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Mills D, Horsley P, Venkatasha V, Back M. Volumetric Response and Survival of Patients With Bulky IDH-Mutated Grade 3 Glioma Managed With FET-FDG-Guided Integrated Boost IMRT. Clin Oncol (R Coll Radiol) 2024; 36:343-352. [PMID: 38553362 DOI: 10.1016/j.clon.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/23/2024] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS Despite relatively favourable outcomes associated with IDH-mutant grade 3 gliomas, many patients present with diffuse non-enhancing disease involving multiple brain regions, prompting concern over both durable disease control and the morbidity associated with large volume radiation therapy. This study audits volumetric response, survival and functional outcomes in this 'large volume' subgroup that undergoes intensity modulated radiation therapy (IMRT). MATERIALS AND METHODS From a prospective database of 187 patients with IDH-mutant grade 3 gliomas managed with IMRT between 2008 and 2020, recorded PTV was divided into quartiles. The top quartile, termed the 'large volume cohort' (LVC), was identified. IMRT involved FET-FDG guided integrated boost (59.4/54Gy in 33 fractions). Manual volumetric segmentation of baseline, four months and 13 months post-IMRT tumour were performed for T1, T2 and T1gd MRI sequences. The primary endpoint was volumetric reduction on the T1 and T2 sequences at 13 months and analysed with relapse-free survival (RFS) and overall survival (OS). Morbidity endpoints were assessed at year four post-IMRT and included performance status (ECOG PS) and employment outcomes. RESULTS The fourth quartile (LVC) identified 44 patients for whom volumetric analysis was available. The LVC had median PTV of 320cm3 compared to 186.2cm3 for the total group. Anaplastic astrocytoma and oligodendroglioma were equally distributed and tumour sites were frontal (54%), temporal (18%) and parietal lobes (16%). Median follow-up for survivors was 71.5 months. Projected 10-year RFS and OS in LVC was 40% and 62%, compared to 53% and 62% respectively in the overall cohort. The RFS (p = 0.06) and OS (p = 0.65) of the LVC was not significantly different to other PTV quartiles; however the impact of PTV volume reached significance when analysed as a continuous variable (RFS p < 0.01; OS p = 0.02). Median T1 volumes were 26.1cm3, 8.0cm3 and 5.3cm3 at months +0, +3 and +12, respectively. The corresponding T2 volumes were 120.8cm3, 29.1cm3 and 26.3cm3. The median T1 and T2 volume reductions were 77% (q1-3: 57-92%) and 78% (q1-3: 60-85%) at 13 months post-IMRT. Initial T2 volume was associated with worse RFS (p = 0.04) but not OS (p = 0.96). There was no association between median T2 volume reduction and RFS (p = 0.77). For patients assessable at year 4 post-IMRT, no late CTCAE Grade 3/4 toxicity events were recognised. 92% of patients were ECOG PS 0-1, 45% were employed at prior capacity and 28% were working with impairment. CONCLUSION Patients with large volume IDH-mutant Grade 3 glioma demonstrated significant tumour reduction post-IMRT, and good long-term outcomes with respect to survival and functional status. Although larger IMRT volumes were associated with poorer RFS, this was also associated with the initial volume of non-enhancing tumour.
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Affiliation(s)
- D Mills
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - P Horsley
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia
| | - V Venkatasha
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Back
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; Genesis Cancer Care, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; The Brain Cancer Group, Sydney, Australia.
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Knight A, Horsley P, Yuile A, Yim J, Suh M, Venketesha V, Kastelan M, Wheeler H, Back M. Volumetric response and pattern of failure of histone altered high grade glioma in adults following management with radiation therapy. J Neurooncol 2023; 163:281-288. [PMID: 37184742 DOI: 10.1007/s11060-023-04332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE H3K27M- and H3G34R-mutant gliomas are recently-classified subgroups of high-grade gliomas (HGGs) affecting younger adults. This study aimed to describe patterns of infiltration and failure, and the volumetric response of these tumours to radiotherapy. METHODS Patients with histone-mutant gliomas aged 16-50 years, managed from 2009 to 2021 were identified and clinical, radiological and histopathological characteristics collected. Tumour volume was assessed on MRI at diagnosis, pre-radiotherapy, month + 1, + 3 and + 5 post-radiation and at relapse. RESULTS Of 538 IDH1/2 wild-type HGGs, 18(15%) had a histone alteration. Eleven were H3K27M- and 7 H3G34R-mutant respectively. Median age at diagnosis was 20 years (range17-48 years). Median overall survival was 20 months (95%CI 14-29 months). Both H3K27M- and H3G34R-mutant tumours exhibited extensive T2F infiltration involving a median of 4 neuroanatomical subsites at diagnosis. Median volume of disease pre-radiotherapy on T1gd and T2F respectively was 0.5cm3 (IQR:0-1.7cm3) and 11.9 cm3 (IQR:7.5-29.6cm3) for H3K27M and 0.9cm3 (IQR:0-8.4cm3) and 43.8cm3 (IQR:25.2-86.6 cm3) for H3G34R tumours. T2F volume reduction > 50% was observed 3-months post-IMRT in 7(64%) patients with H3K27M and 1(14%) with H3G34R tumours. Fourteen patients had relapsed. Relapse was local-only, distant-only and both in 4(44%), 3(33%) and 2(22%) H3K27M-mutant and 1(20%), 2(40%), and 2(40%) H3G34R-mutant tumours. On last scan before death, leptomeningeal spread was present in 4/8(50%) and 1/5(20%) and subependymal spread in 4/8 (50%) and 0/5 H3K27M- and G34R-mutant cases respectively. CONCLUSION H3K27M-mutant gliomas are highly responsive to radiotherapy but exhibit high propensity for subsequent leptomeningeal and subependymal spread. H3G34R-mutant tumours exhibit lesser early volumetric response to radiotherapy and propensity for distant in-brain failure.
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Affiliation(s)
- A Knight
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - P Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - A Yuile
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Genesis Care, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - J Yim
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
| | - M Suh
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - V Venketesha
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Northern Sydney Local Health District Executive, St. Leonards, NSW, Australia
| | - M Kastelan
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- The Brain Cancer Group, Sydney, Australia
| | - H Wheeler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
- Genesis Care, Sydney, Australia
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
- The Brain Cancer Group, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Hung YC, Bauer J, Horsley P, Isenring E. Patient satisfaction with nutrition services amongst cancer patients treated with autologous stem cell transplantation: a comparison of usual and extended care. J Hum Nutr Diet 2013; 27 Suppl 2:333-8. [PMID: 23808817 DOI: 10.1111/jhn.12135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to determine patient satisfaction with clinical nutrition services delivered by an accredited practicing dietitian amongst cancer patients treated with autologous stem cell transplantation that was provided with usual and extended care at 100 days post-transplantation. METHODS Patients were randomised to receive usual nutrition care or extended nutrition care during the course of their stem cell transplantation. After hospital discharge, usual care patients received no further nutrition support, whereas extended care patients received telephone dietary counselling from the same dietitian for up to 100 days post-transplantation. The patient satisfaction with clinical nutrition service questionnaire was completed anonymously at 100 days post-transplantation. Group comparisons were made using independent t-tests. RESULTS Thirty-seven patients consented to participate in the study (54% male; mean age 58.7 ± 9.5 years; median body mass index 26.8 kg m(-2) , range 16.4-47.6 kg m(-2) ); 33 patients completed the study and 28 patients returned the questionnaire (response rate = 85%). All components of the questionnaire were rated highly by both groups; there was no significant difference between the groups (P > 0.05). Although not statistically significant, extended care patients who received at least three telephone calls rated a higher overall satisfaction compared to those who received less calls; this difference was clinically important (score difference = 0.56). CONCLUSIONS Cancer patients treated with autologous stem cell transplantation were satisfied with usual and extended nutrition care. Extended care patients who received at least three telephone calls after hospital discharge were more satisfied than those with less frequent intervention. Further exploration regarding the frequency and intensity of nutrition service is required.
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Affiliation(s)
- Y C Hung
- Centre for Dietetics Research, School of Human Movement Studies, University of Queensland, Brisbane, QLD, Australia
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Bauer JD, Hiscocks K, Fichera R, Horsley P, Martineau J, Denmeade S, Bannister M, de Groot E, Lee S, Waterhouse M. Nutritional status of long-term patients in the acute care setting. Intern Med J 2012; 42:1251-4. [DOI: 10.1111/j.1445-5994.2012.02950.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/13/2012] [Indexed: 11/30/2022]
Affiliation(s)
- J. D. Bauer
- Centre for Dietetics Research; School of Human Movement Studies; University of Queensland; Brisbane Queensland Australia
- The Wesley Hospital; Brisbane Queensland Australia
| | - K. Hiscocks
- Centre for Dietetics Research; School of Human Movement Studies; University of Queensland; Brisbane Queensland Australia
| | - R. Fichera
- The Wesley Hospital; Brisbane Queensland Australia
| | - P. Horsley
- The Wesley Hospital; Brisbane Queensland Australia
| | - J. Martineau
- The Wesley Hospital; Brisbane Queensland Australia
| | - S. Denmeade
- The Wesley Hospital; Brisbane Queensland Australia
| | - M. Bannister
- The Wesley Hospital; Brisbane Queensland Australia
| | - E. de Groot
- The Wesley Hospital; Brisbane Queensland Australia
| | - S. Lee
- The Wesley Hospital; Brisbane Queensland Australia
| | - M. Waterhouse
- The Wesley Research Institute; Brisbane Queensland Australia
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McKellar S, Horsley P, Chambers R, Bauer J, Vendersee P, Clarke C, Callum H, Pullen M. Development of the Diet Habits Questionnaire for Use in Cardiac Rehabilitation. Aust J Prim Health 2008. [DOI: 10.1071/py08035] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this study is to design a tool that could be used in the cardiac rehabilitation setting to quickly assess dietary habits and identify individual participants? dietary education requirements. An initial study compared a research diet history of 4 0 participants against the results of the Diet Habits Questionnaire. Concurrent validity has been established as there was a significant difference between mean (95% CI) intake of 5 .7 (0.6 - 10.7) g saturated fat 6.8 (2.9 - 10.8) g fibre and 417 (5 - 838) mg sodium between participants requiring additional dietary advice and those who do not require additional intervention based on the DHQ score. The inter-rater reliability of the DHQ was high with strength of agreement rated as moderate for fat and substantial for fibre and sodium. The Diet Habits Questionnaire was found to be a valid and reliable screening tool for the assessment of dietary habits in cardiac rehabilitation programs. Further research may establish its usefulness not just in cardiac rehabilitation, but in other health centres such as general practice and community health settings.
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Horsley P, Bauer J, Gallagher B. Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay. Bone Marrow Transplant 2005; 35:1113-6. [PMID: 15821765 DOI: 10.1038/sj.bmt.1704963] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The nutritional status of patients prior to peripheral blood stem cell transplantation (PBSCT) and its impact on length of hospital stay is not well described in the literature. The nutritional status of 66 consecutive patients (46 m:20 f); and the mean age 58.7+/-12.0 years was determined a maximum of 2 weeks pre-transplantation using the scored Patient-Generated-Subjective Global Assessment (PG-SGA). According to the global assessment, 73% patients were well nourished, 23% moderately malnourished and 4% severely malnourished. There was a significant difference in post transplant length of stay (mean difference+/-s.e.m. -7.0+/-2.1 days) between well-nourished and malnourished patients and a trend towards higher mortality in the malnourished group (2 vs 20%). Although 89% of patients described no problems eating, two or more nutrition impact symptoms were reported in 30% of patients. From stepwise multiple regression analysis, nutritional status as determined by PG-SGA score was significantly associated with length of stay, accounting for 12% of the variance. In conclusion, malnutrition prior to PBSCT is associated with increased length of stay. Routine nutrition assessment of patients prior to PBSCT should be undertaken.
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Affiliation(s)
- P Horsley
- The Wesley Hospital, Brisbane, Australia
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