Publications by authors named "Eric Berthelet"

53 Publications

Ninety-day mortality after radiotherapy for head and neck cancer: A population-based comparison between rural and urban patients.

Head Neck 2021 Jul 21. Epub 2021 Jul 21.

Radiation Oncology, BC Cancer - Centre for the North, Prince George, British Columbia, Canada.

Background: This study assesses whether 90-day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality.

Methods: All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Patients were divided into rurality areas according to the Modified Statistics Canada (mSC) definition, which classifies a population <30 000 as rural and ≥30 000 as urban.

Results: Five thousand five hundred and fifty-four patients were included in this study, of which 68% lived in urban centers. The 90-day mortality for rural versus urban patients were 3.0% and 3.9% (p = 0.09), respectively. Univariate and multivariate analyses showed no association with 90-day mortality and rurality.

Conclusion: After controlling for potentially confounding factors, we did not find a significant association between 90-day mortality and rurality in patients who were treated with radiotherapy for HNC in British Columbia.
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http://dx.doi.org/10.1002/hed.26819DOI Listing
July 2021

External Beam Radiation Therapy in pT4 Well-differentiated Thyroid Cancer: A Population-Based Study of 405 Patients.

Int J Radiat Oncol Biol Phys 2021 May 15. Epub 2021 May 15.

Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada. Electronic address:

Purpose: The benefit of external beam radiation therapy (EBRT) in locally advanced, well- differentiated thyroid cancer (WDTC) is uncertain. The purpose of this study is to evaluate locoregional recurrence (LRR), progression-free survival, and cause-specific survival (CSS) of patients with pT4 well-differentiated thyroid carcinoma.

Methods And Materials: A population-based retrospective review was conducted of consecutive patients with pT4 WDTC (per the American Joint Committee on Cancer, 8th edition, criteria) treated provincially between 1985 and 2013. The primary endpoints were cumulative incidence of LRR and CSS. To account for the competing risks of death from other causes, a Fine-Gray's test was used. A Cox-proportional hazards model was used to analyze overall survival (OS). Multivariate models and propensity matching were used to account for the effects of covariates.

Results: A total of 405 patients were identified with a median follow-up time of 14.3 years for a total of 4209 person-years of follow up. The median age at the time of diagnosis was 53 years (range, 20-87). There were 211 patients (52%) who received EBRT. EBRT was associated with age ≥55 years (56% vs 35%; P < .001), airway involvement (42% vs 8%; P < .001), and R1/2 resection (81% vs 51%; P < .001). The 10-year outcomes for the non-EBRT and EBRT groups were 21.6% versus 11.4%, respectively, for LRR, 84.1% versus 93.1%, respectively, for CSS, and 85.7% versus 67.5%, respectively, for OS. On multivariate analysis, EBRT was associated with a lower rate of LRR (hazard ratio [HR]: 0.334; P < .001), but not associated with CSS (HR: 1.56; P = .142) nor OS (HR: 1.216; P = .335). After propensity score matching, the EBRT cohort had lower rates of LRR relative to the non-EBRT cohort (HR: 0.261; P = .0003), but there were no differences in CSS or OS.

Conclusions: In this large, population-based analysis of patients with pT4 WDTC, EBRT was associated with lower rates of LRR, but no difference in CSS or OS.
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http://dx.doi.org/10.1016/j.ijrobp.2021.05.006DOI Listing
May 2021

Clinical features of head and neck cancer patients with brain metastases: A retrospective study of 88 cases.

Oral Oncol 2021 01 10;112:105086. Epub 2020 Nov 10.

University of British Columbia, Department of Surgery, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada; BC Cancer Vancouver, Department of Radiation Oncology, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada. Electronic address:

Objectives: Brain metastases (BM) arising from head and neck cancer (HNC) are rare and not well characterized. This study aims to describe the clinicopathological features, treatments, prognostic factors, and survival in HNC patients with BM.

Materials And Methods: Non-thyroid HNC patients referred to BC Cancer from 1998 to 2016 were retrospectively reviewed for BM. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used to assess post-BM survival and prognostic factors.

Results: Out of 9432 HNC patients, 88 patients developed BM (0.9%, median follow-up 3.4 years). On average, the BM were diagnosed 18.5 months after the primary diagnosis and tended to arise after distant metastases to extracranial sites (85%) such as the lungs (78%). At BM presentation, 84% were symptomatic and two thirds had a poor performance status (ECOG ≥ 2, 68%). The median post-BM survival was 2.5 months (95% CI 2.1-3.3 months). On multivariable analysis, management of BM with radiotherapy (RT) alone (3.3 months, 95% CI 2.3-4.6, p = 0.005) and RT with surgery (4.4 months, 95% CI 2.8-6.9, p < 0.001) was associated with longer survival compared to best supportive care alone (1.4 months, 95% CI 1.0-2.0 months). Age, sex, performance status, sub-localization of the primary HNC, presence of extracranial metastases, and number of intracranial metastases were not associated with post-BM survival (all p ≥ 0.05).

Conclusion: This is the largest study to date in BM from HNC. BM occur late in the course of HNC and carry a poor prognosis. Treatment with intracranial radiotherapy both with and without surgery was associated with improved survival.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105086DOI Listing
January 2021

A Unique Case of Primary EBV-Positive, HPV-Negative Nasopharyngeal Carcinoma Located in the Tonsil.

Head Neck Pathol 2020 Oct 21. Epub 2020 Oct 21.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada.

Nasopharyngeal carcinomas (NPC) are non-keratinizing squamous cell carcinomas of the nasopharynx associated with Epstein-Barr virus (EBV). When occurring outside of the nasopharynx, they are referred to as lymphoepithelioma-like carcinomas (LELCs) and present the same morphology as NPC. LELC have been described in other head and neck regions such as the salivary glands and the soft palate. LELC can also occur in the oropharynx, are associated with human papillomavirus (HPV) and are typically negative for EBV. We herein present a unique case of a 78-year-old Chinese male with EBV-positive, HPV-negative NPC of the left tonsil. His presenting symptom was a left-sided lymph node. There was no evidence of nasopharyngeal lesion seen on physical examination, PET and MRI. The patient was treated with curative-intent external beam radiotherapy which delivered 70 Gy (Gy) to the gross tumour and lymph nodes, and 56 Gy electively to the ipsilateral neck using a volumetric modulated arc therapy technique. This is the first case of primary tonsil EBV-positive NPC described in the literature.
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http://dx.doi.org/10.1007/s12105-020-01237-wDOI Listing
October 2020

Patient-reported outcome measures in patients undergoing radiotherapy for head and neck cancer.

Support Care Cancer 2021 May 19;29(5):2537-2547. Epub 2020 Sep 19.

Univeristy of British Columbia, Vancouver, BC, Canada.

Objectives: Head and neck (H&N) cancer patients experience significant acute side effects from treatment. This study evaluates prospectively collected patient-reported outcomes (PROs) in H&N patients undergoing radiotherapy (RT) to assess feasibility of electronically collecting PROs and to objectively document symptom acuity and trajectory during RT.

Materials And Methods: H&N patients undergoing radical RT at our multicentre institution completed a 12-item partial survey of the Vanderbilt Head & Neck Symptom Survey 2.0 prior to RT and weekly on RT. Between October 2016 and October 2018, 318 of 333 patients completed a baseline survey and at least one weekly survey.

Results: The average number of weekly questionnaires completed was 5 (range 1-8). The mean maximum symptom scores were highest for dysgeusia (5.8/10), pain (5.4/10), mucositis (4.8/10), weight loss due to swallowing (4.5/10) and mucus causing choking/gagging (4.3/10). On multivariate analysis, female gender, sinonasal, nasopharynx and oropharynx primaries were associated with a greater risk of moderate-severe pain (p < 0.05). Sinonasal, nasopharynx, oral cavity, oropharynx and thyroid primaries were associated with a greater risk of moderate-severe mucositis during radiation (p < 0.0001). Salivary gland, sinonasal, nasopharynx and oropharynx primaries and higher radiation dose were associated with a greater risk of moderate-severe dysgeusia (all p < 0.05).

Conclusions: Electronic PRO collection during H&N cancer RT is feasible. H&N cancer patients experience significant symptoms during RT, and the most severe symptoms reported were dysgeusia, pain and mucositis. Oropharynx cancer patients reported the highest symptom scores during RT.
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http://dx.doi.org/10.1007/s00520-020-05778-2DOI Listing
May 2021

Population-based outcomes by immunosuppressed status in patients undergoing radiotherapy for oropharyngeal cancer.

Radiother Oncol 2020 10 13;151:110-117. Epub 2020 Aug 13.

Univeristy of British Columbia, Vancouver, BC, Canada; BC Cancer - Centre for the North, Prince George, BC, Canada; University of Northern British Columbia, BC, Canada.

Introduction: The incidence of immunosuppression in patients with oropharynx head & neck squamous cell carcinoma (SCC) is not well studied. This study evaluates disease characteristics and treatment outcomes in oropharynx SCC in patients with and without immunosuppression.

Methods: A retrospective review of all patients treated with radiotherapy for oropharynx SCC at BC Cancer from 2011 to 2016 was performed. Survival outcomes were assessed using Kaplan-Meier methods and competing risk analysis. Multivariate analysis and propensity score matching were performed.

Results: There were 1077 patients, of which 5.8% (n = 62) had an immunosuppressive medical condition or were taking long-term immunosuppressive medication at diagnosis. Median follow-up was 3.3 years. Three year OS for patients without immunosuppression was 79.5% (95% Confidence Interval [CI] 76.8-82.0%) and for those with immunosuppression was 64.6% (95% CI 50.9-75.3%) (hazard ratio [HR] 1.78, 95% CI 1.18-2.68, p = 0.0062). The three year disease recurrence for patients without immunosuppression was 24.9% (95% CI 22.2-27.7%) and 44.4% (95% CI 31.5-56.6%) for those with immunosuppression (HR 2.12, 95% CI 1.45-3.11, p = 0.0001). Multivariate analysis of disease free survival (DFS) found that active smoking, advanced TNM stage, base of tongue subsite, p16 negative and unknown, no concurrent chemotherapy, higher Charlson Comorbidity Index, and lower radiation dose were also associated with worse DFS (all p < 0.05). Immunosuppressed patients had worse DFS relative to patients without immunosuppression, p < 0.001, HR 1.97 (95% CI 1.33-2.91).

Conclusion: Immunosuppression was an independent predictor of worse DFS in this large cohort of patients with oropharynx SCC.
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http://dx.doi.org/10.1016/j.radonc.2020.08.005DOI Listing
October 2020

Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo-radiotherapy.

Head Neck 2020 09 20;42(9):2560-2570. Epub 2020 Jun 20.

Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Background: Patients receiving chemoradiotherapy for head and neck cancer (HNC) are often malnourished. We assessed the utility of nutritional risk index (NRI) in HNC patients undergoing chemoradiotherapy.

Methods: A population-based retrospective review of HNC patients treated with curative chemoradiation was performed. Demographics, anthropometrics, overall survival (OS), and the composite treatment complication rate (G-tube dependence, radiation incompletion, 90-day mortality, and unplanned hospitalization) were collected.

Results: Two hundred ninety-two patients were identified. Average pretreatment and posttreatment NRI were 110 (SD 3) and 99 (SD 12), respectively (P < .01). Pretreatment NRI risk category, age, ECOG status, and tumor subsites were associated with OS on multivariate analysis. Pretreatment NRI risk category was associated with risk of treatment related complications.

Conclusions: There was a significant decrease between pretreatment and posttreatment NRI in HNC patients receiving chemoradiation. Pretreatment NRI risk category may predict OS and composite treatment complications. Investigation of NRI as a prognostic factor is warranted.
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http://dx.doi.org/10.1002/hed.26315DOI Listing
September 2020

FDG-PET/CT scan assessment of response 12 weeks post radical radiotherapy in oropharynx head and neck cancer: The impact of p16 status.

Radiother Oncol 2020 07 1;148:14-20. Epub 2020 Apr 1.

Department of Radiation Oncology, BC Cancer Vancouver Centre, Canada. Electronic address:

Purpose: To evaluate the predictive value of FDG-PET/CT for detection of residual disease after radical radiotherapy for patients with squamous cell carcinoma (SCC) of the oropharynx, comparing p16 positive (+) versus p16 negative (-) disease.

Methods And Materials: A retrospective analysis of patients with SCC of the oropharynx at our institution treated with radical radiotherapy between 2012 and 2016 was performed. The primary and lymph node metabolic responses were evaluated independently on the post-treatment FDG-PET/CT. The reference standard was pathology when available, subsequent post-treatment FDG-PET/CT results or clinical follow-up.

Results: Median follow-up time was 32 (30-34) months. 556 patients had p16+ disease and 92 had p16- disease. The median time of post-treatment FDG-PET/CT was 96 (45-744) days after radiotherapy completion: 68% had complete metabolic response (CMR) defined as mild non-focal or no uptake, 10% residual primary disease, 11% residual regional lymph node disease, 5% residual primary and regional disease, and 6% distant metastatic disease. The local positive predictive value (PPV) was 26% for p16+ versus 54% for p16- (p = 0.01) and the regional PPV was 31% for p16+ versus 58% for p16- (p = 0.01). The local negative predictive value (NPV) was 100% regardless of p16 status and the regional NPV was 100% for p16+ versus 99% for p16- (p = 0.33). For p16+ cases, regional specificity was 76.2% versus 91.1% (p = 0.0003), local PPV was 0 versus 30% (p = 0.06) and the regional PPV was 12% versus 35% (p = 0.06) for FDG-PET/CT scans performed at ≤12 weeks versus >12 weeks. Five-year overall survival for those with CMR was 87% versus 51% without CMR (p ≤ 0.001).

Conclusions: Metabolic response on post-treatment FDG-PET/CT has excellent NPV regardless of p16 status. The PPV is significantly lower in those with p16+ versus p16- disease, with a significantly reduced regional specificity and a trend towards inferior predictive value if performed ≤12 weeks. CMR predicts for a significantly improved overall survival.
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http://dx.doi.org/10.1016/j.radonc.2020.03.032DOI Listing
July 2020

Treatment for Recurrent Differentiated Thyroid Cancer: A Canadian Population Based Experience.

Cureus 2020 Feb 27;12(2):e7122. Epub 2020 Feb 27.

Medical Oncology, BC Cancer, Vancouver, CAN.

Introduction: Management of recurrent differentiated thyroid cancer (DTC) may include surgery, radioactive iodine (RAI), and external beam radiotherapy (EBRT). Systemic therapy may also be offered for RAI-refractory DTC. The study objective was to review patterns of practice in British Columbia (BC) for treatment of recurrent DTC, assess rates of RAI-refractory disease, and evaluate outcomes.

Methods: BC Cancer provides cancer care to a population of 4.6 million. A retrospective review of all patients with DTC stage I-IVB disease referred to BC Cancer from 2009 to 2013 was conducted. Patient and DTC characteristics, locoregional and distant recurrence, surgical management, RAI, EBRT, and systemic therapy details were retrospectively collected. Relapse-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.

Results/discussion: Some 1062 DTC patients were identified. Median follow-up was 4.1 years. Baseline characteristics: female 74%, median age 50, papillary/follicular/Hurthle cell 92%/6%/2%. Stage at presentation: I 60%, II 8%, III 22%, IVA/IVB 10%. Locoregional and/or distant recurrence occurred in 136 patients (13%). Locoregional recurrence (n=118) was treated with surgery +/- RAI or EBRT 48%, RAI +/- EBRT 40%, EBRT alone 1%, 11% were observed without treatment. Some 27 patients had a second cancer recurrence. Some 37 patients (3%) developed distant metastatic disease and common sites of distant metastases were: lung 76%, bone 30%, and liver 8%. Some 27 cases (2%) were deemed RAI-refractory. Some six patients (0.6%) received systemic therapy with a vascular endothelial growth factor tyrosine kinase inhibitor (VEGF TKI). Five-year RFS was calculated to be 82%, OS 95%, and DSS 98% for the study population.

Conclusions: In our population-based study cohort, 87% of patients were rendered disease-free by primary disease management. Multi-modality treatment of locoregional recurrence facilitated disease-free status in the majority of patients (67%). RAI-refractory disease developed in 2% of patients and despite a significant number of metastatic recurrences, only a small number of patients received systemic therapy.
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http://dx.doi.org/10.7759/cureus.7122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105067PMC
February 2020

Information Needs of Patients Diagnosed with Head and Neck Cancer Undergoing Radiation Therapy: a Survey of Patient Satisfaction.

J Cancer Educ 2020 Mar 18. Epub 2020 Mar 18.

Vancouver Cancer Centre, BC Cancer, Vancouver, BC, Canada.

Research suggests that the information needs of patients diagnosed with head and neck cancer can be particularly complex, given the frequent need for multidisciplinary treatments and resulting potential for profound functional impairments. This study was designed to identify head and neck cancer patients' reported informational needs and to evaluate their satisfaction with the written information they received. The study was divided into 2 phases: phase 1, prior to development of a new educational pamphlet, and phase 2, after its implementation. A survey was designed to evaluate several measures including content, amount, understanding, and timing of information delivery. It was distributed at two points during patients' treatment pathway for each phase: at their last radiation appointment and at their posttreatment follow-up appointment. Participant responses after the revised pamphlet indicated greater preparedness before their first treatment, as well as increased satisfaction with treatment option information. Most were satisfied with information timing, but about a third did indicate that additional information would have been helpful at variable time points. Open-ended responses demonstrated that overall, patients do still desire more information, particularly on side effect and self-care management information. While patients with head and neck cancer appear to be generally satisfied with the written information received, our findings suggest that there is still considerable variability in how the information is understood, when it should be delivered, and in which areas more would have been beneficial. These findings underscore the need to consider how best to balance available resources in order to provide more tailored yet comprehensive education for this group of patients.
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http://dx.doi.org/10.1007/s13187-020-01719-zDOI Listing
March 2020

Treatment de-escalation for HPV-associated oropharyngeal squamous cell carcinoma with radiotherapy vs. trans-oral surgery (ORATOR2): study protocol for a randomized phase II trial.

BMC Cancer 2020 Feb 14;20(1):125. Epub 2020 Feb 14.

Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada.

Background: Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches.

Methods: This is a multicenter phase II study randomizing one hundred and forty patients with T1-2 N0-2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50-60 Gy based on risk factors). Patients will be stratified based on smoking status (< 10 vs. ≥ 10 pack-years). The primary endpoint is OS of each arm compared to historical control; we hypothesize that a 2-year OS of 85% or greater will be achieved. Secondary endpoints include progression free survival, QOL and toxicity.

Discussion: This study will provide an assessment of two de-escalation approaches to the treatment of HPV+ OPC on oncologic outcomes, QOL and toxicity. Results will inform the design of future definitive phase III trials.

Trial Registration: Clinicaltrials.gov identifier: NCT03210103. Date of registration: July 6, 2017, Current version: 1.3 on March 15, 2019.
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http://dx.doi.org/10.1186/s12885-020-6607-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023689PMC
February 2020

Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis.

Lung Cancer 2019 09 22;135:97-103. Epub 2019 Feb 22.

Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada; Radiation Therapy Program, BC Cancer - Prince George (Centre for the North), 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada. Electronic address:

Objectives: Palliative thoracic radiotherapy (RT) can improve quality of life for patients with advanced lung cancer, but treatment can be associated with acute toxicity and symptomatic relief may take several weeks. The optimal fractionation schedule is not known. Delivery of RT near the end of life (EOL) is an emerging indicator of poor quality care. The aim of this study was to determine utilization of palliative thoracic RT in the last 4 weeks of life, and factors associated with its use, in patients with incurable lung cancer in a population-based healthcare system.

Materials And Methods: All patients with lung cancer in British Columbia treated with palliative thoracic RT in 2014 and 2015 were identified. Associations between starting a course of palliative thoracic RT within 4 weeks of death and patient/treatment characteristics were assessed using univariate and multivariate logistic regression analysis.

Results: 1676 courses of palliative thoracic RT were delivered to 1584 lung cancer patients. Median survival was 20 weeks. 12% of palliative thoracic RT courses were delivered in the last 4 weeks of life, with short fractionation schedules and simple RT planning techniques used more frequently near EOL. Of RT courses delivered in the last 4 weeks of life 89% were courses of 1 - 5 fractions, 75% were completed as prescribed and 94% involved simple 1-2 field RT techniques. Receipt of RT in the last 4 weeks of life was associated with male gender, younger age, poor performance status, metastatic disease, small cell carcinoma histology and no prior chemotherapy.

Conclusion: Further study and standardization of quality indicators for palliative RT utilization near EOL is required. Whilst clarification occurs, physicians should consider the prognosis of patients with incurable lung cancer and the realistic expectation of benefit from palliative thoracic RT when considering treatment indications and fractionation schedules.
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http://dx.doi.org/10.1016/j.lungcan.2019.02.024DOI Listing
September 2019

Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial.

Lancet Oncol 2019 10 12;20(10):1349-1359. Epub 2019 Aug 12.

Department of Audiology, London Health Sciences Centre, London, ON, Canada.

Background: Transoral robotic surgery (TORS) with concurrent neck dissection has supplanted radiotherapy in the USA as the most common treatment for oropharyngeal squamous cell carcinoma (OPSCC), yet no randomised trials have compared these modalities. We aimed to evaluate differences in quality of life (QOL) 1 year after treatment.

Methods: The ORATOR trial was an investigator-initiated, multicentre, international, open-label, parallel-group, phase 2, randomised study. Patients were enrolled at six hospitals in Canada and Australia. We randomly assigned (1:1) patients aged 18 years or older, with Eastern Cooperative Oncology Group scores of 0-2, and with T1-T2, N0-2 (≤4 cm) OPSCC tumour types to radiotherapy (70 Gy, with chemotherapy if N1-2) or TORS plus neck dissection (with or without adjuvant chemoradiotherapy, based on pathology). Following stratification by p16 status, patients were randomly assigned using a computer-generated randomisation list with permuted blocks of four. The primary endpoint was swallowing-related QOL at 1 year as established using the MD Anderson Dysphagia Inventory (MDADI) score, powered to detect a 10-point improvement (a clinically meaningful change) in the TORS plus neck dissection group. All analyses were done by intention to treat. This study is registered with ClinicalTrials.gov (NCT01590355) and is active, but not currently recruiting.

Findings: 68 patients were randomly assigned (34 per group) between Aug 10, 2012, and June 9, 2017. Median follow-up was 25 months (IQR 20-33) for the radiotherapy group and 29 months (23-43) for the TORS plus neck dissection group. MDADI total scores at 1 year were mean 86·9 (SD 11·4) in the radiotherapy group versus 80·1 (13·0) in the TORS plus neck dissection group (p=0·042). There were more cases of neutropenia (six [18%] of 34 patients vs none of 34), hearing loss (13 [38%] vs five [15%]), and tinnitus (12 [35%] vs two [6%]) reported in the radiotherapy group than in the TORS plus neck dissection group, and more cases of trismus in the TORS plus neck dissection group (nine [26%] vs one [3%]). The most common adverse events in the radiotherapy group were dysphagia (n=6), hearing loss (n=6), and mucositis (n=4), all grade 3, and in the TORS plus neck dissection group, dysphagia (n=9, all grade 3) and there was one death caused by bleeding after TORS.

Interpretation: Patients treated with radiotherapy showed superior swallowing-related QOL scores 1 year after treatment, although the difference did not represent a clinically meaningful change. Toxicity patterns differed between the groups. Patients with OPSCC should be informed about both treatment options.

Funding: Canadian Cancer Society Research Institute Grant (#701842), Ontario Institute for Cancer Research Clinician-Scientist research grant, and the Wolfe Surgical Research Professorship in the Biology of Head and Neck Cancers grant.
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http://dx.doi.org/10.1016/S1470-2045(19)30410-3DOI Listing
October 2019

Websites, Websites Everywhere: How Thyroid Cancer Patients Use the Internet.

J Cancer Educ 2020 12;35(6):1177-1183

BC Cancer - Vancouver; Division of Radiation Oncology, Department of Surgery, University of British Columbia, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.

Thyroid cancer incidence rates and Internet use are both increasing. Thyroid cancer is common in young patients, who are likely to use the Internet. This study aims to characterize thyroid cancer patient Internet use and search patterns, usability of online resources, and effects on clinical care. From May to December 2017, inclusive, patients with thyroid cancer attending two tertiary cancer centers were invited to complete a survey about Internet use. Thirty-nine of 72 questionnaires were returned (54%). Ninety-seven percent of participants used the Internet, and 87% had looked for thyroid cancer information. The majority (94%) searched on Google. Patients most often looked for information about treatment (94%) and symptom management (76%). Many patients evaluated content quality by comparing several resources (71%), discussing with a physician (56%) or using a credible academic or government site (53%). Online information was somewhat hard to understand for 32%, but 91% found it useful. Over half (60%) of treatment decisions were affected by web resources, and information helped 50% of patients make decisions with their physicians. Respondents highlighted a lack of resources on survivorship and uncommon tumors such as medullary or anaplastic cancer. Physicians should recognize that patients overwhelmingly access online information, which often impacts patients' decision-making. Clinicians can guide thyroid cancer patients through abundant web-based information and assist in interpreting this information. Educators can use this information to guide resource development, tailoring content and design to thyroid cancer patients' needs.
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http://dx.doi.org/10.1007/s13187-019-01576-5DOI Listing
December 2020

Primary organ preservation vs total laryngectomy for T4a larynx cancer.

Head Neck 2019 09 19;41(9):3265-3275. Epub 2019 Jun 19.

Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Background: There is a lack of consensus regarding the management of T4a larynx cancer. We evaluated the outcomes of organ preservation and laryngectomy for T4a laryngeal cancer.

Methods: Retrospective analysis of patients with T4a larynx cancer at BC Cancer from 1984 to 2014 was performed. Outcomes in patients treated with surgery alone (Sx) (n = 47), surgery with adjuvant radiotherapy (Sx/RT) (n = 94), radiation alone (RT) (n = 152), and radiation with concurrent chemoradiotherapy (chemoRT) (n = 36) were compared.

Results: The 5-year overall survival (OS) was 40% for chemoRT, 34% for RT, 23% for Sx, and 45% for Sx/RT. On multivariate analysis (MVA), Sx/RT (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.48-0.91) and chemoRT (HR, 0.44; 95% CI, 0.26-0.72) were associated with better OS than RT alone (P = .001). Sx had similar OS compared to RT (HR, 1.17; 95% CI, 0.82-1.68).

Conclusions: ChemoRT and Sx/RT were associated with better OS compared to single modality treatment. ChemoRT may be considered as an option for T4a larynx cancer.
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http://dx.doi.org/10.1002/hed.25838DOI Listing
September 2019

A Practical Radiotherapy Treatment Planning Technique for Second-Incidence Cancers That Incorporates Complete Organ-At-Risk Dose History.

J Med Imaging Radiat Sci 2019 Mar 24;50(1):74-81. Epub 2018 Dec 24.

BC Cancer, Department of Radiation Oncology, Vancouver, British Columbia, Canada.

Introduction: Patients requiring treatment for second cancer incidences present unique radiotherapy plan development challenges. Historical dose delivered to organs at risk must be accounted for to properly estimate lifetime toxicity risks, but historical dose delivered to the region now occupied by tumours does not contribute to the prescription dose. Treatment planning systems permit inclusion of a base plan but do not provide the ability to manipulate it. We present a technique, dose cropping, which incorporates organ-at-risk dose history into the base plan while selectively excising dose history to diseased tissues now occupied by tumours. A retrospective plan comparison is performed to assess the effectiveness of dose cropping.

Methods And Materials: Nine patients who received a second course of radiotherapy for cancers of the head-and-neck were replanned using the proposed technique. Clinical second courses and replans were compared on the basis of conformity index, heterogeneity index, maximum point dose, tissue control probability (TCP), normal tissue complication probability (NTCP), and whether the planning guidelines could be met by the treatment planning system. Replan constraints and guidelines followed the clinical treatment. In addition, a tissue recovery model was incorporated, applied to both clinical and replan courses, and compared to estimate the relevance of the dose cropping technique in such regimes.

Results And Discussion: Replans had reduced organ-at-risk maximum point doses (5 Gy for spinal cord, 4 Gy for brainstem), NTCP (2.9% median reduction), and were able to more consistently achieve the V > 98% coverage target regardless of the tissue recovery model. At the same time, replans using the dose cropping technique were statistically indistinguishable from clinical second courses on the basis of plan conformity, heterogeneity, or TCP (P > .31 in all cases).

Conclusions: Dosimetric history cropping is a valuable and widely applicable technique for second cancer radiotherapy planning. It also provides a natural means to incorporate tissue recovery models, biologically effective dose conversion, and NTCP and TCP model evaluation.
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http://dx.doi.org/10.1016/j.jmir.2018.10.008DOI Listing
March 2019

Secretory carcinoma of the major salivary gland: Provincial population-based analysis of clinical behavior and outcomes.

Head Neck 2019 05 28;41(5):1227-1236. Epub 2018 Dec 28.

Department of Pathology, BC Cancer Agency - Vancouver Centre, Vancouver, Canada.

Background: Our aim was to identify the number of cases of secretory carcinoma (SC) of the major salivary gland in a population-based cohort and review its clinical behavior with long-term follow-up.

Methods: All malignant salivary gland tumors (MSGTs) diagnosed between 1980 and 2014 were assessed for histological features compatible with SC and 140 were selected for further analysis.

Results: Twenty two new cases of SC were identified, 19 of which were originally classified as acinic cell carcinoma, and 3 as adenocarcinoma, not otherwise specified (NOS). Lymph node involvement was less common in SC tumors (5%) than in the control group (11%). Disease recurrence was seen less frequently in SC (9%) than the control group (20%). Mean disease-free survival was 192 months for SC compared with 162 months for controls (P = 0.15).

Conclusion: The clinical course of SC is typically indolent with a low risk of relapse not significantly different from other low-grade MSGT.
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http://dx.doi.org/10.1002/hed.25536DOI Listing
May 2019

Magnetic Resonance Imaging Volumetry of Primary Nasopharyngeal Cancer in Patients Treated with Induction Gemcitabine and Cisplatin Followed by Concurrent Cisplatin and Volumetric Modulated Arc Therapy.

Cureus 2018 Sep 13;10(9):e3296. Epub 2018 Sep 13.

Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN.

Introduction The addition of induction chemotherapy (IC) to the standard concurrent chemoradiotherapy (CCRT) is under consideration in locally advanced nasopharyngeal carcinoma (LANPC). To-date, no studies have reported primary gross tumour volume (GTVp) changes using gemcitabine and cisplatin as the IC phase in LANPC. We investigated the timing and magnitude of GTVp response throughout sequential gemcitabine and cisplatin IC and CCRT for LANPC. Toxicity and tumour control probability (TCP) analyses are also presented Methods Ten patients with LANPC underwent sequential IC and CCRT between 2011 and 2015. All patients had magnetic resonance imaging (MRI) at three time points: before IC (MRI), after IC (MRI), and three months after CCRT (MRI). Five of the 10 patients had an additional MRI four to five weeks into CCRT (MRI). GTVp contours were delineated retrospectively using contrast-enhanced MRIs, and each GTVp underwent secondary review by a neuroradiologist. Acute toxicities were graded retrospectively via chart review based on the National Cancer Institute Common Terminology for Adverse Events version 4.0 (NCI CTCAE v4.0). Results Mean GTVp reduction between MRI- MRI was from 68 cc to 47 cc and from 47 cc to 9 cc between MRI- MRI. In patients with MRI, the mean GTVp reduction between MRI- MRI was from 57 cc to 32 cc. Tumour control probability estimates increased by 0.11 after IC. Patients tolerated the treatment well with one Grade IV toxicity event. Conclusion The observed GTVp response and improved tumor control probability support further investigation into the use of IC in LANPC.
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http://dx.doi.org/10.7759/cureus.3296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235650PMC
September 2018

Sclerosing Odontogenic Carcinoma with Local Recurrence: Case Report and Review of Literature.

Head Neck Pathol 2019 Sep 12;13(3):371-377. Epub 2018 Oct 12.

Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, BC, Canada.

Sclerosing odontogenic carcinoma is a rare locally destructive neoplasm with many histologic mimics. Here the diagnostic challenges are presented of a case of sclerosing odontogenic carcinoma with variable histologic features, including unusual and unexpected negative immunostaining for CK19.
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http://dx.doi.org/10.1007/s12105-018-0975-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684691PMC
September 2019

Early (90-day) mortality after radical radiotherapy for head and neck squamous cell carcinoma: A population-based analysis.

Head Neck 2018 11 8;40(11):2432-2440. Epub 2018 Oct 8.

Univeristy of British Columbia, Vancouver, BC, Canada.

Background: A retrospective, population-based analysis of 90-day mortality in patients with squamous cell carcinoma of the head and neck treated with radiotherapy was performed to determine the early mortality rate and associated risk factors.

Methods: Data were abstracted for all consecutive patients with cancer of the head and neck treated from 1998 to 2014 at the BC Cancer Agency with curative intent radiotherapy (n = 5658). Logistic regression analysis was used to determine factors associated with early mortality.

Results: The median age at diagnosis was 63 years. The mortality rate at 90 days after starting radiotherapy (RT) was 3.6% (n = 203/5658). The cause of death was attributed to head and neck cancer for 81% of patients. Multivariate analysis demonstrated that increasing age, oral cavity subsite, and advanced T and N classification were associated with an increased risk of early mortality (p < .05).

Conclusions: The risk of early mortality was 3.6%. Elderly patients with advanced T and N classification had the highest risk of early mortality.
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http://dx.doi.org/10.1002/hed.25352DOI Listing
November 2018

Impact of Neoadjuvant Chemotherapy on the Administration of Concurrent Chemoradiation for Locally Advanced Nasopharyngeal Carcinoma.

Cureus 2018 Jul 12;10(7):e2971. Epub 2018 Jul 12.

Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN.

Objectives The standard of care for locally advanced nasopharyngeal carcinoma (NPC) is concurrent cisplatin chemoradiotherapy. Neoadjuvant chemotherapy can be administered to downsize tumors before concurrent treatment to optimize radiation volumes. Our hypothesis was that the use of cisplatin in the neoadjuvant phase could limit the amount of cisplatin that patients could tolerate in the concurrent phase of treatment. Methods This is a retrospective analysis of Canadian NPC patients who received neoadjuvant chemotherapy with the intention to downsize locally advanced tumors prior to concurrent cisplatin plus radiation. Baseline demographic and treatment data were obtained from institutional databases and chart review; all data were analyzed with SPSS (SPSS Inc. Released 2005. SPSS for Windows, Version 14.0. Chicago: SPSS Inc.) Overall survival (OS), disease-specific survival (DSS), and local/regional relapse-free survival (LRRFS) were analyzed using Kaplan-Meier survival functions. Univariate and multivariate models were used to determine factors associated with the total dose of concurrent chemotherapy. Results Forty-six patients were identified as receiving neoadjuvant chemotherapy before concurrent chemoradiotherapy. In the univariate and multivariate analyses of patients who received concurrent chemotherapy, receiving over 200 mg/m concurrent cisplatin with radiation was associated with a higher neoadjuvant dose of chemotherapy received. The median follow-up time was 2.6 years (range, 0.17 years to 10.6 years). At three years, the OS was 83%, DSS was 86%, and LRRFS was 74%. Conclusions NPC patients have been treated with neoadjuvant chemotherapy at this center with favorable outcomes. Most patients could tolerate concurrent chemotherapy after radiotherapy. Receiving higher doses of concurrent chemotherapy was associated with also having higher doses of neoadjuvant cisplatin. This suggests that neoadjuvant cisplatin is not a limiting factor in the delivery of full-dose concurrent chemotherapy.
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http://dx.doi.org/10.7759/cureus.2971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166912PMC
July 2018

Prospective analysis of patient reported symptoms and quality of life in patients with incurable lung cancer treated in a rapid access clinic.

Lung Cancer 2017 10 29;112:35-40. Epub 2017 Jul 29.

Radiation Therapy Program, Vancouver Cancer Centre, BC Cancer Agency, 600 W 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada.

Introduction: The Vancouver Rapid Access (VARA) clinic was designed to provide palliative radiotherapy and holistic care to patients with incurable lung cancer. Analysis of the pilot phase demonstrated improved radiotherapy wait-times and access to supportive services compared to standard practice. This study aims to prospectively assess the impact of the clinic on patient reported symptoms and quality of life.

Materials And Methods: Patient assessments are completed at baseline and by a telephone follow up four-weeks later using Likert scales adapted from the Edmonton Symptom Assessment System (scale 0-10) and European Organization for Research and Treatment of Cancer questionnaires (scale 1-4). Patient reported outcomes at follow-up are compared to baseline using wilcoxon signed-rank test for categorical variables and paired sample t-test for continuous variables.

Results: Baseline data was collected on 125 patients, 109 received palliative radiotherapy (87%). At the 4 week follow up, 22 patients had died. Seventy-one of the remaining 103 patients completed the follow-up questionnaire, resulting in a 69% response rate among survivors. The mean patient reported overall health score, improved from 4.8 to 6.1 (p<0.01). All respiratory symptoms except chest pain (p=0.06) were associated with a statistically significant improvement after the clinic, whereas all respiratory symptoms improved post radiotherapy. Mean bone pain scores decreased from 5.5 to 2.7 (p<0.01). Assessment of symptoms secondary to brain metastases is limited by small patient numbers.

Conclusion: The VARA clinic provides timely access to palliative radiotherapy and supportive services resulting in improved patient reported outcomes. Despite a high symptom and disease burden, patients report improved overall health and palliation of respiratory symptoms and bony pain. The studies completed on the VARA clinic to date, continue to support its value in our center.
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http://dx.doi.org/10.1016/j.lungcan.2017.07.033DOI Listing
October 2017

The role of external beam radiation therapy in well-differentiated thyroid cancer.

Expert Rev Anticancer Ther 2017 10 2;17(10):905-910. Epub 2017 Aug 2.

a BC Cancer Agency , Vancouver , Canada.

Introduction: This review article explores the use of external beam radiotherapy (EBRT) in well differentiated thyroid cancer. Areas covered: The published literature on EBRT for advanced pT4 disease and macroscopic unresectable disease to improve locoregional control is reviewed. EBRT techniques, volumes and doses are discussed in detail. The potential acute and late toxicities of EBRT are discussed in the context of the published literature. The use of EBRT for patients with metastatic disease is also described. Expert commentary: There is good retrospective evidence for EBRT in the setting of unresectable gross residual well-differentiated thyroid cancer as this can result in long-term local control. However, the benefit of EBRT in patients with locally advanced disease that is completely resected is less clear. The use of EBRT for these patients requires careful consideration of age, pathologic factors, comorbidities and patient preference, preferably by a multi-disciplinary team.
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http://dx.doi.org/10.1080/14737140.2017.1361324DOI Listing
October 2017

Population-based assessment of relationship between volume of practice and outcomes in head and neck cancer patients treated in a provincially coordinated radiotherapy program.

Radiother Oncol 2017 07 16;124(1):174-181. Epub 2017 Jun 16.

University of British Columbia, Vancouver, Canada; University of Northern British Columbia, Prince George, Canada; BC Cancer Agency: Vancouver Centre, Canada; BC Cancer Agency: Centre for the North, Prince George, Canada. Electronic address:

Background And Purpose: Literature suggests that higher volumes of practice are associated with better survival outcomes for head and neck cancer (HNC) patients. The objective of this study was to evaluate the effect of treatment center on the overall survival (OS) and cancer-specific survival (CSS) in a provincially coordinated program.

Materials And Methods: A population-based provincial database was used to identify all patients in BC diagnosed for the first time with a primary non-thyroid HNC and treated with radiotherapy between 2006 and 2011.

Results: 2330 HNC patients were included. On multivariable analysis, after controlling for age, gender, cancer stage, anatomical site, treatment and physician case frequency, OS (HR range=0.91-1.05; p=0.60-0.88) did not significantly differ by center. OS was also not significantly different for patients treated by physicians with low case frequency (HR=0.96; 0.81-1.13; p=0.60) and medium case frequency (HR=1.12; 0.84-1.49; p=0.43) in reference to high case frequency. There was no effect on OS or head and neck CSS when physician case frequency was treated as a continuous variable.

Conclusions: In our provincially coordinated radiotherapy program, there was no significant difference in survival between cancer centers after controlling for differences in rurality, physician case volume and other potential confounding variables.
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http://dx.doi.org/10.1016/j.radonc.2017.06.001DOI Listing
July 2017

The Vancouver rapid access clinic for palliative lung radiation, providing more than just rapid access.

Support Care Cancer 2015 Jan 8;23(1):125-32. Epub 2014 Jul 8.

Radiation Therapy Program, BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada.

Purpose: The Vancouver Rapid Access (VARA) clinic aimed to deliver urgent palliative radiotherapy (RT) and holistic care to patients with newly diagnosed incurable lung cancer. The purpose of this paper is to describe the 9-month pilot phase of the clinic and to compare its efficacy to standard practice.

Methods: A multidisciplinary team performed the initial consult, and if appropriate, the patient received RT the same day and was connected with supportive services as required. Patient and treatment details were prospectively collected. A retrospective chart review of similar patients in standard practice 1 year prior to VARA was performed. Variables compared between VARA and standard practice included RT wait times and supportive service referrals.

Results: During the pilot phase, 58 patients were assessed. Forty percent were inpatients, and 62% had an ECOG 2 or higher. Fifty-four patients received RT; the majority (72%) received RT on the same day as their consultation, compared to 41% in standard practice (p < 0.001). The most common sites treated were the bone (42%), lung (34%), and brain (14%). More than half of VARA patients (54%) were referred to an additional health service such as home care nursing compared to 31% of standard practice patients (p = 0.01). The VARA clinic decreased the proportion of patients double-booked into an oncologists schedule from 23 to 13% (p < 0.001).

Conclusions: The VARA clinic has improved wait times for palliative RT, increased patient access to supportive services, and improved the workload for lung radiation oncologists. This clinic could serve as a model for other patients with incurable cancer.
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http://dx.doi.org/10.1007/s00520-014-2345-6DOI Listing
January 2015

The impact of peer review of volume delineation in stereotactic body radiation therapy planning for primary lung cancer: a multicenter quality assurance study.

J Thorac Oncol 2014 Apr;9(4):527-33

*Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; †Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; ‡Department of Oncology, Saint John Regional Hospital, Saint John, New Brunswick, Canada; §Department of Radiation Oncology, British Columbia Cancer Agency Fraser Valley Centre, Surrey, British Columbia, Canada; ‖Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Island Centre, Victoria, British Columbia, Canada; ¶Department of Radiation Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; and #British Columbia Cancer Agency Centre for the North, Prince George, British Columbia, Canada.

Introduction: Although the value of peer review is increasingly recognized, there is little research documenting its impact in the setting of stereotactic body radiation therapy (SBRT) for lung cancer. This study determines the dosimetric effect of peer review of tumor and normal tissue contouring in lung SBRT planning.

Methods: Forty anonymized lung SBRT plans were retrospectively evaluated post treatment. Each plan was independently reviewed by two to three radiation oncologists using established institutional guidelines. For each structure, reviewers recorded recommendations for "no change," "minor change," "major change," or "missing contour" and provided a modified or new contour as needed. Dose-volume histograms were analyzed for dosimetric violations.

Results: Among 472 contoured structures evaluated, recommendations from peer review were 107 major change (23%), 176 minor change (37%), 157 no change (33%), and 32 missing (7%). Common major changes involved the skin (n = 20), heart (n = 18), and proximal bronchial tree (n = 15). Dose constraints were not achieved for 25 new or recontoured structures (5%), of which 17 involved the planning target volume (PTV). Among cases with PTV violations, the mean prescription dose coverage to the modified PTVs was 90%, compared with the protocol standard of greater than or equal to 95% coverage. The remaining violations involved the ribs (n = 5), spinal canal (n = 2), and heart (n = 1).

Conclusions: Peer review of structure contouring resulted in significant changes in lung SBRT plans. Recontouring of several plans revealed violations of dose limits, most often involving inadequate PTV coverage. Peer review, especially of target volume delineation, is warranted to improve consistency and quality in lung SBRT planning.
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http://dx.doi.org/10.1097/JTO.0000000000000119DOI Listing
April 2014

Randomized study evaluating testosterone recovery using short-versus long-acting luteinizing hormone releasing hormone agonists.

Can Urol Assoc J 2011 Jun;5(3):173-9

Radiation Oncology Program, British Columbia Cancer Agency, Victoria, BC; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC;

Introduction: : We sought to compare the rate of return of testosterone levels and sexual function in men with prostate cancer receiving longer acting, 3-month preparation of luteinizing hormone-releasing hormone agonist (L-LHRH-A) versus shorter acting, 1-month preparation of luteinizing hormone-releasing hormone agonist (S-LHRH-A).

Methods And Materials: : Men with low to intermediate risk localized prostate cancer were randomized to either L-LHRH-A (2-3 month duration LHRH-A) or S-LHRH-A (6-1 month duration LHRH-A) of androgen suppression therapy (AST) and prostate brachytherapy using iodine-125 radioisotopes. Serum total testosterone levels and PSA were recorded every 2 months for 2 years.

Results: : A planned target sample size of 100 was not achieved due to insufficient accrual. A total of 55 patients were randomized and 46 were used for analysis. The median time to recovery of testosterone to baseline levels (calculated from end of AST) was 8 and 4 months in the L-LHRH-A and S-LHRH-A arms, respectively (p = 0.268). The median time to testosterone recovery to lower limit of reference range was 4 and 2 months respectively (p = 0.087).

Interpretation: : This randomized study, which failed to reach accrual target, showed a trend towards more rapid recovery of testosterone levels using shorter acting LHRH-A. Another randomized study would be required to validate these findings. Currently, there is insufficient evidence to recommend the use of shorter acting LHRH-A as a means of providing more rapid recovery of testosterone levels.
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http://dx.doi.org/10.5489/cuaj.10102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114026PMC
June 2011

Brain metastasis is an early manifestation of distant failure in stage III nonsmall cell lung cancer patients treated with radical chemoradiation therapy.

Am J Clin Oncol 2008 Dec;31(6):561-6

Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, Victoria, BC, Canada

Objectives: To evaluate the patterns of distant relapse, focusing on brain metastasis, in patients with stage III nonsmall cell lung cancer (NSCLC) treated with radical chemoradiation therapy (CRT).

Methods: The British Columbia Cancer Agency provincial database identified 2268 patients presenting with stage III NSCLC between January 1, 1990 and December 31, 2000. Of these, 120 patients received radical CRT, forming the study cohort. Variables analyzed included gender, age, Eastern Cooperative Oncology Group performance status, stage, histology, sites of metastasis, and survival. Univariate and multivariate analyses were performed.

Results: The study cohort comprised 59 men and 61 women, median age 54.5 years. There were 74 stage IIIA and 46 stage IIIB cases. Histologic subtypes were squamous cell carcinoma (n = 29), adenocarcinoma (n = 53), and other non-squamous histologies (n = 38). Median follow-up time was 17.7 months. Median overall survival time was 19.2 months. Thirty-two patients (27%) developed brain metastasis. Non-brain metastases occurred in 51 patients (42%). No variables were statistically significantly associated with the risk of developing brain metastasis. Trends for higher risks of brain metastasis were observed with younger age (P = 0.09), and poor performance status (P = 0.07). Brain metastasis risk was highest during the first 10 months, progressively declining thereafter.

Conclusions: Stage III NSCLC patients treated with CRT have high risks of brain metastasis which persist during the first 10 months after diagnosis. Studies evaluating cranial prophylaxis will be relevant for these patients, particularly during this early period. Novel systemic therapies continue to be needed because non-brain metastases still represent the majority of distant recurrences.
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http://dx.doi.org/10.1097/COC.0b013e318172d5f9DOI Listing
December 2008

Evaluation of dosimetric parameters and disease response after 125 iodine transperineal brachytherapy for low- and intermediate-risk prostate cancer.

Int J Radiat Oncol Biol Phys 2009 Apr 25;73(5):1432-8. Epub 2008 Nov 25.

Vancouver Cancer Centre, Vancouver, Canada.

Purpose: To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and "low-tier" intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure.

Methods And Materials: A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi 125I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans.

Results: With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% +/- 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p < 0.001), but this did not translate into improved bNED.

Conclusions: In contrast to some previous studies, dosimetric outcomes did not correlate with biochemical recurrence in the first 1,006 patients treated with 125I prostate brachytherapy at the British Columbia Cancer Agency. Despite a median D90 of only 105% of MPD, our bNED rates are indistinguishable from series that reported higher D90 values.
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http://dx.doi.org/10.1016/j.ijrobp.2008.07.042DOI Listing
April 2009

Prognostic significance of blood transfusions in patients with esophageal cancer treated with combined chemoradiotherapy.

Am J Clin Oncol 2007 Oct;30(5):492-7

Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, and the University of British Columbia, British Columbia, Canada.

Objective: Anemia occurs commonly in patients with esophageal cancer. This study evaluates the effect of blood transfusion on survival outcomes in patients with esophageal cancer treated with combined chemoradiotherapy (CRT).

Patients And Methods: Fifty-six consecutive patients with unresectable esophageal cancer received 50 Gy in 25 fractions over 5 weeks concurrent with cycles 2 and 3 of cisplatin and 5-fluorouracil chemotherapy. Data on hemoglobin before and during radiation therapy (RT) and blood transfusion use were abstracted by chart review. Each patient had a blood count before every chemotherapy cycle, and the test was repeated if the blood count was low. Five-year Kaplan-Meier overall survival (OS) and relapse-free survival (RFS) estimates were compared according to pre-RT hemoglobin levels and transfusion use. Multivariate analysis using Cox regression modeling was performed to determine the prognostic significance of pre-RT hemoglobin and transfusion use on survival outcomes.

Results: The 5-year OS and RFS rates were 30% and 37%, respectively. Seventeen patients (30%) received transfusions during CRT. Among 18 patients (32%) with a hemoglobin of < or =12 g/dL at the start of RT, 9 received transfusions. Pre-RT hemoglobin levels of < or =12 g/dL were strongly associated with the use of blood transfusions (P = 0.03). Five-year Kaplan-Meier OS was 65% versus 21% in patients treated with, versus without, a transfusion (P = 0.006). On multivariate analysis, the use of blood transfusion was associated with improved OS (hazard ratio, 0.26; 95% confidence interval, 0.09-0.75, P = 0.01).

Conclusions: The use of blood transfusion is a significant treatment-related factor associated with improved survival in patients undergoing CRT for esophageal cancer.
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http://dx.doi.org/10.1097/01.coc.0000264177.66369.18DOI Listing
October 2007
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