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Article ; Online: Reduction of oesophageal toxicity with VMAT dose-sparing radiotherapy in thoracic metastatic spinal cord compression: A feasibility study.

Gram, Vanja Remberg / Gram, Daniel / Persson, Gitte Fredberg / Suppli, Morten Hiul / Barrett, Sarah

Technical innovations & patient support in radiation oncology

2022 Volume 23, Page(s) 8–14

Abstract: Background: Palliative radiotherapy for metastatic spinal cord compression (MSCC) is given to halt disease progression and sustain quality of life for patients with advanced cancer. Radiotherapy can however induce toxicity, contradicting treatment ... ...

Abstract	Background: Palliative radiotherapy for metastatic spinal cord compression (MSCC) is given to halt disease progression and sustain quality of life for patients with advanced cancer. Radiotherapy can however induce toxicity, contradicting treatment intention. Advanced radiotherapy offers possibility of sparing organs at risk (OARs). The purpose of this dosimetric study is to establish the feasibility and potential benefits of dose sparing of the oesophagus. Materials and methods: 30 patients receiving radiotherapy of 30 Gy/10# for MSCC were retrospectively included and the oesophagus delineated. Two new dose plans were created for each patient (eso-crop and PTV-crop) with the intention of optimising the oesophageal dose. In the eso-crop plan maintaining full target volume coverage was prioritised, for the PTV-crop plan oesophageal dose was further reduced through cropping the planning target volume (PTV) overlapping oesophageal/PTV-area. Time added for delineation was measured. Plans were compared using Wilcoxon signed rank test with p < 0.05 considered statistically significant. Bivariate associations between dose metrics and patient characteristics were quantified using linear regression models. Results: Oesophageal delineation took a mean of 8.6 min. There was significant dose reduction for both V7.7 Gy, D2% and mean oesophageal dose, without significant change in CTV coverage. The mean achievable oesophageal dose reduction was 29.1% and 50.4% for the eso-crop and PTV crop plans, respectively. Minor changes in dose distribution to the lungs was observed, with increased mean and V20Gy for the eso-crop plan and decreased V5Gy to the PTV-crop plan. Conclusion: This study demonstrated the possibility of significant dose sparing of the oesophageal dose using single arc VMAT without impacting on CTV coverage.
Language	English
Publishing date	2022-07-16
Publishing country	England
Document type	Journal Article
ISSN	2405-6324
ISSN (online)	2405-6324
DOI	10.1016/j.tipsro.2022.07.001
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Article ; Online: Early Appearance of Coronavirus Disease 2019 Associated Pulmonary Infiltrates During Daily Radiotherapy Imaging for Lung Cancer.

Suppli, Morten Hiul / Riisgaard de Blanck, Steen / Elgaard, Tenna / Josipovic, Mirjana / Pøhl, Mette

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

2020 Volume 15, Issue 6, Page(s) 1081–1084

MeSH term(s)	Aged ; Betacoronavirus/isolation & purification ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/diagnostic imaging ; Coronavirus Infections/epidemiology ; Coronavirus Infections/virology ; Humans ; Incidence ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/virology ; Male ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/diagnostic imaging ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/virology ; Prognosis ; SARS-CoV-2 ; Tomography, X-Ray Computed/methods
Keywords	covid19
Language	English
Publishing date	2020-04-10
Publishing country	United States
Document type	Case Reports
ZDB-ID	2432037-7
ISSN	1556-1380 ; 1556-0864
ISSN (online)	1556-1380
ISSN	1556-0864
DOI	10.1016/j.jtho.2020.04.004
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Article ; Online: Interim analysis of patient-reported outcome compliance and dosimetry in a phase 3 randomized clinical trial of oesophagus-sparing spinal radiotherapy.

Nielsen, Anna Mann / Storm, Katrine Smedegaard / Laursen, Michael R T / Gram, Vanja Remberg / Rechner, Laura Ann / Ottosson, Wiviann / Suppli, Morten Hiul / Sibolt, Patrik / Behrens, Claus F / Vogelius, Ivan R / Persson, Gitte F

Acta oncologica (Stockholm, Sweden)

2023 Volume 62, Issue 11, Page(s) 1496–1501

Abstract: Background: The randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). Patient-reported outcome (PRO) is the only follow-up measure. Due ... ...

Abstract	Background: The randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). Patient-reported outcome (PRO) is the only follow-up measure. Due to the fragile patient population, low respondent compliance was anticipated. We performed a planned interim analysis of dosimetry and respondent compliance, to ensure that the protocol requirements were met. Methods: Patients >18 years referred for cervical/thoracic MSCC radiotherapy in 1-10 fractions were included from two centres. Patients were randomized (1:1) to standard RT or oesophagus-sparing RT, where predefined oesophageal dose constraints were prioritized over target coverage. Patients completed a trial diary with daily reports of dysphagia for 5 weeks (PRO-CTC-AE) and weekly quality of life reports for 9 weeks (QLQ-C30, EQ-5D-5L). According to power calculation, 124 patients are needed for primary endpoint analysis. The sample size was inflated to 200 patients to account for the fragile patient population. The co-primary endpoints, peak patient-reported dysphagia, and preserved ability to walk (EQ-5D-5L), are analysed at 5 and 9 weeks, respectively. The interim analysis was conducted 90 days after the inclusion of patient no 100. Respondent compliance was assessed at 5 and 9 weeks. In all RT plans, oesophagus and target doses were evaluated regarding adherence to protocol constraints. Results: From May 2021 to November 2022, 100 patients were included. Fifty-two were randomized to oesophagus-sparing RT. In 23% of these plans, oesophagus constraints were violated. Overall, the dose to both target and oesophagus was significantly lower in the oesophagus-sparing plans. Only 51% and 41% of the patients were evaluable for co-primary endpoint analysis at five and nine weeks, respectively. Mortality and hospitalization rates were significantly larger in patients who completed <4 days PRO questionnaires. Conclusion: Compliance was lower than anticipated and interventions to maintain study power are needed.
MeSH term(s)	Humans ; Quality of Life ; Deglutition Disorders ; Spinal Cord Compression/radiotherapy ; Patient Reported Outcome Measures
Language	English
Publishing date	2023-08-30
Publishing country	England
Document type	Randomized Controlled Trial ; Clinical Trial, Phase III ; Journal Article
ZDB-ID	896449-x
ISSN	1651-226X ; 0349-652X ; 0284-186X ; 1100-1704
ISSN (online)	1651-226X
ISSN	0349-652X ; 0284-186X ; 1100-1704
DOI	10.1080/0284186X.2023.2251083
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Article: Early Appearance of Coronavirus Disease 2019 Associated Pulmonary Infiltrates During Daily Radiotherapy Imaging for Lung Cancer

Suppli, Morten Hiul / Riisgaard de Blanck, Steen / Elgaard, Tenna / Josipovic, Mirjana / Pøhl, Mette

J Thorac Oncol

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #46140
Database	COVID19

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Article ; Online: Diabetes increases the risk of serious adverse events after re-irradiation of the spine.

Suppli, Morten Hiul / Munck Af Rosenschöld, Per / Pappot, Helle / Engelholm, Svend Aage

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2019 Volume 136, Page(s) 130–135

Abstract: Introduction: In this study we investigate the risk of radiation-induced serious adverse event of the spine in a large cohort of consecutive retreated patients with palliative radiotherapy (RT) for metastatic cancer in the spine.: Methods and ... ...

Abstract	Introduction: In this study we investigate the risk of radiation-induced serious adverse event of the spine in a large cohort of consecutive retreated patients with palliative radiotherapy (RT) for metastatic cancer in the spine. Methods and materials: From 2010 to 2014, 2387 patients received spinal irradiation with a palliative intent for metastatic spinal cord compression at our institution. The patients were reviewed for prior RT and 220 patients had received re-irradiation of the spine. Clinical and treatment data were obtained from the patients' records and the RT planning system. Results: Patients had metastatic disease from breast, prostate, lung, hematological or other cancers (22.7%, 21.8%, 21.4%, 3.2% and 30.9%, respectively). Median follow-up was 99 days. Median cumulative EQD2 was 57.6 Gy Conclusion: The incidence of RIM and RIF (6 and 9 out of 220 patients, respectively) was low in our cohort of re-irradiated patients. Patients with diabetes had a higher risk of adverse events which should be considered before re-irradiation of the spine.
MeSH term(s)	Aged ; Diabetes Complications/etiology ; Female ; Humans ; Male ; Radiation Injuries/etiology ; Re-Irradiation/adverse effects ; Risk ; Spinal Fractures/etiology ; Spinal Neoplasms/radiotherapy ; Spinal Neoplasms/secondary ; Spine/drug effects
Language	English
Publishing date	2019-04-17
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2019.04.002
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Article ; Online: Prognostic implication of gait function following treatment for spinal cord compression in men diagnosed with prostate cancer.

Lehrmann-Lerche, Caroline Sophie / Thomsen, Frederik Birkebæk / Røder, Martin Andreas / Suppli, Morten Hiul / Brasso, Klaus / Berg, Kasper Drimer

Scandinavian journal of urology

2019 Volume 53, Issue 4, Page(s) 222–228

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adenocarcinoma/complications ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/secondary ; Aged ; Aged, 80 and over ; Androgen Antagonists/therapeutic use ; Cohort Studies ; Decompression, Surgical ; Gait ; Gait Analysis ; Humans ; Male ; Middle Aged ; Prognosis ; Prostatic Neoplasms/complications ; Prostatic Neoplasms/drug therapy ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/pathology ; Radiotherapy ; Spinal Cord Compression/etiology ; Spinal Cord Compression/physiopathology ; Spinal Cord Compression/therapy ; Spinal Neoplasms/complications ; Spinal Neoplasms/radiotherapy ; Spinal Neoplasms/secondary ; Survival Rate ; Treatment Outcome
Chemical Substances	Androgen Antagonists
Language	English
Publishing date	2019-06-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2701936-6
ISSN	2168-1813 ; 2168-1805
ISSN (online)	2168-1813
ISSN	2168-1805
DOI	10.1080/21681805.2019.1626478
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Article ; Online: Patient reported upper gastro-intestinal symptoms associated with fractionated image-guided conformal radiotherapy for metastatic spinal cord compression

Vanja Gram / Lotte Stubkjær Fog / Mette Hemer / Helle Pappot / Marianne C. Aznar / Morten Hiul Suppli / Per Sjøgren / Ane Appelt

Technical Innovations & Patient Support in Radiation Oncology, Vol 13, Iss , Pp 1-

2020 Volume 5

Abstract: Background and purpose: Palliative radiotherapy is given to sustain or improve quality of life for patients with advanced cancer. Radiotherapy may however result in symptomatic side effects, which may affect the patient negatively. This prospective ... ...

Abstract	Background and purpose: Palliative radiotherapy is given to sustain or improve quality of life for patients with advanced cancer. Radiotherapy may however result in symptomatic side effects, which may affect the patient negatively. This prospective longitudinal study of 30 patients aimed at investigating the incidence and severity of early toxicity, particularly focusing on dysphagia, esophagitis and mucositis, following fractionated radiotherapy for cervical and thoracic metastatic spinal cord compression (MSCC), as well as determining the relationship between esophageal dose and early upper gastro-intestinal symptoms. Materials and methods: Thirty patients receiving radiotherapy of 3Gyx10 for MSCC were included in the study. Patients were assessed for a total of 7 weeks from onset of radiotherapy using the Edmonton Symptom Assessment System (ESAS) questionnaire. Upper gastro-intestinal symptoms and severity were assessed from the tenth and eleventh question section of the ESAS questionnaire of “other problems” and how much this affected them. The relationships between the mean and maximum esophageal doses and incidence of dysphagia, esophagitis or mucositis were estimated and dose response curves determined. Results: Eleven patients reported esophageal symptoms (average duration eleven days, range 1–18 days). Incidence of esophageal toxicity in patients treated at Th8 or above was 79 percent, while no patients treated below Th8 reported any symptoms (p < 0.001). Furthermore, 2 out of 3 patients irradiated at the cervical region reported substantial changes in taste sensation.Risk of symptoms correlated with both mean and maximum esophageal dose and may be a useful tool in planning radiotherapy for MSCC, potentially reducing early upper gastro-intestinal toxicity. Keywords: Palliative radiotherapy, Metastatic spinal cord compression, Image-guidance, Intensity modulated radiotherapy, Toxicity, Patient reported outcomes
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	610 ; 616
Language	English
Publishing date	2020-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: New Pulmonary Infiltrates Observed on Computed Tomography-Based Image Guidance for Radiotherapy Warrant Diagnostic Workup for Coronavirus Disease 2019.

Warren, Graham W / Lim, Vun-Sin / Chowdhary, Mudit / Marwaha, Gaurav / Abd Elbadee, Osama Mostafa / Kirakli, Esra Korkmaz / Billiet, Charlotte / Marin, Alexandra Giraldo / Ramos, Monica / Suppli, Morten Hiul / McGinnis, Gwendolyn J / Adjei, Alex A

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

2021 Volume 16, Issue 11, Page(s) 1946–1951

Abstract: ... the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included ...

Abstract	Introduction: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radiotherapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis. Methods: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates. Results: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or infiltrates were observed in eight patients. Conclusions: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged.
MeSH term(s)	COVID-19 ; COVID-19 Testing ; Humans ; Lung ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; SARS-CoV-2 ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2432037-7
ISSN	1556-1380 ; 1556-0864
ISSN (online)	1556-1380
ISSN	1556-0864
DOI	10.1016/j.jtho.2021.06.005
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Article ; Online: Patient reported upper gastro-intestinal symptoms associated with fractionated image-guided conformal radiotherapy for metastatic spinal cord compression.

Gram, Vanja / Fog, Lotte Stubkjær / Hemer, Mette / Pappot, Helle / Aznar, Marianne C / Suppli, Morten Hiul / Sjøgren, Per / Appelt, Ane

Technical innovations & patient support in radiation oncology

2019 Volume 13, Page(s) 1–5

Abstract	Background and purpose: Palliative radiotherapy is given to sustain or improve quality of life for patients with advanced cancer. Radiotherapy may however result in symptomatic side effects, which may affect the patient negatively. This prospective longitudinal study of 30 patients aimed at investigating the incidence and severity of early toxicity, particularly focusing on dysphagia, esophagitis and mucositis, following fractionated radiotherapy for cervical and thoracic metastatic spinal cord compression (MSCC), as well as determining the relationship between esophageal dose and early upper gastro-intestinal symptoms. Materials and methods: Thirty patients receiving radiotherapy of 3Gyx10 for MSCC were included in the study. Patients were assessed for a total of 7 weeks from onset of radiotherapy using the Edmonton Symptom Assessment System (ESAS) questionnaire. Upper gastro-intestinal symptoms and severity were assessed from the tenth and eleventh question section of the ESAS questionnaire of "other problems" and how much this affected them. The relationships between the mean and maximum esophageal doses and incidence of dysphagia, esophagitis or mucositis were estimated and dose response curves determined. Results: Eleven patients reported esophageal symptoms (average duration eleven days, range 1-18 days). Incidence of esophageal toxicity in patients treated at Th8 or above was 79 percent, while no patients treated below Th8 reported any symptoms (p < 0.001). Furthermore, 2 out of 3 patients irradiated at the cervical region reported substantial changes in taste sensation.Risk of symptoms correlated with both mean and maximum esophageal dose and may be a useful tool in planning radiotherapy for MSCC, potentially reducing early upper gastro-intestinal toxicity.
Language	English
Publishing date	2019-12-18
Publishing country	England
Document type	Journal Article
ISSN	2405-6324
ISSN (online)	2405-6324
DOI	10.1016/j.tipsro.2019.11.008
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Article ; Online: Premature Termination of a Randomized Controlled Trial on Image-Guided Stereotactic Body Radiotherapy of Metastatic Spinal Cord Compression.

Suppli, Morten Hiul / Munck Af Rosenschold, Per / Dahl, Benny / Berthelsen, Anne Kiil / Engelholm, Svend Aage / Pappot, Helle

The oncologist

2019 Volume 25, Issue 3, Page(s) 210–e422

Abstract: Lessons learned: It is possible to plan and treat some patients with stereotactic body radiotherapy (SBRT) in a timely fashion in an acute setting. Advanced and, in some indications, already implemented technologies such as SBRT are difficult to test in ...

Abstract	Lessons learned: It is possible to plan and treat some patients with stereotactic body radiotherapy (SBRT) in a timely fashion in an acute setting. Advanced and, in some indications, already implemented technologies such as SBRT are difficult to test in a randomized trial. Background: Stereotactic body radiotherapy (SBRT) in metastatic spinal cord compression (MSCC) could be an alternative to decompressive surgery followed by fractionated radiotherapy. Methods: In a randomized, single-institution, noninferiority trial, patients with MSCC were assigned to stereotactic body radiotherapy of 16 Gy in 1 fraction or decompression surgery followed by fractionated radiotherapy of 30 Gy in 10 fractions. Primary endpoint was ability to walk by EQ5D-5L questionnaire. Based on power calculations, 130 patients had to be included to be 89% sure that a 15% difference between the treatment arm and the experimental arm could be detected. Results: Ten patients were accrued in 23 months, with six patients allocated to surgery and four patients to stereotactic body radiotherapy. The trial was closed prematurely because of poor accrual. One patient undergoing surgery and one patient undergoing stereotactic body radiotherapy were unable to walk at 6 weeks. Two patients were not evaluable at 6 weeks. Conclusion: A randomized, phase II, clinical trial comparing surgery followed by fractionated radiotherapy or image-guided SBRT of MSCC was initiated. SBRT was shown to be feasible, with three out of four patients retaining walking function. The trial was determined futile as a result of low accrual.
MeSH term(s)	Humans ; Radiosurgery/adverse effects ; Spinal Cord Compression/etiology ; Spinal Cord Compression/radiotherapy ; Spinal Cord Compression/surgery ; Spinal Neoplasms/radiotherapy ; Spinal Neoplasms/surgery ; Treatment Outcome ; Walking
Language	English
Publishing date	2019-10-11
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1409038-7
ISSN	1549-490X ; 1083-7159
ISSN (online)	1549-490X
ISSN	1083-7159
DOI	10.1634/theoncologist.2019-0672
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