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Artikel ; Online: Recurrence Risk Stratification for Women With FIGO Stage I Uterine Endometrioid Carcinoma Who Underwent Surgical Lymph Node Evaluation.

Ghanem, Ahmed I / Bhatnagar, Aseem / Elshaikh, Muneer / Hijaz, Miriana / Elshaikh, Mohamed A

2023 Band 46, Heft 12, Seite(n) 537–542

Abstract: Objective: The aim of this study was to estimate the recurrence risk based on the number of prognostic factors for patients with stage I uterine endometrioid carcinoma (EC) who underwent surgical lymph node evaluation (SLNE) and were managed with ... ...

Abstract	Objective: The aim of this study was to estimate the recurrence risk based on the number of prognostic factors for patients with stage I uterine endometrioid carcinoma (EC) who underwent surgical lymph node evaluation (SLNE) and were managed with observation. Methods: We queried our database for women with FIGO-2009 stage I EC who underwent surgical staging including SLNE. Multivariate analysis with stepwise model selection was used to determine independent risk factors for 5-year recurrence-free survival (RFS). Study groups based on risk factors were compared for RFS, disease-specific survival, and overall survival. Results: A total of 706 patients were identified: median age was 60 years (range, 30 to 93 y) and median follow-up was 120 months. Median number of examined lymph nodes was 8 (range, 1 to 66). 91% were stage IA, 75% had grade 1 and lymphovascular space invasion was detected in 6%. Independent predictors of 5-year RFS included age 60 years and above ( P =0.038), grade 2 ( P =0.003), and grade 3 ( P <0.001) versus grade 1. Five-year RFS for group 0 (age less than 60 y and grade 1) was 98% versus 92% for group 1 (either: age 60 y and older or grade 2/3) versus 84% for group 2 (both: age 60 y and above and grade 2/3), respectively ( P <0.001). Five-year disease-specific survival was 100% versus 98% versus 95%, ( P =0.012) and 5-year overall survival was 98% versus 90% versus 81%, for groups 0, 1, and 2, respectively ( P <0.001). Conclusions: In patients with stage I EC who received SLNE and no adjuvant therapy, only age 60 years and above and high tumor grade were independent predictors of recurrence and can be used to quantify individualized recurrence risk, whereas lymphovascular space invasion was not an independent prognostic factor in this cohort.
Mesh-Begriff(e)	Humans ; Female ; Middle Aged ; Prognosis ; Carcinoma, Endometrioid/surgery ; Carcinoma, Endometrioid/pathology ; Neoplasm Staging ; Retrospective Studies ; Hysterectomy ; Endometrial Neoplasms/pathology ; Lymph Nodes/surgery ; Lymph Nodes/pathology ; Lymph Node Excision ; Risk Assessment ; Neoplasm Recurrence, Local/pathology
Sprache	Englisch
Erscheinungsdatum	2023-09-08
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	604536-4
ISSN	1537-453X ; 0277-3732
ISSN (online)	1537-453X
ISSN	0277-3732
DOI	10.1097/COC.0000000000001043
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Enhancing Precision in Cardiac Segmentation for MR-Guided Radiation Therapy through Deep Learning.

Summerfield, Nicholas / Morris, Eric / Banerjee, Soumyanil / He, Qisheng / Ghanem, Ahmed I / Zhu, Simeng / Zhao, Jiwei / Dong, Ming / Glide-Hurst, Carri

International journal of radiation oncology, biology, physics

2024

Abstract: Introduction: Cardiac substructure dose metrics are more strongly linked to late cardiac morbidities than whole-heart metrics. MR-guided radiation therapy (MRgRT) enables substructure visualization during daily localization, allowing potential for ... ...

Abstract	Introduction: Cardiac substructure dose metrics are more strongly linked to late cardiac morbidities than whole-heart metrics. MR-guided radiation therapy (MRgRT) enables substructure visualization during daily localization, allowing potential for enhanced cardiac sparing. We extend a publicly available state-of-the-art deep learning (DL) framework, nnU-Net, to incorporate self-distillation (nnU-Net.wSD) for substructure segmentation for MRgRT. Methods: Eighteen (Institute A) patients who underwent thoracic or abdominal radiation therapy on a 0.35 T MR-guided linac were retrospectively evaluated. On each image, one of two radiation oncologists delineated reference contours of 12 cardiac substructures (chambers, great vessels, and coronary arteries) used to train (n=10), validate (n=3), and test (n=5) nnU-Net.wSD leveraging a teacher-student network and comparing to standard 3D U-Net. The impact of using simulation data or including 3-4 daily images for augmentation during training was evaluated for nnU-Net.wSD. Geometric metrics (Dice similarity coefficient (DSC), mean distance to agreement (MDA), and 95% Hausdorff distance (HD95)), visual inspection, and clinical dose volume histograms (DVHs) were evaluated. To determine generalizability, Institute A's model was tested on an unlabeled dataset from Institute B (n=22) and evaluated via consensus scoring and volume comparisons. Results: nnU-Net.wSD yielded a DSC (reported mean ± standard deviation) of 0.65±0.25 across the 12 substructures (Chambers: 0.85±0.05, Great Vessels: 0.67±0.19, and Coronary Arteries 0.33±0.16, mean MDA <3 mm, and mean HD95 <9 mm) while outperforming the 3D U-Net (0.583±0.28, p<0.01). Leveraging fractionated data for augmentation improved over a single MR-SIM timepoint (0.579±0.29, p<0.01). Predicted contours yielded DVHs that closely matched the clinical treatment plans where mean and D Conclusions: This work is a critical step to rapid and reliable cardiac substructure segmentation to improve cardiac sparing in low-field MRgRT.
Sprache	Englisch
Erscheinungsdatum	2024-05-24
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2024.05.013
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The Prognostic Significance of the Depth of Cervical Stromal Invasion in Women With FIGO Stage II Uterine Endometrioid Carcinoma.

Al Khatib, Sondos / Bhatnagar, Aseem / Elshaikh, Noor / Ghanem, Ahmed I / Burmeister, Charlotte / Allo, Ghassan / Alkamachi, Bassam / Paridon, Alex / Elshaikh, Mohamed A

American journal of clinical oncology

2023 Band 46, Heft 10, Seite(n) 445–449

Abstract: Objective: The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC).: Methods: Our database of women with EC was ... ...

Abstract	Objective: The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC). Methods: Our database of women with EC was quired for patients with stage II EC. Pathologic slides were retrieved and reviewed by gynecologic pathologists to determine cervical stromal thickness and depth of CSI as a percentage of stromal thickness (%CSI). Kaplan-Meier, univariate, and multivariate analyses were used to compare recurrence-free, disease-specific (DSS), and overall survival (OS) between women who had<50% versus ≥50% CSI. Univariate and multivariate analyses were used to assess other prognostic variables associated with survival endpoints. Results: A total of 117 patients were included in our study who had hysterectomy between 1/1990 and 8/2021. Seventy-nine patients (68%) with <50% and 38 (32w%) with ≥50% CSI. After a median follow-up of 131 months, 5-year DSS was significantly worse for women with ≥50% CSI (78% vs. 91%; P =0.04). However, %CSI was not an independent predictor for any of the studied survival endpoints. Independent predictors of worse 5-year recurrence-free survival and DSS included FIGO grade 3 tumors ( P =0.02) and the presence of lymphovascular space invasion ( P =0.03). Grade 3 tumors were the only independent predictor of worse 5-year OS ( P =0.02). Conclusions: Our results suggest that deep CSI is not an independent prognostic factor for survival endpoints in women with stage II uterine endometroid adenocarcinoma. The lack of independent prognostic significance of the depth CSI needs to be validated in a multi-institutional analysis.
Mesh-Begriff(e)	Female ; Humans ; Prognosis ; Carcinoma, Endometrioid/surgery ; Carcinoma, Endometrioid/pathology ; Neoplasm Staging ; Retrospective Studies ; Endometrial Neoplasms/pathology ; Uterine Neoplasms/pathology
Sprache	Englisch
Erscheinungsdatum	2023-08-01
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	604536-4
ISSN	1537-453X ; 0277-3732
ISSN (online)	1537-453X
ISSN	0277-3732
DOI	10.1097/COC.0000000000001033
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Radiomics outperforms clinical factors in characterizing human papilloma virus (HPV) for patients with oropharyngeal squamous cell carcinomas.

Bagher-Ebadian, Hassan / Siddiqui, Farzan / Ghanem, Ahmed I / Zhu, Simeng / Lu, Mei / Movsas, Benjamin / Chetty, Indrin J

Biomedical physics & engineering express

2022 Band 8, Heft 4

Abstract: Purpose. ...

Abstract	Purpose.
Mesh-Begriff(e)	Adolescent ; Alphapapillomavirus ; Head and Neck Neoplasms ; Humans ; Papillomaviridae ; Papillomavirus Infections/diagnostic imaging ; Pilot Projects ; Retrospective Studies ; Squamous Cell Carcinoma of Head and Neck/diagnostic imaging
Sprache	Englisch
Erscheinungsdatum	2022-06-07
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2057-1976
ISSN (online)	2057-1976
DOI	10.1088/2057-1976/ac39ab
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Does the Interval Between Hysterectomy and Start of Adjuvant Radiation Treatment Influence Survival in Women With Endometrial Carcinoma?: A National Cancer Database analysis.

Ghanem, Ahmed I / Modh, Ankit / Burmeister, Charlotte / Mahmoud, Omar / Elshaikh, Mohamed A

American journal of clinical oncology

2020 Band 43, Heft 8, Seite(n) 602–606

Abstract: Objective: The objective of this study was to analyze the impact of the time interval (TI) between hysterectomy and initiation of adjuvant radiation treatment (ART) on overall survival (OS) among women with early stage endometrial carcinoma (EC) using ... ...

Abstract	Objective: The objective of this study was to analyze the impact of the time interval (TI) between hysterectomy and initiation of adjuvant radiation treatment (ART) on overall survival (OS) among women with early stage endometrial carcinoma (EC) using the National Cancer Database (NCDB). Materials and methods: The NCDB was queried for women with the International Federation of Gynecology and Obstetrics (FIGO) stage I to II EC who underwent hysterectomy followed by ART. We examined the prognostic impact of TI on OS using the cutoff ≤8 or >8 weeks to initiate radiation treatment (RT). Two groups of patients were created. Kaplan-Meier curves were created for OS analysis. Predictors of OS were identified. Results: A total 16,520 women were identified. The median follow-up time for the entire cohort was 59.1 months. Median age was 63 years, and 82% were FIGO stage I. Pelvic external beam RT alone was used in 9569 (58%) and vaginal brachytherapy alone in 4265 women (26%). In total, 10,040 women (61%) received RT ≤8 weeks. Delay in initiating RT >8 weeks was associated with shorter 5-year OS (P=0.048). Independent predictors of shorter OS includes older age, African American race, higher comorbidity burden, higher tumor grade, the presence of lymphovascular invasion and stage II tumors. Although TI in initiating RT was a significant predictor for OS in univariate analysis, its independent significance of OS was lost on multivariate analysis (P=0.28). Conclusion: Our study suggests that TI between hysterectomy and initiation of ART was not an independent predictor of OS in women with early stage EC.
Mesh-Begriff(e)	Aged ; Aged, 80 and over ; Databases, Factual ; Endometrial Neoplasms/mortality ; Endometrial Neoplasms/pathology ; Endometrial Neoplasms/radiotherapy ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate ; Time Factors
Sprache	Englisch
Erscheinungsdatum	2020-05-11
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	604536-4
ISSN	1537-453X ; 0277-3732
ISSN (online)	1537-453X
ISSN	0277-3732
DOI	10.1097/COC.0000000000000713
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Incorporating sensitive cardiac substructure sparing into radiation therapy planning.

Morris, Eric D / Aldridge, Kate / Ghanem, Ahmed I / Zhu, Simeng / Glide-Hurst, Carri K

Journal of applied clinical medical physics

2020 Band 21, Heft 11, Seite(n) 195–204

Abstract: Purpose: Rising evidence suggests that cardiac substructures are highly radiosensitive. However, they are not routinely considered in treatment planning as they are not readily visualized on treatment planning CTs (TPCTs). This work integrated the soft ... ...

Abstract	Purpose: Rising evidence suggests that cardiac substructures are highly radiosensitive. However, they are not routinely considered in treatment planning as they are not readily visualized on treatment planning CTs (TPCTs). This work integrated the soft tissue contrast provided by low-field MRIs acquired on an MR-linac via image registration to further enable cardiac substructure sparing on TPCTs. Methods: Sixteen upper thoracic patients treated at various breathing states (7 end-exhalation, 7 end-inhalation, 2 free-breathing) on a 0.35T MR-linac were retrospectively evaluated. A hybrid MR/CT atlas and a deep learning three-dimensional (3D) U-Net propagated 13 substructures to TPCTs. Radiation oncologists revised contours using registered MRIs. Clinical treatment plans were re-optimized and evaluated for beam arrangement modifications to reduce substructure doses. Dosimetric assessment included mean and maximum (0.03cc) dose, left ventricular volume receiving 5Gy (LV-V5), and other clinical endpoints. As metrics of plan complexity, total MU and treatment time were evaluated between approaches. Results: Cardiac sparing plans reduced the mean heart dose (mean reduction 0.7 ± 0.6, range 0.1 to 2.5 Gy). Re-optimized plans reduced left anterior descending artery (LADA) mean and LADA Conclusions: By introducing 0.35T MRIs acquired on an MR-linac to verify cardiac substructure segmentations for CT-based treatment planning, an opportunity was presented for more effective sparing with limited increase in plan complexity. Validation in a larger cohort with appropriate margins offers potential to reduce radiation-related cardiotoxicities.
Mesh-Begriff(e)	Heart/diagnostic imaging ; Humans ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated ; Retrospective Studies
Sprache	Englisch
Erscheinungsdatum	2020-10-18
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.13037
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Quantifying inter-fraction cardiac substructure displacement during radiotherapy via magnetic resonance imaging guidance.

Morris, Eric D / Ghanem, Ahmed I / Zhu, Simeng / Dong, Ming / Pantelic, Milan V / Glide-Hurst, Carri K

Physics and imaging in radiation oncology

2021 Band 18, Seite(n) 34–40

Abstract: Purpose: Emerging evidence suggests cardiac substructures are highly radiosensitive during radiation therapy for cancer treatment. However, variability in substructure position after tumor localization has not been well characterized. This study ... ...

Abstract	Purpose: Emerging evidence suggests cardiac substructures are highly radiosensitive during radiation therapy for cancer treatment. However, variability in substructure position after tumor localization has not been well characterized. This study quantifies inter-fraction displacement and planning organ at risk volumes (PRVs) of substructures by leveraging the excellent soft tissue contrast of magnetic resonance imaging (MRI). Methods: Eighteen retrospectively evaluated patients underwent radiotherapy for intrathoracic tumors with a 0.35 T MRI-guided linear accelerator. Imaging was acquired at a 17-25 s breath-hold (resolution 1.5 × 1.5 × 3 mm Results: Across substructures, inter-fraction displacements for 14% in the left-right, 18% in the anterior-posterior, and 21% of fractions in the superior-inferior were > 5 mm. Due to lack of breath-hold compliance, ~4% of all structures shifted > 10 mm in any axis. For the chambers, median displacements were 1.8, 1.9, and 2.2 mm in the left-right, anterior-posterior, and superior-inferior axis, respectively. Great vessels demonstrated larger displacements (> 3 mm) in the superior-inferior axis (43% of shifts) and were only 25% (left-right) and 29% (anterior-posterior) elsewhere. PRVs from 3 to 5 mm were determined as anisotropic substructure-specific margins. Conclusions: This exploratory work derived substructure-specific safety margins to ensure highly effective cardiac sparing. Findings require validation in a larger cohort for robust margin derivation and for applications in prospective clinical trials.
Sprache	Englisch
Erscheinungsdatum	2021-04-16
Erscheinungsland	Netherlands
Dokumenttyp	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2021.03.005
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Characterizing Sensitive Cardiac Substructure Excursion Due to Respiration.

Miller, Claudia R / Morris, Eric D / Ghanem, Ahmed I / Pantelic, Milan V / Walker, Eleanor M / Glide-Hurst, Carri K

Advances in radiation oncology

2021 Band 7, Heft 3, Seite(n) 100876

Abstract: Purpose: Whole-heart dose metrics are not as strongly linked to late cardiac morbidities as radiation doses to individual cardiac substructures. Our aim was to characterize the excursion and dosimetric variation throughout respiration of sensitive ... ...

Abstract	Purpose: Whole-heart dose metrics are not as strongly linked to late cardiac morbidities as radiation doses to individual cardiac substructures. Our aim was to characterize the excursion and dosimetric variation throughout respiration of sensitive cardiac substructures for future robust safety margin design. Methods and materials: Eleven patients with cancer treatments in the thorax underwent 4-phase noncontrast 4-dimensional computed tomography (4DCT) with T2-weighted magnetic resonance imaging in end-exhale. The end-exhale phase of the 4DCT was rigidly registered with the magnetic resonance imaging and refined with an assisted alignment surrounding the heart from which 13 substructures (chambers, great vessels, coronary arteries, etc) were contoured by a radiation oncologist on the 4DCT. Contours were deformed to the other respiratory phases via an intensity-based deformable registration for radiation oncologist verification. Measurements of centroid and volume were evaluated between phases. Mean and maximum dose to substructures were evaluated across respiratory phases for the breast (n = 8) and thoracic cancer (n = 3) cohorts. Results: Paired Conclusions: This study characterized the intrafraction displacement of the cardiac substructures through the respiratory cycle and highlighted their increased dosimetric sensitivity to local dose changes not captured by whole heart metrics. Results suggest value of cardiac substructure margin generation to enable more robust cardiac sparing and to reduce the effect of respiration on overall treatment plan quality.
Sprache	Englisch
Erscheinungsdatum	2021-12-24
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2021.100876
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Cetuximab and anemia prevention in head and neck cancer patients undergoing radiotherapy.

Maahs, Lucas / Ghanem, Ahmed I / Gutta, Radhika / Tang, Amy / Arya, Swarn / Al Saheli, Zaid / Ali, Haythem / Chang, Steven / Tam, Samantha / Wu, Vivian / Siddiqui, Farzan / Sheqwara, Jawad

BMC cancer

2022 Band 22, Heft 1, Seite(n) 626

Abstract: Background: Epidermal growth factor receptor (EGFR) activation is associated with increased production of interleukin 6 (IL6), which is intensified by radiotherapy (RT) induced inflammatory response. Elevated IL6 levels intensifies RT-induced anemia by ... ...

Abstract	Background: Epidermal growth factor receptor (EGFR) activation is associated with increased production of interleukin 6 (IL6), which is intensified by radiotherapy (RT) induced inflammatory response. Elevated IL6 levels intensifies RT-induced anemia by upregulating hepcidin causing functional iron deficiency. Cetuximab, an EGFR inhibitor, has been associated with lower rates of anemia for locally advanced head and neck squamous cell carcinoma (HNSCC). We hypothesized that concomitant cetuximab could prevent RT-induced anemia. Methods: We queried our institutional head and neck cancers database for non-metastatic HNSCC cases that received RT with concomitant cetuximab or RT-only between 2006 and 2018. Cetuximab was administered for some high-risk cases medically unfit for platinum agents per multidisciplinary team evaluation. We only included patients who had at least one complete blood count in the 4 months preceding and after RT. We compared the prevalence of anemia (defined as hemoglobin (Hb) below 12 g/dL in females and 13 g/dL in males) and mean Hb levels at baseline and after RT. Improvement of anemia/Hb (resolution of baseline anemia and/or an increase of baseline Hb ≥1 g/dL after RT), and overall survival (OS) in relation to anemia/Hb dynamics were also compared. Results: A total of 171 patients were identified equally distributed between cetuximab-plus-RT and RT-only groups. The cetuximab-plus-RT group had more locally-advanced stage, oropharyngeal and high grade tumors (p < 0.001 for all). Baseline anemia/Hb were similar, however anemia after RT conclusion was higher in the cetuximab-plus-RT vs RT-only (63.5% vs. 44.2%; p = 0.017), with a mean Hb of 11.98 g/dL vs. 12.9 g/dL; p = 0.003, for both respectively. This contributed to significantly worse anemia/Hb improvement for cetuximab-plus-RT (18.8% vs. 37.2%; p = 0.007). This effect was maintained after adjusting for other factors in multivariate analysis. The prevalence of iron, vitamin-B12 and folate deficiencies; and chronic kidney disease, was non-different. Baseline anemia was associated with worse OS (p = 0.0052) for the whole study cohort. Nevertheless, improvement of anemia/Hb was only marginally associated with better OS (p = 0.068). Conclusions: In contrast to previous studies, cetuximab was not associated with lower rates of anemia after RT for nonmetastatic HNSCC patients compared to RT-alone. Dedicated prospective studies are needed to elucidate the effect of cetuximab on RT-induced anemia.
Mesh-Begriff(e)	Anemia/epidemiology ; Anemia/etiology ; Cetuximab/adverse effects ; ErbB Receptors ; Female ; Head and Neck Neoplasms/complications ; Head and Neck Neoplasms/drug therapy ; Head and Neck Neoplasms/radiotherapy ; Humans ; Interleukin-6 ; Male ; Squamous Cell Carcinoma of Head and Neck/therapy
Chemische Substanzen	Interleukin-6 ; ErbB Receptors (EC 2.7.10.1) ; Cetuximab (PQX0D8J21J)
Sprache	Englisch
Erscheinungsdatum	2022-06-07
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-09708-9
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Charlson Comorbidity score influence on prostate cancer survival and radiation-related toxicity.

Ghanem, Ahmed I / Khalil, Remonda M / Khedr, Gehan A / Tang, Amy / Elsaid, Amr A / Chetty, Indrin J / Movsas, Benjamin / Elshaikh, Mohamed A

The Canadian journal of urology

2020 Band 27, Heft 2, Seite(n) 10154–10161

Abstract: Introduction: In addition to survival endpoints, we explored the impact of Charlson Comorbidity-Index (CCI) on the acute and late toxicities in men with localized prostate cancer who received dose-escalated definitive radiotherapy (RT).: Materials and ...

Abstract	Introduction: In addition to survival endpoints, we explored the impact of Charlson Comorbidity-Index (CCI) on the acute and late toxicities in men with localized prostate cancer who received dose-escalated definitive radiotherapy (RT). Materials and methods: CCI scores at diagnosis and survival outcomes were identified for men with intermediate/high-risk prostate cancer treated with RT (1/2007-12/2012). Study-cohort was accordingly grouped into no, mild and severe comorbidity (CCI-0, 1 or 2+). CCI-groups were compared for demographics, prognostic-factors; and RT-related toxicities based on RTOG/CTCAE criteria. Kaplan-Meier curves and Uni/multivariate (MVA) analyses were used to examine the influence of CCI-group on overall (OS), disease-specific (DSS) and biochemical-relapse free (BRFS) survival. Results: We included 257 patients with median age 73 years (48-85), 53% African-American and 67% had intermediate-risk. Median prostate RT-dose was 76 Gy; and 47% received androgen-deprivation therapy. CCI-0,1,2+ groups encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively and were well-balanced. Ten and 15-years OS were significantly different (76% versus 46% versus 55% for 10-years OS and 53% versus 31% versus 14% for 15-years OS for CCI-0 versus CCI-1[HR:2.25; CI[1.31-3.87]] versus CCI-2+[HR:2.73; CI[1.73-4.31]]; p < 0.001. CCI-0 had better DSS than CCI-2+ (HR:2.23; CI[1.06-4.68]; p = 0.03) and BRFS was similar (p = 0.99). Late G2/3 RT-toxicities were more common in CCI-2+ (47%) than CCI-1 (44%) and CCI-0 (29%), p = 0.032; with non-different acute-toxicities (p = 0.62). On MVA, increased CCI was deterministic for OS (HR:3.65; CI [1.71:7.79]; p < 0.001) and was only marginal for DSS (HR:2.55; CI [0.98-6.6]; p = 0.05) with no impact on BRFS (p > 0.05). Conclusions: Higher CCI is a significant predictor for late RT-related side-effects and shorter OS in men with localized prostate cancer. Baseline comorbidities should be considered during initial counseling and follow up visits.
Mesh-Begriff(e)	Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Neoplasms/complications ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/radiotherapy ; Radiation Injuries/mortality ; Retrospective Studies ; Survival Rate
Sprache	Englisch
Erscheinungsdatum	2020-04-24
Erscheinungsland	Canada
Dokumenttyp	Journal Article
ZDB-ID	2064475-9
ISSN	1195-9479
ISSN	1195-9479
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 5607: Hefte anzeigen

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