Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients with Head and Neck Cancers and Lung Cancers Receiving Radiotherapy

Publication date: Available online 2 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Noam A. VanderWalde, Allison M. Deal, Elizabeth Comitz, Lori Stravers, Hyman Muss, Bryce B. Reeve, Ethan Basch, Joel Tepper, Bhishamjit Chera
Purpose/ObjectiveTo evaluate the association between functional status based on a Geriatric Assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer (HNC) receiving radiation (RT) or chemoradiation (CRT).Methods and MaterialsA prospective cohort study was conducted in patients ≥ 65 years with HNC or lung cancer undergoing curative intent RT or CRT. Pre-treatment GA, Health Related Quality of Life (HRQoL), and Patient Reported Outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks post treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living (I-ADL) scale. Poor tolerance to treatment was defined by hospitalization, > 3 day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiotherapy, HRQoL changes, and PRO ratings were evaluated.ResultsOf the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 (range 65-92). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (RF) (p= .01) and Global Health Score (GHS) (p= .04) domains. However, from end of RT to 6 week follow up, those with dysfunction were more likely to continue to drop in the physical, RF and Social domains (all p<0.01). Dysfunction at baseline was also associated with higher severity of certain PROs.ConclusionsPre-treatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

Teaser

In this prospective observational study of older head and neck or lung cancer patients, pre-treatment dysfunction as measured by domains in a geriatric assessment were not associated with the pre-defined outcome of poor tolerance to treatment. However, dysfunction was associated with post treatment quality of life and severity of patient reported outcomes. Pre-treatment geriatric assessment may help identify older patients who experience lack of recovery following treatment of their lung or head and neck cancers.


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Influence of Fractionation Scheme and Tumor Location on Toxicities Following Stereotactic Body Radiotherapy for Large (≥5 Centimeter) Non-Small Cell Lung Cancer: A Multi-Institutional Analysis

Publication date: Available online 2 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Vivek Verma, Valerie K. Shostrom, Weining Zhen, Mutian Zhang, Steve E. Braunstein, John Holland, Christopher L. Hallemeier, Matthew M. Harkenrider, Adrian Iskhanian, Salma K. Jabbour, Albert Attia, Percy Lee, Kyle Wang, Roy H. Decker, Ronald C. McGarry, Charles B. Simone
PurposeStereotactic body radiotherapy (SBRT) for ≥5cm non-small cell lung cancer (NSCLC) has been understudied. There are concerns regarding toxicities from irradiating higher volumes with ablative doses. We describe the impact of fractionation scheme and tumor location on toxicities as part of a multi-institutional analysis.MethodsPatients with primary ≥5cm N0 M0 NSCLC that underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to CTCAE. Patients treated daily were compared to those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed.ResultsNinety-two patients from 12 institutions were evaluated (2004-2016) with median follow-up of 12 months. In total, there were 23 (25%) and six (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9%, and 4%, respectively; one patient treated daily experienced grade 5 radiation pneumonitis. Patients experiencing pulmonary toxicities had greater smoking history (median 70 vs. 53 pack-years, p=0.009). Of the entire cohort, 46 patients underwent daily SBRT and 46 received every other day (QOD, n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared to daily treatment (7% vs. 43%, p<0.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (p=0.014) and any toxicities (p<0.001). Patients with peripheral tumors (N=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (N=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (p>0.05).ConclusionsFrom this multi-institutional study, toxicity of SBRT for ≥5cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.

Teaser

There are toxicity concerns from irradiating large (≥5cm) non-small cell lung cancers with stereotactic body radiotherapy (≤5-fractions). We describe the impact of fractionation scheme and tumor location on toxicities as part of a multi-institutional analysis. Although there was no association with tumor location (central versus peripheral), receipt of daily radiotherapy (as opposed to every other day/other regimens) was associated with a higher rate of toxicity.


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Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients with Head and Neck Cancers and Lung Cancers Receiving Radiotherapy

Publication date: Available online 2 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Noam A. VanderWalde, Allison M. Deal, Elizabeth Comitz, Lori Stravers, Hyman Muss, Bryce B. Reeve, Ethan Basch, Joel Tepper, Bhishamjit Chera
Purpose/ObjectiveTo evaluate the association between functional status based on a Geriatric Assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer (HNC) receiving radiation (RT) or chemoradiation (CRT).Methods and MaterialsA prospective cohort study was conducted in patients ≥ 65 years with HNC or lung cancer undergoing curative intent RT or CRT. Pre-treatment GA, Health Related Quality of Life (HRQoL), and Patient Reported Outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks post treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living (I-ADL) scale. Poor tolerance to treatment was defined by hospitalization, > 3 day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiotherapy, HRQoL changes, and PRO ratings were evaluated.ResultsOf the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 (range 65-92). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (RF) (p= .01) and Global Health Score (GHS) (p= .04) domains. However, from end of RT to 6 week follow up, those with dysfunction were more likely to continue to drop in the physical, RF and Social domains (all p<0.01). Dysfunction at baseline was also associated with higher severity of certain PROs.ConclusionsPre-treatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

Teaser

In this prospective observational study of older head and neck or lung cancer patients, pre-treatment dysfunction as measured by domains in a geriatric assessment were not associated with the pre-defined outcome of poor tolerance to treatment. However, dysfunction was associated with post treatment quality of life and severity of patient reported outcomes. Pre-treatment geriatric assessment may help identify older patients who experience lack of recovery following treatment of their lung or head and neck cancers.


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Influence of Fractionation Scheme and Tumor Location on Toxicities Following Stereotactic Body Radiotherapy for Large (≥5 Centimeter) Non-Small Cell Lung Cancer: A Multi-Institutional Analysis

Publication date: Available online 2 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Vivek Verma, Valerie K. Shostrom, Weining Zhen, Mutian Zhang, Steve E. Braunstein, John Holland, Christopher L. Hallemeier, Matthew M. Harkenrider, Adrian Iskhanian, Salma K. Jabbour, Albert Attia, Percy Lee, Kyle Wang, Roy H. Decker, Ronald C. McGarry, Charles B. Simone
PurposeStereotactic body radiotherapy (SBRT) for ≥5cm non-small cell lung cancer (NSCLC) has been understudied. There are concerns regarding toxicities from irradiating higher volumes with ablative doses. We describe the impact of fractionation scheme and tumor location on toxicities as part of a multi-institutional analysis.MethodsPatients with primary ≥5cm N0 M0 NSCLC that underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to CTCAE. Patients treated daily were compared to those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed.ResultsNinety-two patients from 12 institutions were evaluated (2004-2016) with median follow-up of 12 months. In total, there were 23 (25%) and six (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9%, and 4%, respectively; one patient treated daily experienced grade 5 radiation pneumonitis. Patients experiencing pulmonary toxicities had greater smoking history (median 70 vs. 53 pack-years, p=0.009). Of the entire cohort, 46 patients underwent daily SBRT and 46 received every other day (QOD, n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared to daily treatment (7% vs. 43%, p<0.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (p=0.014) and any toxicities (p<0.001). Patients with peripheral tumors (N=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (N=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (p>0.05).ConclusionsFrom this multi-institutional study, toxicity of SBRT for ≥5cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities.

Teaser

There are toxicity concerns from irradiating large (≥5cm) non-small cell lung cancers with stereotactic body radiotherapy (≤5-fractions). We describe the impact of fractionation scheme and tumor location on toxicities as part of a multi-institutional analysis. Although there was no association with tumor location (central versus peripheral), receipt of daily radiotherapy (as opposed to every other day/other regimens) was associated with a higher rate of toxicity.


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Laparoscopic transgastric removal of eroding gastric band: a different approach

Gastric banding is a popular method for the treatment of morbid obesity. Amongst complications, gastric erosion remains uncommon but could prove fatal. Multiple techniques, from open surgery to endoscopic and standard laparoscopic technique for their removal, have been previously detailed in the literature. However, only a few reports have mentioned their total laparoscopic transgastric removal in the literature. Herein, we report a successful removal of an eroding gastric band with its technical suggestion in a 43-year-old female patient 22 months following its application.

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Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess

Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic pyelonephritis with progressive loss of renal function. Commonly, obstructing urinary calculi are seen. It is difficult to differentiate between XGPN and malignancy in many cases, and the diagnosis is usually only confirmed post-operatively upon histopathological examination of the specimen. Surgical treatment is often the main treatment modality due to suspicion for malignancy. Here, we present a case of XGPN that presented with abdominal distension, which was eventually discovered to be due to a preperitoneal abscess.

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Emergency cardiac double valve surgery in active infective endocarditis due to Acinetobacter baumannii with aortic root abscess in a patient with dialysis-dependent end-stage renal failure: a rare case report

We report an end-stage renal disease (ESRD) patient on regular haemodialysis awaiting renal transplant having native aortic valve endocarditis due to Acinetobacter baumannii complicated with aortic root abscess and severe mitral valve regurgitation with NYHA class IV symptoms. He underwent emergency aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement along with mitral valve repair. This emergency intervention in active infective endocarditis due to A. baumannii and associated ESRD is very rare. We could not trace any case report for such combination of clinical scenario in the literature.

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Diet and the risk of head-and-neck cancer among never-smokers and smokers in a Chinese population

Publication date: February 2017
Source:Cancer Epidemiology, Volume 46
Author(s): Carrie Butler, Yuan-Chin Amy Lee, Shuang Li, Qian Li, Chien-Jen Chen, Wan-Lun Hsu, Pen-Jen Lou, Cairong Zhu, Jian Pan, Hongbing Shen, Hongxia Ma, Lin Cai, Baochang He, Yu Wang, Xiaoyan Zhou, Qinghai Ji, Baosen Zhou, Wei Wu, Jie Ma, Paolo Boffetta, Zuo-Feng Zhang, Min Dai, Mia Hashibe
BackgroundFew studies have been conducted in China to investigate the association between diet and the risk of head-and-neck cancer (HNC). The aim of this study was to determine the relationship between diet and HNC risk in the Chinese population and to examine whether smoking status has any effect on the risk.MethodsOur multicenter case–control study included 921 HNC cases and 806 controls. We obtained information on the frequency of both animal- and plant-based food consumption. Unconditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (95%CIs).ResultsThe risk of HNC increased with more frequent consumption of processed meat and fermented foods but decreased with frequent consumption of fruits and vegetables. There was a significant increasing P for trend of 0.006 among smokers who consumed meat and an increased OR among smokers who consumed processed meat (OR 2.95, 95%CI 1.12–7.75). Protective odds ratios for vegetable consumption were observed among smokers only. We also observed protective odds ratios for higher egg consumption among never-smokers (P for trend=0.0.003).ConclusionsReduced HNC risks were observed for high fruit and vegetable intake, a finding consistent with the results of previous studies. Processed meat intake was associated with an increased risk. The role of dietary factors in HNC in the East Asian population is similar to that in European populations.



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Prevalence and characteristics of cancer patients receiving care from single vs. multiple institutions

Publication date: February 2017
Source:Cancer Epidemiology, Volume 46
Author(s): Christina A. Clarke, Sally L. Glaser, Rita Leung, Kathleen Davidson-Allen, Scarlett L. Gomez, Theresa H.M. Keegan
IntroductionPatients may receive cancer care from multiple institutions. However, at the population level, such patterns of cancer care are poorly described, complicating clinical research. To determine the population-based prevalence and characteristics of patients seen by multiple institutions, we used operations data from a state-mandated cancer registry.Methods and materials59,672 invasive cancers diagnosed in 1/1/2010-12/31/2011 in the Greater Bay Area of northern California were categorized as having been reported to the cancer registry within 365days of diagnosis by: 1) ≥1 institution within an integrated health system (IHS); 2) IHS institution(s) and ≥1 non-IHS institution (e.g., private hospital); 3) 1 non-IHS institution; or 4) ≥2 non-IHS institutions. Multivariable logistic regression was used to characterize patients reported by multiple vs. single institutions.ResultsOverall in this region, 17% of cancers were reported by multiple institutions. Of the 33% reported by an IHS, 8% were also reported by a non-IHS. Of non-IHS patients, 21% were reported by multiple institutions, with 28% for breast and 27% for pancreatic cancer, but 19%% for lung and 18% for prostate cancer. Generally, patients more likely to be seen by multiple institutions were younger or had more severe disease at diagnosis.ConclusionsPopulation-based data show that one in six newly diagnosed cancer patients received care from multiple institutions, and differed from patients seen only at a single institution. Cancer care data from single institutions may be incomplete and possibly biased.



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Diet and the risk of head-and-neck cancer among never-smokers and smokers in a Chinese population

Publication date: February 2017
Source:Cancer Epidemiology, Volume 46
Author(s): Carrie Butler, Yuan-Chin Amy Lee, Shuang Li, Qian Li, Chien-Jen Chen, Wan-Lun Hsu, Pen-Jen Lou, Cairong Zhu, Jian Pan, Hongbing Shen, Hongxia Ma, Lin Cai, Baochang He, Yu Wang, Xiaoyan Zhou, Qinghai Ji, Baosen Zhou, Wei Wu, Jie Ma, Paolo Boffetta, Zuo-Feng Zhang, Min Dai, Mia Hashibe
BackgroundFew studies have been conducted in China to investigate the association between diet and the risk of head-and-neck cancer (HNC). The aim of this study was to determine the relationship between diet and HNC risk in the Chinese population and to examine whether smoking status has any effect on the risk.MethodsOur multicenter case–control study included 921 HNC cases and 806 controls. We obtained information on the frequency of both animal- and plant-based food consumption. Unconditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (95%CIs).ResultsThe risk of HNC increased with more frequent consumption of processed meat and fermented foods but decreased with frequent consumption of fruits and vegetables. There was a significant increasing P for trend of 0.006 among smokers who consumed meat and an increased OR among smokers who consumed processed meat (OR 2.95, 95%CI 1.12–7.75). Protective odds ratios for vegetable consumption were observed among smokers only. We also observed protective odds ratios for higher egg consumption among never-smokers (P for trend=0.0.003).ConclusionsReduced HNC risks were observed for high fruit and vegetable intake, a finding consistent with the results of previous studies. Processed meat intake was associated with an increased risk. The role of dietary factors in HNC in the East Asian population is similar to that in European populations.



http://ift.tt/2gQNEe7

Prevalence and characteristics of cancer patients receiving care from single vs. multiple institutions

Publication date: February 2017
Source:Cancer Epidemiology, Volume 46
Author(s): Christina A. Clarke, Sally L. Glaser, Rita Leung, Kathleen Davidson-Allen, Scarlett L. Gomez, Theresa H.M. Keegan
IntroductionPatients may receive cancer care from multiple institutions. However, at the population level, such patterns of cancer care are poorly described, complicating clinical research. To determine the population-based prevalence and characteristics of patients seen by multiple institutions, we used operations data from a state-mandated cancer registry.Methods and materials59,672 invasive cancers diagnosed in 1/1/2010-12/31/2011 in the Greater Bay Area of northern California were categorized as having been reported to the cancer registry within 365days of diagnosis by: 1) ≥1 institution within an integrated health system (IHS); 2) IHS institution(s) and ≥1 non-IHS institution (e.g., private hospital); 3) 1 non-IHS institution; or 4) ≥2 non-IHS institutions. Multivariable logistic regression was used to characterize patients reported by multiple vs. single institutions.ResultsOverall in this region, 17% of cancers were reported by multiple institutions. Of the 33% reported by an IHS, 8% were also reported by a non-IHS. Of non-IHS patients, 21% were reported by multiple institutions, with 28% for breast and 27% for pancreatic cancer, but 19%% for lung and 18% for prostate cancer. Generally, patients more likely to be seen by multiple institutions were younger or had more severe disease at diagnosis.ConclusionsPopulation-based data show that one in six newly diagnosed cancer patients received care from multiple institutions, and differed from patients seen only at a single institution. Cancer care data from single institutions may be incomplete and possibly biased.



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The role of mesenchymal stem cells in oncology and regenerative medicine

Future Oncology Ahead of Print.


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