- Email: [email protected]
35 Factors influencing the use of single versus multiple fractions of palliative radiotherapy for bone metastases: a 5-year review
CARO 2003
variance in outcome prediction by each stage grouping scheme, and Balance (evenness of case distribution by groups) were calculated. Results: The stage distribution for the 4th edition was 1:27(5%); 11:306.5%; 111:56(11%); IV:407(78%) and for the 5th edition 1:52(10%); i1:137(26%); 111:163(31%); IV:168(32%). Stage stratified 5-year cause-specific survival probabilities (4th edition) were: 1:91%; 11:96%; 111:72%;IV:70% and (5th edition): 1:93%; 11:81%; 111:75%; IV:56%. The stage distributions in both TNM editions were similar for Asian and Caucasians with no multivariate statistical outcome differences according to ethnicity or histological subtype. PVE was 2.1% (overall), 2.45% (Asians) and 1.3% (Caucasians) for the 4th edition compared to 7.5% (overall), 8.6% (Asians), and 7.6% (Caucasians) for the 5th edition. Balance was considerably better for 5th than the 4th edition across all subgroups. Conclusions: These data strongly indicate that the 5th edition TNM performs better overall and for both Asian and Caucasian groups in a single institution series in Canada compared to the 4th edition TNM Race and histology did not add independent prediction of outcome by stage in this series. 33
Role of radiation therapy in patients with both lupus and cancer V. Benk 1, A. AI-Herz2, D. Gladman2, M. Urowitz 2, P. Fortin2 1Department of Radiation Oncology, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada 2Division of Rheumatology, University Health Network - Western Division, University of Toronto, Toronto, Ontario, Canada Obiective: To evaluate if radiation therapy (RT) is denied to persons with lupus and cancer and whether RT causes severe toxicity in those receiving it. Material and method: A review of the literature was conducted and all reported cases of RT in patients with lupus were summarized. Lupus patients followed at the University of Toronto Lupus Clinic between 1972 and 2001 and who developed cancer were included in our study. Demographic, clinical and laboratory information are collected prospectively following a rigorous protocol. Pathological proof of cancer was obtained. Three radiation oncologists blinded for the diagnosis of lupus, the modalities of cancer treatment, and the hypothesis of the study reviewed independently of each other the patient data. They assessed the indication for RT and whether it should be curative or symptomatic. Recommendation for RT was considered when at least two out of the three radiation oncologists concurred. Results: Forty cases of cancer in 38 patients were identified. Median age was 58 years. Most frequent cancer sites were breast (8), skin (8), digestive (7) and hematological malignancies (7). The literature review did not support the fact that lupus patients do not tolerate RT. The radiation oncologists recommended RT in 26 cases, either with a curative (15) or a symptomatic intent (11). Despite this, only four patients received RT. None of these four patients developed any unusual toxicity. Conclusion: Persons with lupus deemed eligible by an expert panel of radiation oncologists to receive RT did not receive it: 65% of our cases could have received RT either with a curative intent (58%) or a symptomatic intent (42%). Only 10% received it and did not develop any toxicity. RT may be inappropriately withheld from lupus patients. 34
Effective prevention of radiation induced dermatitis with silver leaf dressing during concurrent chemotherapy and radical radiation on the perineum: results of a phase II study using multiple blinded observers to score end of treatment photographs T. Vuong 1,2, E. Franco 1, C. Lambert 1, L. Porte/ance 1, E. Nast2, S. Faria 1, J. Hay3, S. Larsson 4, G. Shenouda 1, L. Souhami 1, F. Wong 5, C. Freeman 1 1McGill University Health Centre, Montreal, Quebec, Canada 2Saint Joseph University, Beyrouth, Liban 3British Columbia Cancer Agency, Vancouver, British Columbia, Canada 4British Columbia Cancer Agency, Victoria, Canada 5British Columbia Cancer Agency, Fraser Valley, British Columbia, Canada Purpose: Silver coated dressing has been shown to have effective antimicrobial activity and enhance the healing, in burns and skin grafts. The purpose of this study is to evaluate the value of silver leaf dressing, as a preventive intervention of radiation dermatitis during perineum irradiation.
3-5 October 2003
$9
Material and Methods: Fifteen consecutive patients with anal canal or gynaecological cancer undergoing radical radiation with doses ranging from 45-54 Gy to the perineal skin with concurrent chemotherapy were offered to wear the dressing, from the day one until two weeks after the treatment. The evaluation was based on photographs obtained at the end treatment. The skin was scored using the RTOG acute toxicity scoring system. The end of treatment photographs of 15 previously treated patients with same treatment parameters and receiving standard skin cares were used as historical controls. Ten blinded observers were enrolled in the evaluation of these pictures in order to decrease the subjectivity of the scoring. The following value was assigned: 0 for GO, 1 for G1, etc, to compute dermatitis scores. All readers read all patients so the net score is simply the combined score divided by 10. The Mann-Whitney test was used to assess the statistical significance for the difference between dermatitis scores measured in two groups of patients. Results: The mean dermatitis score for controls was 2.62, (Standard deviation: 0.48). The mean score for silver coated dressing 1.18 (standard deviation: 0.40). The difference between mean scores having reached statistical significance (P<0.0001). On average, degree of dermatitis for patients using the dressing was rated 1.5 points lower than for the control patients. No toxicity observed with the dressing. Conclusion: The results of this study suggest that silver coated dressing is effective in reducing radiation dermatitis for patients undergoing radical chemotherapy and radiation of either anal canal or gynecological cancer. 35
Factors influencing the use of single versus multiple fractions of palliative radiotherapy for bone metastases: a 5-year review P. Haddad, R. Wong, M. McLean, W. Levin, F. Soban, D. Williams, A. Bezjak Palliative Radiation Oncology Program, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Supported by evidence from a number of randomized trials and a metaanalysis, single-fraction radiotherapy (RT) for palliative treatment of painful bone metastases is commonly used in Canada. We undertook a review of our palliative RT program's database to explore patient or treatment factors influencing single- versus multiple-fractionation of RT for bone metastases. In 1998 to 2002, 882 courses of RT were prescribed for bone metastases in our program, of which 283 (32%) were a single fraction. The proportion of single treatments was 37% in 1998, 30% in 1999 and 43% in 2000, but dropped to 26 and 28% in 2001 and 2002 (p=0.02). Mean age was 64 and 68 years for multiple and single treatments respectively (p<0.001). The proportion of single fractions increased from 10% to 69% in patients with a good to poor performance status (p<0.001), and was 26% and 35% in patients without and with weight loss (p=O.01). This proportion was 20% in palliative irradiation of spine, 36% in pelvis and long bones, and 59% in chest wall (p<0.001). Participation in any palliative RT clinical trial or study approached statistical significance (p=O.08). There was no significant difference with regard to treating physicians, patients' gender, primary cancers and number of metastatic sites. In multivariate analysis, age, performance status, anatomical site and year of RT were significantly different between single- versus multiple-fractionated treatments (p<0.01). In conclusion, only 1/3 of palliative RT courses for bone metastases in our program were given with a single fraction. Performance status, age, and anatomical site of RT were significant factors affecting single versus multiple fractionation. There was a trend towards less frequent use of single fractions after the year 2000; this may have been due to the emergence of data from a Canadian trial suggesting better pain relief with multiple fractions. 36
Coordination of supportive cancer care by non-oncologist physicians J. Sussman 1,2, T. Whelan 1,2, K. Brazil 1, M.A. O'Brien 1, D. Bainbridge 1, N. Pyette 1 1Supportive Cancer Care Research Unit, McMaster University, Hamilton, Ontario, Canada 2Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada Backqround: Cancer care is becoming increasingly complex with patients and practitioners reporting frustration with the fragmentation of care and problems with continuity. Many patients report unmet supportive care needs. Most often these are in the domains of information and psychological needs. Patients identity non-oncologist physicians as sources of support or referral especially when not under care within the cancer system. Purpose: To study non-oncologist physicians practices specific to coordina-
variance in outcome prediction by each stage grouping scheme, and Balance (evenness of case distribution by groups) were calculated. Results: The stage distribution for the 4th edition was 1:27(5%); 11:306.5%; 111:56(11%); IV:407(78%) and for the 5th edition 1:52(10%); i1:137(26%); 111:163(31%); IV:168(32%). Stage stratified 5-year cause-specific survival probabilities (4th edition) were: 1:91%; 11:96%; 111:72%;IV:70% and (5th edition): 1:93%; 11:81%; 111:75%; IV:56%. The stage distributions in both TNM editions were similar for Asian and Caucasians with no multivariate statistical outcome differences according to ethnicity or histological subtype. PVE was 2.1% (overall), 2.45% (Asians) and 1.3% (Caucasians) for the 4th edition compared to 7.5% (overall), 8.6% (Asians), and 7.6% (Caucasians) for the 5th edition. Balance was considerably better for 5th than the 4th edition across all subgroups. Conclusions: These data strongly indicate that the 5th edition TNM performs better overall and for both Asian and Caucasian groups in a single institution series in Canada compared to the 4th edition TNM Race and histology did not add independent prediction of outcome by stage in this series. 33
Role of radiation therapy in patients with both lupus and cancer V. Benk 1, A. AI-Herz2, D. Gladman2, M. Urowitz 2, P. Fortin2 1Department of Radiation Oncology, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada 2Division of Rheumatology, University Health Network - Western Division, University of Toronto, Toronto, Ontario, Canada Obiective: To evaluate if radiation therapy (RT) is denied to persons with lupus and cancer and whether RT causes severe toxicity in those receiving it. Material and method: A review of the literature was conducted and all reported cases of RT in patients with lupus were summarized. Lupus patients followed at the University of Toronto Lupus Clinic between 1972 and 2001 and who developed cancer were included in our study. Demographic, clinical and laboratory information are collected prospectively following a rigorous protocol. Pathological proof of cancer was obtained. Three radiation oncologists blinded for the diagnosis of lupus, the modalities of cancer treatment, and the hypothesis of the study reviewed independently of each other the patient data. They assessed the indication for RT and whether it should be curative or symptomatic. Recommendation for RT was considered when at least two out of the three radiation oncologists concurred. Results: Forty cases of cancer in 38 patients were identified. Median age was 58 years. Most frequent cancer sites were breast (8), skin (8), digestive (7) and hematological malignancies (7). The literature review did not support the fact that lupus patients do not tolerate RT. The radiation oncologists recommended RT in 26 cases, either with a curative (15) or a symptomatic intent (11). Despite this, only four patients received RT. None of these four patients developed any unusual toxicity. Conclusion: Persons with lupus deemed eligible by an expert panel of radiation oncologists to receive RT did not receive it: 65% of our cases could have received RT either with a curative intent (58%) or a symptomatic intent (42%). Only 10% received it and did not develop any toxicity. RT may be inappropriately withheld from lupus patients. 34
Effective prevention of radiation induced dermatitis with silver leaf dressing during concurrent chemotherapy and radical radiation on the perineum: results of a phase II study using multiple blinded observers to score end of treatment photographs T. Vuong 1,2, E. Franco 1, C. Lambert 1, L. Porte/ance 1, E. Nast2, S. Faria 1, J. Hay3, S. Larsson 4, G. Shenouda 1, L. Souhami 1, F. Wong 5, C. Freeman 1 1McGill University Health Centre, Montreal, Quebec, Canada 2Saint Joseph University, Beyrouth, Liban 3British Columbia Cancer Agency, Vancouver, British Columbia, Canada 4British Columbia Cancer Agency, Victoria, Canada 5British Columbia Cancer Agency, Fraser Valley, British Columbia, Canada Purpose: Silver coated dressing has been shown to have effective antimicrobial activity and enhance the healing, in burns and skin grafts. The purpose of this study is to evaluate the value of silver leaf dressing, as a preventive intervention of radiation dermatitis during perineum irradiation.
3-5 October 2003
$9
Material and Methods: Fifteen consecutive patients with anal canal or gynaecological cancer undergoing radical radiation with doses ranging from 45-54 Gy to the perineal skin with concurrent chemotherapy were offered to wear the dressing, from the day one until two weeks after the treatment. The evaluation was based on photographs obtained at the end treatment. The skin was scored using the RTOG acute toxicity scoring system. The end of treatment photographs of 15 previously treated patients with same treatment parameters and receiving standard skin cares were used as historical controls. Ten blinded observers were enrolled in the evaluation of these pictures in order to decrease the subjectivity of the scoring. The following value was assigned: 0 for GO, 1 for G1, etc, to compute dermatitis scores. All readers read all patients so the net score is simply the combined score divided by 10. The Mann-Whitney test was used to assess the statistical significance for the difference between dermatitis scores measured in two groups of patients. Results: The mean dermatitis score for controls was 2.62, (Standard deviation: 0.48). The mean score for silver coated dressing 1.18 (standard deviation: 0.40). The difference between mean scores having reached statistical significance (P<0.0001). On average, degree of dermatitis for patients using the dressing was rated 1.5 points lower than for the control patients. No toxicity observed with the dressing. Conclusion: The results of this study suggest that silver coated dressing is effective in reducing radiation dermatitis for patients undergoing radical chemotherapy and radiation of either anal canal or gynecological cancer. 35
Factors influencing the use of single versus multiple fractions of palliative radiotherapy for bone metastases: a 5-year review P. Haddad, R. Wong, M. McLean, W. Levin, F. Soban, D. Williams, A. Bezjak Palliative Radiation Oncology Program, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada Supported by evidence from a number of randomized trials and a metaanalysis, single-fraction radiotherapy (RT) for palliative treatment of painful bone metastases is commonly used in Canada. We undertook a review of our palliative RT program's database to explore patient or treatment factors influencing single- versus multiple-fractionation of RT for bone metastases. In 1998 to 2002, 882 courses of RT were prescribed for bone metastases in our program, of which 283 (32%) were a single fraction. The proportion of single treatments was 37% in 1998, 30% in 1999 and 43% in 2000, but dropped to 26 and 28% in 2001 and 2002 (p=0.02). Mean age was 64 and 68 years for multiple and single treatments respectively (p<0.001). The proportion of single fractions increased from 10% to 69% in patients with a good to poor performance status (p<0.001), and was 26% and 35% in patients without and with weight loss (p=O.01). This proportion was 20% in palliative irradiation of spine, 36% in pelvis and long bones, and 59% in chest wall (p<0.001). Participation in any palliative RT clinical trial or study approached statistical significance (p=O.08). There was no significant difference with regard to treating physicians, patients' gender, primary cancers and number of metastatic sites. In multivariate analysis, age, performance status, anatomical site and year of RT were significantly different between single- versus multiple-fractionated treatments (p<0.01). In conclusion, only 1/3 of palliative RT courses for bone metastases in our program were given with a single fraction. Performance status, age, and anatomical site of RT were significant factors affecting single versus multiple fractionation. There was a trend towards less frequent use of single fractions after the year 2000; this may have been due to the emergence of data from a Canadian trial suggesting better pain relief with multiple fractions. 36
Coordination of supportive cancer care by non-oncologist physicians J. Sussman 1,2, T. Whelan 1,2, K. Brazil 1, M.A. O'Brien 1, D. Bainbridge 1, N. Pyette 1 1Supportive Cancer Care Research Unit, McMaster University, Hamilton, Ontario, Canada 2Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada Backqround: Cancer care is becoming increasingly complex with patients and practitioners reporting frustration with the fragmentation of care and problems with continuity. Many patients report unmet supportive care needs. Most often these are in the domains of information and psychological needs. Patients identity non-oncologist physicians as sources of support or referral especially when not under care within the cancer system. Purpose: To study non-oncologist physicians practices specific to coordina-