups. Seventy-five healthy siblings (7-16 years old, 41 males) participated. Both groups had 8 weekly 2-hr sessions. Intervention sessions had psychoeducational, social, and therapeutic problem-solving goals taught through games and crafts (n = 41); controls (n = 34) had games and crafts only. Self-reported symptoms of depression (Children's Depression Inventory, CDI) and self- and proxy-reported quality of life (QOL) (Pediatric Quality of Life Inventory, PedsQL) were obtained at baseline, postintervention, and 3 months later. Multivariable analyses with a mixed effects model were performed. Results No significant main group effect or group × time interactions were found for any of the scales assessed. Significant improvement over time was found for total CDI (p < .01) and proxy-reported PedsQL total (p < .001) in both groups, which may have been attributable to the passage of time. Conclusions No sufficient evidence was obtained for the efficacy of the intervention in the current study. Future research may examine conducting a larger RCT comparing sibling support group to no treatment control group.
Collapse
Affiliation(s)
- Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children
| | | | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children
| | - Fiona Schulte
- Department of Psychology, Division of Hematology/Oncology, Alberta Children's Hospital
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children
| |
Collapse
|
31
|
Faruqi S, Soliman H, Myrehaug S, Zeng KL, Husain Z, Atenafu E, Tseng CL, Das S, Perry J, Maralani P, Heyn C, Mainprize T, Ruschin M, Sahgal A. 235 Radiation Necrosis Following Five Daily Fractions of Stereotactic Radiotherapy for Surgical Cavities and Intact Brain Metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Nguyen T, Sahgal A, Detsky J, Atenafu E, Myrehaug S, Tseng CL, Husain Z, Ruschin M, Heyn C, Soliman H. 230 Predictors of Leptomeningeal Disease After Hypofractionated Stereotactic Radiotherapy for Intact and Resected Brain Metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Barry A, Atenafu E, Kim J, Brierley J, Ringash J, Brade A, Dinniwell R, Wong R, Cho C, Kim T, Sapisochin G, Dawson L. 233 Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Macrovascular Invasion. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Birang E, Deporter D, Birang R, Mahabadi M, Atenafu E, Ketabi M. Effectiveness of buccal pouch grafting in minimizing loss of alveolar dimension: A canine investigation. Dent Res J (Isfahan) 2019; 16:338-345. [PMID: 31543941 PMCID: PMC6749860] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The study's purpose was to study buccal pouch grafting (BPG) with xenograft, freeze-dried bone allograft (FDBA), or FDBA + decalcified FDBA (DFDBA) on alveolar ridge width preservation and overlying soft tissue thickness at dog premolar extraction sites. MATERIALS AND METHODS In this animal study, 4 dogs had their mandibular first premolar (P1) and distal roots of P2, P3, and P4 extracted (after endodontic treatment of the mesial roots) bilaterally. A small buccal pouch was created at each extraction socket and four treatments tested: nothing, xenograft, FDBA, or FDBA + DFDBA. Casts made pretreatment and at 1 and 3 months after treatment allowed measurements of buccolingual alveolar ridge width (BLRW), while overlying buccal soft tissue thicknesses were measured clinically. Data were assessed using analysis of variance to compare changes in soft tissue thickness and BLRW between times and treatments. Tukey-Kramer adjustment for multiple comparisons was applied for doing post hoc, pairwise comparisons. Results were considered significant if P < 0.05. RESULTS Control sites showed significant (P = 0.0067) decreases in soft tissue thickness over time while there was a trend for increased soft tissue thickness at all grafted sites. There were significant losses in BLRW over time for control (P = 0.0032) and FDBA groups (P = 0.015) with a trend for loss with FDBA + DFDBA. Pairwise comparison using Tukey-Kramer adjustment revealed significant increases in BLRW from T1 to T3 for the xenograft group relative to all the others. CONCLUSION BPG using xenograft is effective in maintaining hard and soft tissue stability following tooth extraction.
Collapse
Affiliation(s)
- Ehsan Birang
- Department of Periodontics, Isalmic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Douglas Deporter
- Department of Periodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Reza Birang
- Department of Periodontics, Dental Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Meysam Mahabadi
- Department of Prosthodontics, School of Dentistry, Isalmic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Eshetu Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Ketabi
- Department of Periodontics, School of Dentistry, Isalmic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran,Address for correspondence: Dr. Mohammad Ketabi, Department of Periodontics, School of Dentistry, Isalmic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran. E-mail:
| |
Collapse
|
35
|
Faruqi S, Soliman H, Myrehaug S, Zeng K, Husain Z, Atenafu E, Tseng C, Das S, Perry J, Maralani P, Heyn C, Mainprize T, Ruschin M, Sahgal A. Radiation Necrosis Following Five Daily Fractions of Stereotactic Radiotherapy for Surgical Cavities and Intact Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Nguyen T, Sahgal A, Detsky J, Atenafu E, Myrehaug S, Tseng C, Husain Z, Ruschin M, Lee Y, Heyn C, Soliman H. Predictors of Leptomeningeal Disease after Hypofractionated Stereotactic Radiotherapy for Intact and Resected Brain Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Green BJ, Nguyen V, Atenafu E, Weeber P, Duong BTV, Thiagalingam P, Labib M, Mohamadi RM, Hansen AR, Joshua AM, Kelley SO. Phenotypic Profiling of Circulating Tumor Cells in Metastatic Prostate Cancer Patients Using Nanoparticle-Mediated Ranking. Anal Chem 2019; 91:9348-9355. [DOI: 10.1021/acs.analchem.9b01697] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Brenda J. Green
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Vivian Nguyen
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
| | - Eshetu Atenafu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2C1, Canada
| | - Phillip Weeber
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
| | - Bill T. V. Duong
- Department of Chemistry, University of Toronto, Toronto, Ontario M5S 3H6, Canada
| | - Punithan Thiagalingam
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
| | - Mahmoud Labib
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
| | - Reza M. Mohamadi
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
| | - Aaron R. Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2C1, Canada
| | - Anthony M. Joshua
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2C1, Canada
- Kinghorn Cancer Centre, St. Vincent’s Hospital Sydney, Darlinghurst, New South Wales 2010, Australia
| | - Shana O. Kelley
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
- Department of Pharmaceutical Sciences, University of Toronto, Toronto M5S 3M2, Canada
- Department of Chemistry, University of Toronto, Toronto, Ontario M5S 3H6, Canada
- Department of Biochemistry, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| |
Collapse
|
38
|
Salas MQ, Atenafu E, Law A, Lam W, Kim DD, Michelis FV, Thyagu S, Viswabandya A, Lipton JH, Gupta V, Kumar R. Outcome of Adult Patients Diagnosed with Aplastic Anemia That Underwent Allogeneic Stem Cell Transplantation: A Single Institution Experience. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Ketabi M, Birang E, Deporter D, Birang R, Mahabadi M, Atenafu E. Effectiveness of buccal pouch grafting in minimizing loss of alveolar dimension: A canine investigation. Dent Res J (Isfahan) 2019. [DOI: 10.4103/1735-3327.266087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
40
|
Moraes F, Winter J, Atenafu E, Dasgupta A, Coolens C, Millar B, Laperriere N, Tsang D, Bernstein M, Kongkham P, Zadeh G, Conrad T, Berlin A, Shultz D. Comparison of Local Failure and Radionecrosis According to Dose Prescription for Small to Medium Sized Brain Metastasis treated with Radiosurgery. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Hasan M, Bang A, Lechtman E, Atenafu E, Sun A, Bissonnette J. Quantifying Upstage Rate as a Function of Delay from Diagnostic Imaging for Locally-Advanced Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
Ganesan SL, Stewart CP, Atenafu E, Ochi A, Otsubo H, Go C, Hahn CD. T74. Factors that reduce the accuracy of seizure identification using quantitative EEG displays. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Babic S, Lee Y, Ruschin M, Lochray F, Lightstone A, Atenafu E, Phan N, Mainprize T, Tsao M, Soliman H, Sahgal A. To frame or not to frame? Cone-beam CT-based analysis of head immobilization devices specific to linac-based stereotactic radiosurgery and radiotherapy. J Appl Clin Med Phys 2018; 19:111-120. [PMID: 29363282 PMCID: PMC5849846 DOI: 10.1002/acm2.12251] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Noninvasive frameless systems are increasingly being utilized for head immobilization in stereotactic radiosurgery (SRS). Knowing the head positioning reproducibility of frameless systems and their respective ability to limit intrafractional head motion is important in order to safely perform SRS. The purpose of this study was to evaluate and compare the intrafractional head motion of an invasive frame and a series of frameless systems for single fraction SRS and fractionated/hypofractionated stereotactic radiotherapy (FSRT/HF‐SRT). Methods The noninvasive PinPoint system was used on 15 HF‐SRT and 21 SRS patients. Intrafractional motion for these patients was compared to 15 SRS patients immobilized with Cosman‐Roberts‐Wells (CRW) frame, and a FSRT population that respectively included 23, 32, and 15 patients immobilized using Gill‐Thomas‐Cosman (GTC) frame, Uniframe, and Orfit. All HF‐SRT and FSRT patients were treated using intensity‐modulated radiation therapy on a linear accelerator equipped with cone‐beam CT (CBCT) and a robotic couch. SRS patients were treated using gantry‐mounted stereotactic cones. The CBCT image‐guidance protocol included initial setup, pretreatment and post‐treatment verification images. The residual error determined from the post‐treatment CBCT was used as a surrogate for intrafractional head motion during treatment. Results The mean intrafractional motion over all fractions with PinPoint was 0.62 ± 0.33 mm and 0.45 ± 0.33 mm, respectively, for the HF‐SRT and SRS cohort of patients (P‐value = 0.266). For CRW, GTC, Orfit, and Uniframe, the mean intrafractional motions were 0.30 ± 0.21 mm, 0.54 ± 0.76 mm, 0.73 ± 0.49 mm, and 0.76 ± 0.51 mm, respectively. For CRW, PinPoint, GTC, Orfit, and Uniframe, intrafractional motion exceeded 1.5 mm in 0%, 0%, 5%, 6%, and 8% of all fractions treated, respectively. Conclusions The noninvasive PinPoint system and the invasive CRW frame stringently limit cranial intrafractional motion, while the latter provides superior immobilization. Based on the results of this study, our clinical practice for malignant tumors has evolved to apply an invasive CRW frame only for metastases in eloquent locations to minimize normal tissue exposure.
Collapse
Affiliation(s)
- Steven Babic
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Fiona Lochray
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alex Lightstone
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nic Phan
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Todd Mainprize
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - May Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
44
|
Tseng C, Campbell M, Soliman H, Myrehaug S, Ruschin M, Lee Y, Atenafu E, Sahgal A. Imaging-Based Outcomes for 24 Gy in 2 Daily Fractions for Patients With De Novo Spinal Metastases Treated with Spine Stereotactic Body Radiation Therapy: An Emerging Standard. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
45
|
Khoja L, Atenafu E, Joshua A, Ocular Melanoma Group I. Validating prognostic models in metastatic uveal melanoma (MUM), an international rare cancers initiative. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
Czarnecka-Kujawa K, Rochau U, Siebert U, Atenafu E, Darling G, Waddell TK, Pierre A, De Perrot M, Cypel M, Keshavjee S, Yasufuku K. Cost-effectiveness of mediastinal lymph node staging in non–small cell lung cancer. J Thorac Cardiovasc Surg 2017; 153:1567-1578. [DOI: 10.1016/j.jtcvs.2016.12.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/07/2016] [Accepted: 12/17/2016] [Indexed: 12/25/2022]
|
47
|
Borkhoff CM, Johnston PR, Stephens D, Atenafu E. Response to the letter by Guogen Shan and Hua Zhang (response to letter commenting: J Clin Epidemiol. 2015;68:733-739). J Clin Epidemiol 2017; 84:190-191. [PMID: 28063916 DOI: 10.1016/j.jclinepi.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Department of Pediatrics and Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada; Women's College Research Institute, Women's College Hospital, 7th Floor, 790 Bay St., Toronto, Ontario, M5G 1N8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Patrick R Johnston
- Clinical Research Program, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Derek Stephens
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St., Toronto, Ontario, M5T 3M7, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St., Toronto, Ontario, M5T 3M7, Canada; Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| |
Collapse
|
48
|
Sahgal A, Chan M, Thibault I, Atenafu E, Letourneau D, Cho J, Lee Y, Yu E, Yee A, Fehlings M. Patterns of Epidural Progression Following Postoperative Spine Stereotactic Body Radiation Therapy (SBRT): Implications for Clinical Target Volume Delineation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Borkhoff CM, Johnston PR, Stephens D, Atenafu E. The special case of the 2 × 2 table: asymptotic unconditional McNemar test can be used to estimate sample size even for analysis based on GEE. J Clin Epidemiol 2014; 68:733-9. [PMID: 25510372 DOI: 10.1016/j.jclinepi.2014.09.025] [Citation(s) in RCA: 3] [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: 03/01/2013] [Revised: 08/15/2014] [Accepted: 09/04/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Aligning the method used to estimate sample size with the planned analytic method ensures the sample size needed to achieve the planned power. When using generalized estimating equations (GEE) to analyze a paired binary primary outcome with no covariates, many use an exact McNemar test to calculate sample size. We reviewed the approaches to sample size estimation for paired binary data and compared the sample size estimates on the same numerical examples. STUDY DESIGN AND SETTING We used the hypothesized sample proportions for the 2 × 2 table to calculate the correlation between the marginal proportions to estimate sample size based on GEE. We solved the inside proportions based on the correlation and the marginal proportions to estimate sample size based on exact McNemar, asymptotic unconditional McNemar, and asymptotic conditional McNemar. RESULTS The asymptotic unconditional McNemar test is a good approximation of GEE method by Pan. The exact McNemar is too conservative and yields unnecessarily large sample size estimates than all other methods. CONCLUSION In the special case of a 2 × 2 table, even when a GEE approach to binary logistic regression is the planned analytic method, the asymptotic unconditional McNemar test can be used to estimate sample size. We do not recommend using an exact McNemar test.
Collapse
Affiliation(s)
- Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Department of Pediatrics and Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada; Women's College Research Institute, Women's College Hospital, 7th Floor, 790 Bay St., Toronto, Ontario, M5G 1N8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Patrick R Johnston
- Clinical Research Program, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Derek Stephens
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St., Toronto, Ontario, M5T 3M7, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St., Toronto, Ontario, M5T 3M7, Canada; Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| |
Collapse
|
50
|
Salavati B, Seeman MV, Agha M, Atenafu E, Chung J, Nathan PC, Barrera M. Which Siblings of Children with Cancer Benefit Most from Support Groups? Children's Health Care 2014. [DOI: 10.1080/02739615.2013.837820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|