Meredith Giuliani

Refining American Joint Committee on Cancer/Union for International Cancer Control TNM Stage and Prognostic Groups for Human Papillomavirus–Related Oropharyngeal Carcinomas

PURPOSE To refine stage and prognostic group for human papillomavirus (HPV) -related nonmetastatic (M0) oropharyngeal cancer (OPC). METHODS All patients with nonmetastatic (M0) p16-confirmed OPC treated with radiotherapy with or without chemotherapy from 2000 to 2010 were included. Overall survival (OS) was compared among TNM stages for patients with HPV-related and HPV-unrelated OPC separately. For HPV-related OPC, recursive partitioning analysis (RPA) derived new RPA stages objectively. Cox regression was used to calculate adjusted hazard ratios (AHRs) to derive AHR stages. The performance of survival prediction of RPA stage and AHR stage was assessed against the current seventh edition TNM stages. Prognostic groups were derived by RPA, combining RPA stage and nonanatomic factors. RESULTS The cohort comprised 573 patients with HPV-related OPC and 237 patients with HPV-unrelated OPC, with a median follow-up of 5.1 years. Lower 5-year OS with higher TNM stage was evident for patients with HPV-unrelated OPC (stage I, II, III, and IV 5-year OS: 70%, 58%, 50%, and 30%, respectively; P = .004) but not for patients with HPV-related OPC (stage I, II, III, and IV 5-year OS: 88%, 78%, 71%, and 74%, respectively; P = .56). RPA divided HPV-related OPC into RPA-I (T1-3N0-2b), RPA-II (T1-3N2c), and RPA-III (T4 or N3; 5-year OS: 82%, 76%, and 54%, respectively; P < .001). AHR also yielded a valid classification, but RPA stage demonstrated better survival prediction. A further RPA (including RPA stage, age, and smoking pack-years [PYs]) derived the following four valid prognostic groups for survival: group I (T1-3N0-N2c_≤ 20 PY), group II (T1-3N0-N2c_> 20 PY), group III (T4 or N3_age ≤ 70), and group IVA (T4 or N3_age > 70; 5-year OS: 89%, 64%, 57%, and 40%, respectively; P < .001). CONCLUSION An RPA-based TNM stage grouping (stage I/II/III: T1-3N0-N2b/T1-3N2c/T4 or N3, with M1 as stage IV) is proposed for HPV-related OPC as a result of significantly improved survival prediction compared with the seventh edition TNM, and prognostication is further improved by an RPA-based prognostic grouping within the American Joint Committee on Cancer/Union for International Cancer Control TNM framework for HPV-related OPC.

Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes in oropharyngeal cancer stratified by human papillomavirus status.

The objective of this study was to investigate the prognostic value of the pretreatment circulating neutrophil count (CNC), circulating monocyte count (CMC), and circulating lymphocyte count (CLC) in human papillomavirus (HPV)–related (HPV+) and HPV‐unrelated (HPV–) oropharyngeal cancer (OPC).

Utilization of prophylactic cranial irradiation in patients with limited stage small cell lung carcinoma

This study reports the adoption of prophylactic cranial irradiation (PCI) in patients with limited stage small cell lung carcinoma (LS‐SCLC) at Princess Margaret Hospital (PMH) and the factors that impact PCI utilization.

Clinical outcomes of extensive stage small cell lung carcinoma patients treated with consolidative thoracic radiotherapy.

UNLABELLED The purpose of this review was to determine the effect of consolidative thoracic radiotherapy (TRT) in patients with extensive stage small cell lung cancer (ES-SCLC) with minimal metastatic disease. Locoregional failure, distant failure and OS were 39%, 74% and 14% respectively at 2 years. No patients experienced clinical pneumonitis. Consolidative TRT is well tolerated in selected patients with ES-SCLC. OBJECTIVES To determine the rates of loco-regional (LR) failure and toxicity in extensive-stage small cell lung carcinoma (ES-SCLC) patients treated with consolidative thoracic radiotherapy (TRT). METHODS A retrospective review was conducted on SCLC patients treated from January 2005 to July 2009. Patients with ES-SCLC who received consolidative TRT ≥30Gy were identified. Sites of disease failure, toxicity Common Terminology Criteria for Adverse Events version 3.0, incidence, and cause of treatment delays and vital status were determined. The cumulative LR and distant failure rates were calculated. Progression-free and overall survivals (OS) were determined by the Kaplan-Meier method. RESULTS Three hundred thirty-six patients were identified with a diagnosis of SCLC and 215 patients had ES-SCLC. Nineteen (9%) patients were identified as receiving ≥30Gy consolidative TRT. Of this subgroup, the median age was 60 years (range 47 years to 82 years) and the median follow-up was 13 months (range 8 months to 32 months). Consolidative TRT was 40Gy/15 fractions (n = 16), 45Gy/30 fractions delivered twice daily (n = 2) and 36Gy/12 fractions (n = 1). Chemotherapy was sequential (n = 11) or concurrent (n = 8) with consolidative TRT. The incidence of LR failure was 26% and 39% at 1 and 2 years, respectively. The incidence of distant failure was 58% and 74% at 1 and 2 years, respectively. The median OS was 14 months. The 1-year and 2-year OS was 58% and 14%, respectively. No patients experienced clinical pneumonitis requiring treatment. CONCLUSIONS Consolidative TRT controlled LR disease in most patients with minimal acute toxicity, though distant failure remained a significant problem.

Stereotactic Body Radiotherapy in Patients with Previous Pneumonectomy: Safety and Efficacy

Introduction: There are limited treatment options for patients with prior pneumonectomy and a new lung malignancy. The safety and efficacy of stereotactic body radiotherapy in this subpopulation has not been well defined. Methods: Postpneumonectomy patients treated with lung SBRT were identified from a prospective single institution database. Treatment toxicity was recorded prospectively using the Common Terminology Criteria for Adverse Events version 3.0. Disease recurrences were categorized as local, regional, or distant metastatic disease. Overall survival was calculated using the Kaplan-Meier method. Results: Of 406 patients, 13 postpneumonectomy patients were identified and 14 tumors were treated with SBRT. Median age was 69 years. Three lesions were biopsy confirmed. The SBRT doses were 60 Gy/3 (n = 1), 54 Gy/3 (n = 1), 48 Gy/4 (n = 7), 60 Gy/8 (n = 2), and 50 Gy/10 (n = 3). Median follow-up was 24 months. Two patients had grade 3 radiation pneumonitis 3 and 4 months post-SBRT; they died 3 and 1 months later, respectively, one of myocardial infarction and the other of progressive dyspnea thought to be related to congestive heart failure. There were no local failures, one regional failure, and three distant failures. Median survival was 29 months, 1 and 2 year overall survival were 69% (95% confidence interval: 48–100%) and 61% (95% confidence interval: 39–95%), respectively. Conclusions: SBRT in patients with prior pneumonectomy poses challenges because of limited lung reserve. However, local control and long-term survival can be achieved using SBRT in this inoperable population. Careful consideration must be given to radiation planning to minimize the risk of radiation pneumonitis.

Cost-Effectiveness Analysis Comparing Conventional Versus Stereotactic Body Radiotherapy for Surgically Ineligible Stage I Non-Small-Cell Lung Cancer

INTRODUCTION In 25% to 35% of patients with early stage I non-small-cell lung cancer (NSCLC), surgery is not feasible, and external-beam radiation becomes their standard treatment. Conventionally fractionated radiotherapy (CFRT) is the traditional radiation treatment standard; however, stereotactic body radiotherapy (SBRT) is increasingly being adopted as an alternate radiation treatment. Our objective was to conduct a cost-effectiveness analysis, comparing SBRT with CFRT for stage I NSCLC in a public payer system. METHODS Consecutive patients were reviewed using 2010 Canadian dollars for direct medical costs from a public payer perspective. A subset of direct radiation treatment delivery costs, excluding physician billings and hospitalization, was also included. Health outcomes as life-years gained (LYGs) were computed using time-to-event methods. Sensitivity analyses identified critical factors influencing costs and benefits. RESULTS From January 2002 to June 2010, 168 patients (CFRT, n = 50; SBRT, n = 118) were included; median follow-up was 24 months. Mean overall survival was 2.83 years (95% CI, 1.8 to 4.1) for CFRT and 3.86 years (95% CI, 3.2 to not reached) for SBRT (P = .06). Mean costs for CFRT were

Reimagining care for adolescent and young adult cancer programs: Moving with the times.

6,886 overall and

Incidental Prophylactic Nodal Irradiation and Patterns of Nodal Relapse in Inoperable Early Stage NSCLC Patients Treated With SBRT: A Case-Matched Analysis

5,989 for radiation treatment delivery only versus

Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

8,042 and

Outcomes and prognostic factors for major salivary gland carcinoma following postoperative radiotherapy.

6,962, respectively, for SBRT. Incremental costs (incremental cost-effectiveness ratio [ICER]) per LYG for SBRT versus CFRT were