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홍병혜. "Study on the Gu Xiong’ Wanyue-Ci." Journal of Sinology and China Studies 73, no. ll (December 2017): 127–55. http://dx.doi.org/10.18077/chss.2017.73..006.
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Choi, Seung-Kwon, Myong Kim, Sang Mi Lee, Cheryn Song, Jun Hyuk Hong, Choung-Soo Kim, and Hanjong Ahn. "High-Grade Late Urinary Toxicity Following Salvage Radiotherapy After Radical Prostatectomy: A Retrospective Cohort Study." Journal of Urologic Oncology 22, no. 1 (March 31, 2024): 21–28. http://dx.doi.org/10.22465/juo.244600080004.
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Purpose: To find out the incidence and predictors for late high-grade genitourinary (GU) toxicity following salvage radiotherapy (SRT), we investigated the consecutive patients who were treated with SRT after radical prostatectomy.Materials and Methods: Patients who underwent SRT for biochemical recurrence after radical prostatectomy were reviewed. The incidence of GU toxicity was assessed and risk factors for grade ≥2 and ≥3 GU toxicity were evaluated. The STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guided the reporting of this study.Results: Among the total of 217 patients, 88 patients (40.5%) showed late grade ≥2 GU toxicity. The incidence of late grade ≥3 GU toxicity was 11.5%. The presence of grade ≥2 baseline GU dysfunction (hazard ratio [HR], 6.097; 95% confidence interval [CI], 3.280–11.333; p<0.001) and short interval (<1 year) from surgery to SRT (HR, 1.994; 95% CI, 1.182–3.365; p=0.01) were associated with late grade ≥2 GU toxicity. A short interval from surgery to SRT was an independent predictor of late grade ≥3 GU toxicity (HR, 2.975; 95% CI, 1.135–7.794; p=0.027).Conclusions: The incidence of late high-grade GU toxicity was not uncommon after SRT. Thus, care should be taken when we consider SRT in patients with baseline urinary dysfunction and a short interval from surgery to SRT, to determine an optimal treatment strategy with balancing quality of life and oncologic outcome of patients.
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Tran, Kathy M., Hagop M. Kantarjian, Syed M. Kazmi, Alfonso Quintás-Cardama, Jorge E. Cortes, Zeev Estrov, Maro Ohanian, et al. "Cytogenetic and Molecular Characterization of Genitourinary Extramedullary Disease in Acute Myeloid Leukemia." Blood 120, no. 21 (November 16, 2012): 4326. http://dx.doi.org/10.1182/blood.v120.21.4326.4326.
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Abstract Abstract 4326 Background: Extramedullary (EM) disease is a well-known manifestation of acute myeloid leukemia (AML). Despite its recognized incidence, little is known about organ-specific EM-AML, including genitourinary (GU) AML. The purpose of this study is to identify the patients (pts) who develop GU-AML and to characterize the clinicopathologic, cytogenetic, and molecular features of this population. Methods: A database of 2,181 consecutive patients who were diagnosed with AML and underwent induction therapy from 2000 to 2011 at M.D. Anderson Cancer Center was reviewed retrospectively. All pts with histologically proven EM-AML were included in this series. Clinicopathologic, cytogenetic, and molecular data were examined and statistically analyzed. Results: A total of 1,120 pts underwent at least one EM biopsy and 244 were diagnosed with EM-AML. Of these, 9 pts (6 females) demonstrated GU-AML (0.4% of total population, 3.7% of EM-AML pts). Furthermore, 3 GU-AML pts demonstrated additional EM-AML in non-GU sites. At AML dx, GU-AML pts demonstrated median bone marrow blasts of 35% (range 1–69%) and median peripheral blood blasts of 1% (range 0–46%). CBC included median WBC of 3.5 K/uL (range 1.6–21.0 K/uL), median Hgb level of 9.4 g/dL (range 8.0–14.3 g/dL), and median platelet count of 118 K/uL (range 28–206 K/uL). Median age of AML dx in GU-AML pts was 45 years (range 28–69 years) and was significantly younger than the median age of AML dx in all other non-GU pts (60 years, range 12–89 years, p=0.025, Student's t-test). A total of 78% of GU-AML dx were made before or at AML presentation and 89% of GU-AML dx were made within 3 months of AML presentation. A total of 67% of GU-AML pts demonstrated cytogenetic abnormalities. Cytogenetic features included inversion 16 (inv (16), 33%), trisomy 8 (33%), diploid (33%), trisomy 22 (22%) and complex (22%). For all pts with GU-AML, no molecular mutations were present in RAS (0/9), FLT3 (0/7), NPM1 (0/2) or JAK2 (0/2). CR was achieved by 78% of pts with GU-AML. The pts who did not achieve CR expired early in induction therapy (within 29 days) due to sepsis. Of the GU-AML pts with CR, CR duration was 50.7 months (95% CI 15.2–86.2 months). CR duration of GU-AML pts was significantly longer than that of EM-AML pts with no GU sites (18.0 months, 95% CI 14.1–22.0 months, p=0.03, Kaplan-Meier method). Overall survival (OS) for all GU-AML pts was 41.6 months (95% CI 12.7–70.5 months) and was statistically equal to OS of pts without GU-AML and to OS of EM-AML pts with no GU sites. Conclusion: GU-AML is a rare but noteworthy manifestation of AML that tends to be diagnosed before or at AML presentation. Pts with GU-AML developed AML at a significantly younger age by 15 years than pts without GU-AML (p=0.025). Most GU-AML pts demonstrated cytogenetic abnormalities but none demonstrated molecular mutations. The presence of GU-AML, rather than EM-AML in other sites, may contribute to extended duration of CR (p=0.03). However, despite this finding and other advantages such as majority achievement of CR and young age of AML dx, there was no statistical advantage in OS in pts with GU-AML compared to those pts without GU-AML or to pts with EM-AML in non-GU sites. Disclosures: No relevant conflicts of interest to declare.
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Benjamin, David Joseph, Arash Rezazadeh, Irfan Shafi, and Omid Yazdanpanah. "In-hospital outcomes of acute pulmonary embolism admissions in individuals with genitourinary cancers: Insights from a national population study in the United States." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): e16581-e16581. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e16581.
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e16581 Background: Management of acute pulmonary embolism (PE) in patients with genitourinary (GU) malignancies is usually challenging. It is usually associated with adverse outcomes and can significantly contribute to morbidity and mortality and detrimentally impacts quality of life among cancer patients. There has been scarce previous national population study on patients with PE and GU malignancies. Here, we studied the rate of readmissions and mortality for patients admitted for PE with GU cancers in the U.S. and its burden on health care system. Methods: Utilizing the Nationwide Readmissions Database (NRD), we conducted a retrospective cohort study on patients admitted with PE and segregated the individuals with GU cancers (GUC) including renal cell carcinoma (RCC), urothelial Carcinoma (UC), prostate cancer (PCa), testicular cancer (TC), and penile cancer (Pen Ca) between 2016 and 2019 across the United States. We used multivariable logistic regression to determine the predictors of unplanned readmissions within 30 days and mortality. Results: A total of 402,054 patients hospitalized with PE and 44,373 (11%) were readmitted within the next 30 days. Mean length of stay was 4.64 days (95% CI 4.62-4.65). Total charge for index hospitalization was $51,409 (95% CI 51,174-51,643). A total of 8,998 patients were found to have GU cancers. Following baseline comorbidities were associated with highest risk of readmission: Atrial fibrillation, proximal and caval deep vein thrombosis, obesity, hypertension, smoking, and diabetes mellites ( P <0.001). Among GUC, rate of readmission was highest for UC (P<0.01; OR 2.49, 95% CI 1.76 - 3.5) as shown in the table. Risk of in hospital mortality was also highest for UC (P<0.01; OR 2.40, 95% CI 1.39-4.14) followed by RCC (P<0.01; OR 2.06, 95% CI 1.62-2.5). Conclusions: There was higher risk of readmission and mortality for patients with GU malignancies who were hospitalized for PE. UC was the leading GU cancer for rate of readmission and mortality. These readmissions were lengthy and costly for the health care system. This study suggests that more aggressive intervention might be needed in this population to prevent readmission and mortality. [Table: see text]
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Ratnakumaran, Ragu, Victoria Hinder, Douglas Brand, John Staffurth, Emma Hall, Nicholas van As, and Alison Tree. "The Association between Acute and Late Genitourinary and Gastrointestinal Toxicities: An Analysis of the PACE B Study." Cancers 15, no. 4 (February 17, 2023): 1288. http://dx.doi.org/10.3390/cancers15041288.
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Several studies have demonstrated the association between acute and late radiotherapy toxicity in prostate cancer using older radiotherapy techniques. However, whether this association is present with newer techniques such as stereotactic body radiotherapy (SBRT), remains unclear. We use univariable and multivariable logistic regression to analyse the association between grade 2 or worse acute gastrointestinal (GI) and genitourinary (GU) toxicities with equivalent late toxicities in patients treated with SBRT and conventional or moderately fractionated radiotherapy (CRT) within the PACE-B study. 842 patients were included in this analysis. Common Terminology Criteria for Adverse Events (CTCAE) was the primary clinician reported outcome measure used in this analysis. In univariable analysis, experiencing a grade 2+ acute GU toxicity was significantly associated with developing a grade 2+ late GU toxicity after SBRT (OR 4.63, 95% CI (2.96–7.25), p < 0.0001) and CRT (OR 2.83, 95% CI (1.69–4.71), p < 0.0001). This association remained significant in multivariable analysis. In univariable analysis, experiencing a grade 2+ acute GI toxicity was also associated with developing a grade 2+ late GI toxicity after SBRT (OR 3.67, 95% CI (1.91–7.03), p < 0.0001) and CRT (OR 4.4, 95% CI (2.04–9.47), p < 0.0001). This association also remained significant in multivariable analysis. Grade 2+ baseline GU symptoms were also associated with grade 2+ late urinary toxicity in both univariable and multivariable analysis. Overall, acute toxicity is an important predictor variable for late GU/GI toxicity after localised prostate radiotherapy using SBRT and CRT. Future work should test whether optimising symptoms pre-treatment and early intervention in those with significant acute toxicities could mitigate the development late of toxicity.
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Hunter, G. K., C. A. Reddy, K. Angermeier, J. Ulchaker, K. L. Stephans, R. D. Tendulkar, C. Zippe, P. Kupelian, E. A. Klein, and J. P. Ciezki. "Long-term (potential 10-year follow-up) toxicity after treatment for prostate cancer with either external beam radiation therapy, interstitial brachytherapy, or radical prostatectomy." Journal of Clinical Oncology 29, no. 7_suppl (March 1, 2011): 65. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.65.
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65 Background: To examine gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated in 1999 with external beam radiotherapy (RT), prostate interstitial brachytherapy (PI) or radical prostatectomy (RP). Methods: The records of 483 patients treated in 1999 were retrospectively reviewed to evaluate toxicity profiles, with 24% of the patients treated with PI, 40% with RP, and 36% with RT. Late GI and GU morbidity profiles were specifically examined and both were graded according to the RTOG acute and late morbidity scoring criteria. Other factors examined were patient age, BMI, smoking history, and medical comorbidities including presence of diabetes mellitus (DM), peripheral vascular disease, and connective tissue disease. Due to the low event rate for late GU and GI toxicities, a competing risk regression (CRR) analysis was done with death as the competing event. Results: See Table. Median follow-up time was 8.6 years (range 0.2-11.5). On CRR univariate analysis the presence of DM was associated with GU toxicity grade ≥2 (p=0.043, HR 2.35, 95% CI=1.03-5.39). DM remained significant on multivariate analysis (p=0.034, HR 2.44, 95% CI= 1.07-5.59). Since there were no events in the RP group, only the PI and RT patients were included in the CRR analysis for late GI toxicity Grade <=2. On univariate analysis, RT and DM were significantly associated with late GI toxicity. On multivariable analysis, both variables remained significant (RT: p=0.038, HR=4.71, 95%CI=1.09-20.3; DM: p=0.008, HR=3.81, 95%CI=1.42-10.2). Conclusions: Late effects occur with all three treatment modalities. The presence of DM at the time of treatment was significantly associated with worse late GI and GU toxicity. RT was significantly associated with worse late GI toxicity compared to PI and RP. [Table: see text] No significant financial relationships to disclose.
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Abdel-Wahab, Noha, Jean H. Tayar, Faisal Fa'ak, Gaurav Sharma, Maria A. Lopez-Olivo, Abdelrahman Yousif, Tasneam Shagroni, Sami Al-Hawamdeh, Cristhiam M. Rojas-Hernandez, and Maria E. Suarez-Almazor. "Systematic review of observational studies reporting antiphospholipid antibodies in patients with solid tumors." Blood Advances 4, no. 8 (April 27, 2020): 1746–55. http://dx.doi.org/10.1182/bloodadvances.2020001557.
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Abstract This review summarizes the evidence on antiphospholipid (aPL) antibodies and related thromboembolic events in patients with solid tumors. Data sources included Medline, EMBASE, Web of Science, PubMed ePubs, and the Cochrane Central Register of Controlled Trials through August 2019 without restrictions. Observational studies that evaluated patients with solid tumors for the presence of aPL antibodies were included. Data were extracted and quality was assessed by one reviewer and cross-checked by another. Thirty-three studies were identified. Gastrointestinal (GI) and genitourinary (GU) cancers were the most frequently reported. Compared with healthy patients, patients with GI cancer were more likely to develop anticardiolipin antibodies (risk ratio [RR], 5.1; 95% confidence interval [CI], 2.6-9.95), as were those with GU (RR, 7.3; 95% CI, 3.3-16.2) and lung cancer (RR, 5.2; 95% CI, 1.3-20.6). The increased risk for anti-β2-glycoprotein I or lupus anticoagulant was not statistically significant. Patients with lung cancer who had positive aPL antibodies had higher risk of developing thromboembolic events than those who had negative antibodies (RR, 3.8%; 95% CI, 1.2-12.2), while the increased risk in patients with GU cancer was not statistically significant. Deaths due to thromboembolic events were more common among patients with lung cancer who had elevated aPL antibodies. A limitation of this review is that the results are contingent on the reported information. We found an increased risk of developing aPL antibodies in patients with GI, GU, and lung cancers resulting in thromboembolic events and death. Further studies are needed to better understand the pathogenesis and development of aPL antibodies in cancer.
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Mann, Joshua R., and Suzanne McDermott. "Are Maternal Genitourinary Infection and Pre-Eclampsia Associated With ADHD in School-Aged Children?" Journal of Attention Disorders 15, no. 8 (September 13, 2010): 667–73. http://dx.doi.org/10.1177/1087054710370566.
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Objective: To investigate the hypothesis that maternal genitourinary infection (GU) infection is associated with increased risk of ADHD. Method: The authors obtained linked Medicaid billing data for pregnant women and their children in South Carolina, with births from 1996 through 2002 and follow-up data through 2008. Maternal GU infections and pre-eclampsia were identified on the basis of diagnoses made during pregnancy, and cases of ADHD were identified on the basis of diagnoses made in the child’s Medicaid file. Results: There were 84,721 children in the data set used for analyses. Maternal genitourinary infection was associated with significantly increased odds of ADHD (OR = 1.29, 95% CI = 1.23-1.35). Pre-eclampsia was also associated with increased risk (OR = 1.19, 95% CI = 1.07-1.32). Children whose mothers had both GU infection and pre-eclampsia were 53% more likely to have ADHD, compared to those with neither exposure. When we examined specific infection diagnoses, chlamydia/nongonococcal urethritis, trichomoniasis, urinary tract infection, and candidiasis were associated with increased risk of ADHD, whereas gonorrhea was not. Discussion: Maternal GU infection appeared to be associated with increased risk of ADHD, and based on the findings it was concluded that further research is needed to describe the mechanism(s) underlying the association.
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Baty, Manon, Joel Castelli, Khemara Gnep, Nolwenn Delaby, Romain Mathieu, and Renaud de Crevoisier. "Stereotactic reirradiation for local prostate cancer recurrence: Mono-institutional experience of 108 patients." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 365. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.365.
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365 Background: The aim of this study was to report the efficacy and toxicity of salvage stereotactic body radiation therapy (SBRT) for local prostate cancer recurrence after radiotherapy. Methods: We retrospectively reviewed a total of 108 medical records of patients treated with salvage SBRT for prostate cancer recurrence, between July 2015 and February 2021 in our institution. Patients who had initial radical prostatectomy were excluded. The median time interval between the two radiation treatments was 9 years (range, 3-20 years). All the patients had biochemical recurrence, with a PSA of 3.5 ng/mL (range, 1.8-43 ng/mL). Local recurrence was to be proven by biopsies, without distant lymph node or metastasis. The local recurrence was visible in 82% and 99% of patients on mpMRI and choline/PSMA PET/CT, respectively. The salvage treatment consisted in SBRT at a total dose of 36 Gy in six fractions delivered every other day, associated with androgen deprivation therapy in 44% of patients. We reported efficacy and toxicity (according to CTCAE v 4.03 classification) after salvage SBRT. Results: Median follow-up was 19.6 months (range, 2.3-67 months). Two year biochemical recurrence-free survival and lymph node/metastases free survival rates were 76% (95% CI: 66-87%) and 88% (95% CI: 80-96%), respectively. Regarding acute toxicity, rates of grade 2 and 3 GU toxicities were 27% and 2%, respectively. Rate of grade 2 GI toxicity was 2%, without grade ≥3. Regarding late toxicity, 2 year rates of grade 2 and 3 GU toxicities were 50% (95% CI: 44-56%) and 8% (95% CI: 2-14%), respectively. One patient experimented a grade 4 GU toxicity (bladder necrosis requiring a cystectomy) 8 months after SBRT. Two year rate of grade 2 GI toxicity was 2 (95% CI: 0-5%), without grade ≥3. Conclusions: The main toxicity of prostate salvage SBRT is GU. With a short follow-up, a subset of patients may be controlled by the salvage treatment.
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Yu, James B., Laura D. Cramer, Jeph Herrin, Pamela R. Soulos, Arnold L. Potosky, and Cary P. Gross. "Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer: Comparison of Toxicity." Journal of Clinical Oncology 32, no. 12 (April 20, 2014): 1195–201. http://dx.doi.org/10.1200/jco.2013.53.8652.
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Purpose Stereotactic body radiation therapy (SBRT) is a technically demanding prostate cancer treatment that may be less expensive than intensity-modulated radiation therapy (IMRT). Because SBRT may deliver a greater biologic dose of radiation than IMRT, toxicity could be increased. Studies comparing treatment cost to the Medicare program and toxicity are needed. Methods We performed a retrospective study by using a national sample of Medicare beneficiaries age ≥ 66 years who received SBRT or IMRT as primary treatment for prostate cancer from 2008 to 2011. Each SBRT patient was matched to two IMRT patients with similar follow-up (6, 12, or 24 months). We calculated the cost of radiation therapy treatment to the Medicare program and toxicity as measured by Medicare claims; we used a random effects model to compare genitourinary (GU), GI, and other toxicity between matched patients. Results The study sample consisted of 1,335 SBRT patients matched to 2,670 IMRT patients. The mean treatment cost was $13,645 for SBRT versus $21,023 for IMRT. In the 6 months after treatment initiation, 15.6% of SBRT versus 12.6% of IMRT patients experienced GU toxicity (odds ratio [OR], 1.29; 95% CI, 1.05 to 1.53; P = .009). At 24 months after treatment initiation, 43.9% of SBRT versus 36.3% of IMRT patients had GU toxicity (OR, 1.38; 95% CI, 1.12 to 1.63; P = .001). The increase in GU toxicity was due to claims indicative of urethritis, urinary incontinence, and/or obstruction. Conclusion Although SBRT was associated with lower treatment costs, there appears to be a greater rate of GU toxicity for patients undergoing SBRT compared with IMRT, and prospective correlation with randomized trials is needed.
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AlQurini, Naser M. KH M. S., Narhari Timilshina, Rana Jin, Allison Loucks, Arielle Berger, Lindy Romanovsky, Martine Puts, and Shabbir M. H. Alibhai. "Does screening for frailty with the vulnerable elders survey (VES-13) identify older adults with GU malignancy who benefit most from a consultation in a geriatric oncology clinic?" Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 209. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.209.
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209 Background: The VES-13 is a well-studied brief frailty screening tool for ≥ 65 older adults (OAs) in the oncology setting. Vulnerable patients (scoring ≥ 3) are at higher risk for adverse outcomes and will benefit from a Comprehensive Geriatric assessment (CGA) and cancer treatment decision optimization. Whether the VES-13 is effective specifically in patients with Genitourinary (GU) malignancies remains to be established. Primary objective: to determine if the VES-13 can predict which OAs with GU cancer (Bladder, Prostate, Kidney) had subsequent treatment modification after CGA. Secondary objective: to investigate if there is any association between VES-13 score with comorbidity and chemotherapy toxicity prediction tool (CARG). Methods: The VES-13 was administered to consecutive patients referred to the geriatric oncology (GO) clinic from GU site at the Princess Margaret Cancer Centre, Canada. All patients underwent CGA. CGA assess 8 domains including cognition, comorbidities, function, falls risk. Among patients referred for pre-treatment assessment, we examined whether the VES-13 predicted changes in the final treatment plan after CGA. Descriptive statistics were used to describe the VES-13 scores and final treatment impact. Results: From July 2015-October 2019, 77 were included in this analysis. The VES-13 ≥ 3 group were 52/77 (67.5%), and significantly associated with higher comorbidities (P = 0.003) and worse CARG scores (P = 0.005). The final treatment plan was modified in 36/77 (47%). In univariate analysis, the odds ratio (OR) for VES-13 ≥3 was 1.92 (95% CI 0.72-5.12) for change in final treatment, which was not statistically significant likely due to modest sample size. Interestingly in the same univariate analysis, there was a strong association between final treatment plan with falls risk (OR 2.63, 95% CI 1.03-6.72), physical performance (OR 2.51, 95% CI 0.98-6.45) and cognition (OR 3.95, 95% CI 1.19-13.19). Conclusions: The VES-13 identified vulnerable GU patients who will benefit from CGA and may predict treatment optimization by identifying patients at higher risk of chemotherapy toxicity and higher comorbidity.
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Parry, Matthew G., Arunan Sujenthiran, Thomas E. Cowling, Julie Nossiter, Paul Cathcart, Noel W. Clarke, Heather Payne, Jan van der Meulen, and Ajay Aggarwal. "Treatment-Related Toxicity Using Prostate-Only Versus Prostate and Pelvic Lymph Node Intensity-Modulated Radiation Therapy: A National Population-Based Study." Journal of Clinical Oncology 37, no. 21 (July 20, 2019): 1828–35. http://dx.doi.org/10.1200/jco.18.02237.
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PURPOSE There is a debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation for the treatment of men with high-risk prostate cancer. This study compared the toxicity of intensity-modulated radiation therapy (IMRT) to the prostate and the pelvic lymph nodes (PPLN-IMRT) with prostate-only IMRT (PO-IMRT). MATERIALS AND METHODS Patients with high-risk localized or locally advanced prostate cancer treated with IMRT in the English National Health Service between 2010 and 2013 were identified by using data from the Cancer Registry, the National Radiotherapy Dataset, and Hospital Episode Statistics, an administrative database of all hospital admissions. Follow-up was available up to December 31, 2015. Validated indicators were used to identify patients with severe toxicity according to the presence of both a procedure code and diagnostic code in patient Hospital Episode Statistics records. A competing risks regression analysis, with adjustment for patient and tumor characteristics, estimated subdistribution hazard ratios (sHRs) by comparing GI and genitourinary (GU) complications for PPLN-IMRT versus PO-IMRT. RESULTS Three-year cumulative incidence in the PPLN-IMRT (n = 780) and PO-IMRT (n = 3,065) groups was 14% for both groups for GI toxicity, and 9% and 8% for GU toxicity, respectively. Patients receiving PPLN-IMRT and PO-IMRT had similar levels of severe GI (adjusted sHR, 1.00; 95% CI, 0.80 to 1.24; P = .97) and GU (adjusted sHR, 1.10; 95% CI, 0.83 to 1.46; P = .50) toxicity rates. CONCLUSION Including PLNs in radiation fields for high-risk or locally advanced prostate cancer is not associated with increased GI or GU toxicity at 3 years. Additional follow-up is required to answer questions about its impact on late GU toxicity. Results from ongoing trials will provide insight into the anticancer effectiveness of PLN irradiation.
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Rorije, Nienke MG, Margaret M. Shea, Gowri Satyanarayana, Sarah P. Hammond, Vincent T. Ho, Lindsey R. Baden, Joseph H. Antin, Robert J. Soiffer, and Francisco M. Marty. "BK Virus Disease Following Allogeneic Stem Cell Transplantation: A Cohort Analysis." Blood 120, no. 21 (November 16, 2012): 1927. http://dx.doi.org/10.1182/blood.v120.21.1927.1927.
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Abstract Abstract 1927 BK virus (BKV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) affects the genitourinary (GU) tract with manifestations ranging from asymptomatic viruria to severe hemorrhagic cystitis. Knowledge about epidemiology, morbidity and clinical spectrum of BKV disease is limited. We studied a recent HSCT cohort at our institution to assess and quantify the incidence and severity of BKV disease. Between January 1, 2010 and December 31, 2011, 491 patients underwent first HSCT. BKV disease was defined as detection of BKV by PCR testing in association with GU symptoms. BKV disease was considered severe when patients had at least 1 of the following: hematuria with clot formation, GU tract inflammation on imaging, need for invasive GU interventions, or hospitalization for BKV disease management. Medical records were reviewed for patient and HSCT characteristics. For patients with BKV disease, reason for testing, clinical presentation and course, imaging results, and treatments were captured. Time at risk was censored at time of death, second HSCT or on July 1, 2012. Fisher's exact or Wilcoxon test were used to compare variables. Cox modeling was used to analyze potential risk factors for BKV disease. 168 (34.2%) patients were tested for BKV at our institution during the study period. Median time to testing was 61 days (range, 2–663; IQR 19.5 – 114). 88 patients (17.9%) were diagnosed with BKV disease with an incidence rate of 0.54/1000 patient-days (95% CI, 0.43 – 0.66). Most common symptoms at presentation and during a first BKV disease episode are shown in the Table. Table. Common symptoms of BKV disease (n=88). Symptom At presentation During first episode Dysuria 45 (51.1%) 59 (67.0%) Hematuria 31 (35.2%) 42 (47.7%) Urinary frequency 16 (18.2%) 40 (45.5%) Urgency 10 (11.4%) 21 (23.9%) Bladder spasms 3 (3.4%) 15 (17.0%) Flank pain 3 (3.4%) 11 (12.5%) 31 patients had severe BK disease (35.2%, 6.3% of the cohort): 17 patients (19.3%) had hematuria with clot formation; 16 patients (18.2%) demonstrated GU tract inflammation on imaging studies, including bladder wall (14, 15.9%) or ureteral (5, 5.7%) thickening. 4 patients were hospitalized for management of BKV associated symptoms. Invasive GU interventions were performed in 16 (18.2%) patients including Foley catheter placement in 12, bladder irrigation in 7, intravesicular cidofovir in 3, cystoscopy in 2, and alum instillation in 1. Additional prescribed treatments during BKV disease episodes included quinolones (39, 44.3%), antispasmodics (29, 33.0%), IVIG (20, 22.7%) and pain medications (18, 20.5%). Cidofovir was used in 7 (8.0%) patients and leflunomide in 8 (9.1%). 3 patients had concomitant bacterial GU infections; 1 patient had GU adenovirus disease. Patients (n=71) were symptomatic for a median of 31 days (range 2–385, IQR 9–67). Additional BKV disease episodes were seen in 26/88 patients (29.5%). Median initial urine BKV load was 3.4×108 copies/mL (range; 600, >1×1010). Median peak urine BKV load during first BKV disease episode was 1.5×109 c/mL (range; 600, >1×1010). Blood BKV loads were obtained in 35 patients, with median initial BKV load of 800 c/mL (range, 0, 1.52×106) and median peak BKV load of 2000 c/mL (range, 0, 1.52×106). Detection of BKV viremia was 74% sensitive and 38% specific for severe BKV disease. Cohort characteristics associated with increased BKV disease risk included myeloablative conditioning (p=0.01), cyclophosphamide conditioning (p=0.0008), cord blood HSCT (p=0.03), GVHD prophylaxis with mycophenolate (MMF, p=0.0006) and acute GVHD (aGVHD) grades II-IV (p< 0.0001). On multivariate Cox modeling, time-dependent aGVHD (adjusted HR [aHR] 3.65, 95%CI 2.23 – 5.97), MMF use (aHR 3.11, 95%CI 1.76 – 5.48), and cyclophosphamide use (aHR 1.95, 95%CI 1.25 – 3.04) remained significant. Time-dependent aGVHD (aHR 5.02, 95%CI 2.20 – 11.5), cord blood HSCT (aHR 4.60, 95%CI 1.67 – 12.7) and cyclophosphamide use (aHR 2.17, 95%CI 1.04 – 4.56) were independent risk factors for severe BKV disease. BKV disease is a common complication of HSCT, associated with significant and prolonged morbidity, especially in the setting of aGVHD, cyclophosphamide and MMF use, and after cord blood HSCT. Prospective studies are needed to better define the morbidity of BKV disease and to properly inform the impact of future prophylaxis and treatment trials. Disclosures: Off Label Use: ciprofloxacin, levofloxacin, moxifloxacin, cidofovir, leflunomide use for treatment of BK virus infection. Marty:Chimerix: Consultancy, Research Funding.
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Nebhan, Caroline, Alessio Cortellini, Weijie Ma, Teja Ganta, Haocan Song, Fei Ye, Rebecca Irlmeier, et al. "239 Efficacy and toxicity of single agent immune checkpoint inhibitors among adults with cancer aged ≥80 years: a multicenter international cohort study." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A257. http://dx.doi.org/10.1136/jitc-2021-sitc2021.239.
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BackgroundImmune checkpoint inhibitors (ICIs) are approved by the U.S. Food&Drug Administration in over 17 tumor types. Older adult patients make up about a quarter of all cancer patients but are historically understudied in cancer clinical trials. ICIs are associated with immune-related adverse events (irAEs), which may be particularly morbid for older adult patients with underlying comorbidities and impaired functional status. In this study, we provide insight into the real-world safety and efficacy of ICIs among older adult patients (≥80 years) with cancer.MethodsThis is a multicenter, international retrospective study of tumor-agnostic older adult patients with cancer treated with single-agent ICIs between 2010–2019 from 18 academic centers in the U.S. and Europe. A cohort of 928 patients aged ≥80 years during treatment with ICI was assembled and analyzed to evaluate clinical outcomes and irAE patterns in older adult patients treated with single-agent ICIs.ResultsMedian age at ICI initiation was 83.0 years (range 75.8–97.0). Most patients (86.9%) were treated with anti-PD-1 therapy. Among the full cohort, the three most common tumors were non-small cell lung cancer (NSCLC, 37.2%,n=345), melanoma (35.5%,n=329), and genitourinary (GU) tumors (16.5%,n=153). Objective response rates for patients with NSCLC, melanoma, and GU tumors were 32.2%, 39.3%, and 26.2%, respectively. Median progression-free survival (PFS) was 6.7 months (95%CI, 5.2–8.6) for patients with NSCLC, 11.1 months (95%CI, 8.9–16.0) for patients with melanoma, and 6.0 months (95% CI, 5.0–10.7) for patients with GU malignancy. Median overall survival (OS) was 10.9 months (95%CI, 8.6–13.1) for patients with NSCLC, 30.0 months (95%CI, 23.6–46.4) for patients with melanoma, and 15.0 months (95%CI 9.1–25.4) for GU patients (Figure 1A-C). Within histology-specific cohorts (NSCLC, melanoma and GU), clinical outcomes were similar across age subgroups (<85,85–89,>90). Among all patients (N=928), 41.3% experienced ≥1 irAE(s), including 12.2% reported to be grade (G)3–4. No irAE-related deaths occurred. The median time to irAE onset was 9.8 weeks; 57% occurred within the first 3 months after ICI initiation. ICI was discontinued due to irAEs in 16.1% patients. There was no significant difference in the rate of irAEs among patients age <85, 85–89, and ≥90 years (p=0.15). Despite similar rates of G3+ irAEs, ICIs were discontinued due to irAE more than twice as often among patients ≥90 years compared to patients <90 years (30.9% vs. 15.1%, p=0.008) (table 1).ConclusionsICIs are effective and generally well-tolerated among older patients with cancer. However, ICI discontinuation due to irAE is more frequent with increasing age.
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Tariq, S., S. G. Edwards, A. Nalabanda, H. Ward, E. Allen, K. Fenton, D. Mercey, and G. Sethi. "Sexual health services for South Asians in London, UK: a case–control study." International Journal of STD & AIDS 18, no. 8 (August 1, 2007): 563–64. http://dx.doi.org/10.1258/095646207781439676.
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National guidance on sexual health in England recommends service development to meet the specific needs of ethnic minority populations. Our aim was to evaluate mode of referral, number of sexually transmitted infections (STIs) diagnosed, and the offering and uptake of HIV testing in patients of South Asian ethnicity. A retrospective case–control study was undertaken in two London genito-urinary (GU) medicine clinics. There were 250 case–control pairs with approximately equal numbers of men and women. South Asians were less likely to have an STI (Odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45, 0.97) or to report risk factors for HIV (OR 0.45, 95% CI 0.28, 0.71). Offering and uptake of HIV antibody testing were high in both South Asian and non-South Asian groups (OR 0.62, 95% CI 0.27, 1.51). South Asians were significantly more likely than controls to have been referred by other medical services rather than self-referred (OR 2.00, 95% CI 1.32, 3.01), which is in keeping with poorer access to GU medicine services in London.
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Kenny, Dorothy, and Jue Wang. "Clinical characteristics and outcomes of SARS-CoV-2 infection in patients with genitourinary cancer." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 7. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.7.
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7 Background: Cancer patients have increased risk for severe outcomes related to SARS-CoV-2 infection (COVID-19), due to their increased vulnerability to infection, older age, and comorbidities in comparison to the general population. While multiple studies have been completed examining outcomes of COVID-19 infection in cancer patients overall, there has been limited investigation into the outcomes of COVID-19 infection in patients with genitourinary (GU) cancers. Methods: We completed a single institution retrospective study to examine the outcomes of adults with GU cancers and COVID-19 infection from March 10, 2020 to June 15, 2022. Baseline data included age, sex, BMI, type of malignancy, cancer status (stable or progressive disease, in remission), current and previous anticancer therapy received, and comorbidities. Results: Eighty-four patients with a GU cancer diagnosis and laboratory-confirmed SARS-CoV-2 infection were identified. Seventy-nine (94%) were male and the median age was 64 years (range 24-91). Forty-four (52%) were non-Hispanic white, 28 (33%) were Hispanic, and 11 (13%) were African-American. Prostate cancer was the most common (n = 45), followed by renal cell carcinoma (n = 20), testicular (n = 9), bladder (n = 6), and penile cancer (n = 3). Eight patients had ≥2 episodes of COVID-19 infection. Sixty-three percent of patients were unvaccinated at the time of infection, while 37% of patients had breakthrough infection. Hospitalization was required for 39.3% (n = 33), with 4.8% (n = 4) requiring ICU admission. Of the patients requiring hospitalization, 26.2% (n = 22) died. Hospitalization was associated with having ≥2 comorbidities (OR 18.6 [95% CI, 3.1-111.8], p<0.01) and receiving active cancer treatment (OR 12.4 [95% CI, 1.92-79.7], p< 0.01). Mortality was associated with advanced age (OR 21.7 [95% CI, 1.40-341.7], p=0.03) and ≥2 comorbidities (OR 19.2 [95% CI, 3.02-122.5], p=0.02). Vaccination was negatively associated with both hospitalization (OR 0.04 [95% CI, 0.02-0.91], p=0.04) and mortality (OR 0.14 [95% CI, 0.02-0.84], p=0.03). Conclusions: Among patients with GU cancer, advanced age and comorbidities are associated with adverse outcomes of COVID-19 infection; vaccination is protective. With the emergence of variants and waning immunity of vaccines, our findings highlight the importance of development and implementation of enhanced mitigation strategies in cancer patients, especially those undergoing active cancer treatment.
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Paragomi, Pedram, Bashir Dabo, Claudio Pelucchi, Rossella Bonzi, Abdulaziz T. Bako, Nabila Muhammad Sanusi, Quan H. Nguyen, et al. "The Association between Peptic Ulcer Disease and Gastric Cancer: Results from the Stomach Cancer Pooling (StoP) Project Consortium." Cancers 14, no. 19 (October 7, 2022): 4905. http://dx.doi.org/10.3390/cancers14194905.
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Background. Gastric cancer (GC) is the fifth most common type of cancer and the fourth most common cause of cancer-related mortality. Although the risk of GC and peptic ulcer disease (PUD) is known to be increased by H. pylori infection, evidence regarding the direct relationship between PUD and GC across ethnicities is inconclusive. Therefore, we investigated the association between PUD and GC in the Stomach cancer Pooling (StoP) consortium. Methods. History of peptic ulcer disease was collected using a structured questionnaire in 11 studies in the StoP consortium, including 4106 GC cases and 6922 controls. The two-stage individual-participant data meta-analysis approach was adopted to generate a priori. Unconditional logistic regression and Firth’s penalized maximum likelihood estimator were used to calculate study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between gastric ulcer (GU)/duodenal ulcer (DU) and risk of GC. Results. History of GU and DU was thoroughly reported and used in association analysis, respectively, by 487 cases (12.5%) and 276 controls (4.1%), and 253 cases (7.8%) and 318 controls (6.0%). We found that GU was associated with an increased risk of GC (OR = 3.04, 95% CI: 2.07–4.49). No association between DU and GC risk was observed (OR = 1.03, 95% CI: 0.77–1.39). Conclusions. In the pooled analysis of 11 case–control studies in a large consortium (i.e., the Stomach cancer Pooling (StoP) consortium), we found a positive association between GU and risk of GC and no association between DU and GC risk.
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Cullen, Jennifer, Thomas Gerald, Allen Burke, Huai-Ching Kuo, Inger L. Rosner, Shiv Srivastava, and Isabell Sesterhenn. "History of PSA screening on prostate cancer aggressiveness." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 5066. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.5066.
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5066 Background: In 2012, PSA screening for prostate cancer (CaP) detection was given a “Grade D” recommendation for all men by the USPSTF. Recent U.S. studies report declines in PSA screening with concomitant increases in advanced CaP at diagnosis. This study examined the association between PSA screening history and CaP aggressiveness in a racially diverse, military cohort with equal health care access. Methods: This retrospective cohort study evaluated CaP patients undergoing radical prostatectomy (RP) from 1994-2015 at Walter Reed National Military Medical Center. Whole-mounted prostatectomy specimens were classified using 2014 ISUP Gleason grading system. Excluding the diagnostic PSA, screening history was categorized as: ≥ 6 PSA’s prior to CaP diagnosis (uppermost quartile), 1-5 (lower 3 quartiles), vs. no screening history. Multivariable logistic regression (MLR) was used to examine NCCN risk stratum (intermediate-high vs. low) and Gleason upgrade (GU) from biopsy to RP. Multivariable Cox proportional hazards (Cox PH) analyses were used to model time to biochemical recurrence (BCR). Multivariable models controlled for age at RP, race, family history and obesity (BMI > 30 vs. ≤ 30 kg/m2). The GU and BCR models also controlled for NCCN risk classification. Results: There were 1,772 eligible patients with a median follow-up and age at RP of 7.0 and 59.8 years, respectively. Prior to CaP diagnosis, 42% and 19% of men had 1-5 and ≥ 6 PSA’s screenings, respectively. MLR showed greater odds of intermediate or high vs. low risk disease for PSA screening history of none vs. 1-5 (OR = 1.33, CI = 1.03-1.70, p = 0.028) but not for none vs. ≥ 6 (p = 0.44). MLR showed increased odds of GU for none vs. ≥ 6 (OR = 1.81, CI = 1.23-2.7, p < 0.001). Multivariable Cox PH models showed incrementally poorer BCR-free survival as screening history decreased (HRNone vs. ≥6 = 2.27, CI = 1.54-3.33, p < 0.001; HRNone vs. 1-5= 1.49, CI = 1.15-1.92, p = 0.002). Conclusions: In this RP cohort, higher risk stratum, increased GU, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.
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Loke, W. C., L. Bacchus, C. Torres, and E. Fox. "Domestic violence in a genitourinary medicine setting – an anonymous prevalence study in women." International Journal of STD & AIDS 19, no. 11 (November 2008): 747–51. http://dx.doi.org/10.1258/ijsa.2008.008117.
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Domestic violence (DV) affects around one in four women in the UK. This study aimed to determine the prevalence of DV and the associations with sociodemographic and sexual behaviour variables in female attendees of an inner-city genitourinary (GU) medicine clinic. In this cross-sectional survey, 177 of 380 women (46.6%) disclosed a history of abuse and 17.4% reported DV in the preceding 12 months. Women with a history of a sexually transmitted infection (STI) were more likely to have experienced DV at some point in their lives (odds ratio [OR] = 2.39; 95% confidence interval [CI]: 1.58–3.63). Logistic regression analysis revealed that being black compared with white, (OR = 1.7; 95% CI: 2.4–12.5) current cohabitation with a partner (OR = 2.24; 95% CI: 1.06–4.75), increasing number of sexual partners in the last year (OR = 1.24; 95% CI: 1.01–1.5) and consumption of illicit drugs (OR = 2.05; 95% CI: 1.02–4.11) were significantly associated with DV in the last 12 months but age, current occupation, history of STIs, age of coitarche and condom use were not. DV was common in this GU medicine clinic population and associated with STIs. We recommend that health practitioners undergo training to increase awareness of the links between partner violence and sexual health problems.
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Pyo, Jeung Hui, Hyuk Lee, Jee Eun Kim, Yoon Ho Choi, Tae Jun Kim, Yang Won Min, Byung Hoon Min, et al. "Obesity and Risk of Peptic Ulcer Disease: A Large-Scale Health Check-Up Cohort Study." Nutrients 11, no. 6 (June 6, 2019): 1288. http://dx.doi.org/10.3390/nu11061288.
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The association between obesity and peptic ulcer disease (PUD) is inconclusive. To evaluate the association of obesity and metabolically healthy obesity (MHO) with PUD risk, we performed a retrospective cohort study of 32,472 subjects without PUD at baseline who underwent repeated health examinations. Participants were stratified by body mass index (BMI) and metabolically healthy state. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard modelling. During the follow-up period, 1940 PUD cases occurred. PUD, particularly gastric ulcer (GU), had significantly higher cumulative incidence in obese subjects compared to non-obese subjects (p value < 0.001). The HR for developing GU was 1.32 (95% CI, 1.16–1.49; p value <0.001); after adjusting for confounding factors (lifestyle, metabolic, and Helicobacter pylori status), the association was no more significant (p value = 0.789). For duodenal ulcer (DU), cumulative incidence between obese and non-obese groups was not significantly different (p value = 0.464). The risk of developing DU in the obese group was not significantly different from the non-obese group (HR 0.95; 95% CI, 0.83–1.09; p value = 0.469) and consistently showed no association after adjusting for metabolic parameters (p value = 0.199). Furthermore, MHO subjects had no increase in GU or DU risks. In this large cohort study, PUD risk was not associated with obesity or MHO.
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Chen, Lily, Ang Gao, Bhavani S. Gannavarapu, Aurelie Garant, Neil Bipinchandra Desai, Michael Ryan Folkert, Chul Ahn, et al. "Safety and outcome of stereotactic body radiation therapy (SBRT) with rectal hydrogel spacer for prostate cancer." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 76. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.76.
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76 Background: Ultra-hypofractionated radiotherapy delivered using stereotactic body radiotherapy (SBRT) is a cost-effective treatment for localized prostate cancer. Optimal dosing remains unclear, as commonly used 30-40Gy/5fx regimens appear to overestimate hypofractionation’s control benefits. Here, we report the largest experience of 45Gy/5Fx of SBRT for prostate cancer patients treated with hydrogel peri-rectal spacer (‘hydrogel’). Methods: An IRB-approved retrospective protocol was used to conduct a registry search identifying all patients with prostate cancer who received 45Gy/5Fx between 2015-2019 with hydrogel. Genitourinary (GU) and gastrointestinal (GI) toxicities were defined using the NCI Common Toxicity Criteria for Adverse Events (CTCAE) v.5.0. The ASTRO-Phoenix failure definition of Nadir+2 ng/mL was used for biochemical failure. Results: We analyzed 250 low (9.2%), intermediate (85.2%), and high-risk (5.6%) prostate cancer patients with a median follow-up of 9.9 months (range: 0-45.7 months). Acute GU and GI grade ≥ II toxicities were noted in 15.2% and 7.2% of patients, respectively. Late GU grade II and III toxicities occurred in 24.0% and 1.2% of patients, respectively, while late GI grade II and III toxicities occurred in 4.0% and 0.4% of patients, respectively. In patients (N=44) with follow-up >2 years, late GU and GI grade III toxicities occurred in 4.55% and 2.27% of patients, respectively. A significant correlation was noted for acute GI and GU toxicity predicting the respective late GI and GU toxicity (p-value < 0.001 for both). Physician-reported Grade ≥ II new onset erectile dysfunction was 17.2%. A gradual decline in prostate-specific antigen with a mean nadir of 0.04 (95% CI: [0.018, 0.067]) at 36 months was noted. The actuarial freedom from biochemical failure was 96.33% at 3 years. Overall survival was 94.09% at 3 years with no deaths attributed to prostate cancer. Conclusions: SBRT treatment of 45Gy/5Fx with hydrogel is well tolerated with GU/GI toxicities comparable to those reported for conventional fractionation. Although short, the 3-year biochemical control rate is encouraging. Longer follow-up and prospective evaluation are warranted.
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Riaz, Anum, Yusra Saleem, Syed Arsalan Ahmed Naqvi, Mahnoor Islam, Syeda Zainab Kazmi, Kaneez Zahra Rubab Khakwani, Safi U. Khan, et al. "Socioeconomic vulnerability and the risk of genitourinary cancer mortality among United States counties." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 116. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.116.
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116 Background: The impact of socioeconomic status on genitourinary (GU) cancer mortality in the United States (US) is unclear. Hence, we evaluated the association of the socioeconomic status with GU cancer mortality across the US counties. Methods: County-level age-adjusted mortality rates (AAMR) per 100,000 person-years (PY) for populations diagnosed with GU cancers were abstracted from the wide-ranging online data for epidemiological research (WONDER) database. The agency for toxic substances and disease registry (ATSDR) was queried to obtain county-level social vulnerability indices from 2014-2018. Percentile ranking scores (PRS: ranging from 0-1) were computed for each US county and further categorized into quartiles (Q: 1st: 0-0.25 [least vulnerable]; 4th: 0.75-1.00 [most vulnerable]). AAMRs were then linked with quartile rankings. A population-weighted, Poisson regression analysis was conducted to compute rate ratios (RR) of AAMRs between 4th and 1st Q with the corresponding 95% confidence intervals (CI). Results: A total 3142 US counties were included in this analysis. The AAMR for GU cancers was 22.6 overall deaths (OD) and 4.20 premature deaths (PD; defined as death at age <65 years) per 100,000 PY. GU cancer-related mortality increased in a stepwise fashion from the 1st Q to the 4th Q (OD: 21.6 vs 24.1; PD: 3.48 vs 5.19). In terms of OD by specific GU cancers, significantly higher AAMRs were observed in the 4th Q compared to the 1st Q for patients with prostate cancer (RR; 1.19 [95% CI;1.14-1.24]), and renal cell carcinoma (RCC; 1.12 [1.04-1.21]) but not for those with lower urothelial tract cancers (0.92 [0.87-0.96]). Among subgroups, non-Hispanic Blacks (1.19 [1.07-1.33]), and Hispanics (1.28 [1.08-1.51]) with prostate cancer and men with RCC (1.11; 1.03-1.19) in the 4th Q experienced significantly higher overall mortality when compared to those in the 1st Q. With regards to PD, significantly higher AAMRs were observed in the 4th Q vs 1st Q for patients with prostate cancer (1.54 [1.34-1.77]), and RCC (1.28 [1.12-1.45]). Consistently, men with RCC in the 4th Q also experienced higher premature mortality when compared to the 1st Q. Sparsity of mortality data among different ethnic/racial subgroups across the US counties precluded any formal assessment of disparity by specific GU cancers. A sensitivity analysis, conducted using the weighted linear regression approach, showed consistent results. Conclusions: Population level data suggest that socially vulnerable populations, especially Non-Hispanic Black and Hispanic men with prostate cancer, and men with renal cell carcinoma may be at an increased risk of cancer-related mortality. Hence, there is a dire need to address this mortality gap across different socioeconomic subgroups to ensure health-care equity. Investigations at the patient level are required to further ascertain these findings.
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Di Muzio, Nadia Gisella, Chiara Lucrezia Deantoni, Chiara Brombin, Claudio Fiorino, Cesare Cozzarini, Flavia Zerbetto, Paola Mangili, et al. "Ten Year Results of Extensive Nodal Radiotherapy and Moderately Hypofractionated Simultaneous Integrated Boost in Unfavorable Intermediate-, High-, and Very High-Risk Prostate Cancer." Cancers 13, no. 19 (October 3, 2021): 4970. http://dx.doi.org/10.3390/cancers13194970.
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Aims: To report 10-year outcomes of WPRT and HD moderately hypofractionated SIB to the prostate in UIR, HR, and VHR PCa. Methods: From 11/2005 to 12/2015, 224 UIR, HR, and VHR PCa patients underwent WPRT at 51.8 Gy/28 fractions and SIB at 74.2 Gy (EQD2 88 Gy) to the prostate. Androgen deprivation therapy (ADT) was prescribed in up to 86.2% of patients. Results: Median follow-up was 96.3 months (IQR: 71–124.7). Median age was 75 years (IQR: 71.3–78.1). At last follow up, G3 GI–GU toxicity was 3.1% and 8%, respectively. Ten-year biochemical relapse-free survival (bRFS) was 79.8% (95% CI: 72.3–88.1%), disease-free survival (DFS) 87.8% (95% CI: 81.7–94.3%), overall survival (OS) 65.7% (95% CI: 58.2–74.1%), and prostate cancer-specific survival (PCSS) 94.9% (95% CI: 91.0–99.0%). Only two patients presented local relapse. At univariate analysis, VHR vs. UIR was found to be a significant risk factor for biochemical relapse (HR: 2.8, 95% CI: 1.17–6.67, p = 0.021). After model selection, only Gleason Score ≥ 8 emerged as a significant factor for biochemical relapse (HR = 2.3, 95% CI: 1.12–4.9, p = 0.023). Previous TURP (HR = 3.5, 95% CI: 1.62–7.54, p = 0.001) and acute toxicity ≥ G2 (HR = 3.1, 95% CI = 1.45–6.52, p = 0.003) were significant risk factors for GU toxicity ≥ G3. Hypertension was a significant factor for GI toxicity ≥ G3 (HR = 3.63, 95% CI: 1.06–12.46, p = 0.041). ADT (HR = 0.31, 95% CI: 0.12–0.8, p = 0.015) and iPsa (HR = 0.37, 95% CI: 0.16–0.83, p = 0.0164) played a protective role. Conclusions: WPRT and HD SIB to the prostate combined with long-term ADT, in HR PCa, determine good outcomes with acceptable toxicity.
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Farooq, Muhammad Zain, Sara Khan, Ibrahim Zahid, Aruba Sohail, and Michael Vishal Jaglal. "Gender disparities in the National Institutes of Health funding for genitourinary oncology." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 264. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.264.
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264 Background: Traditionally, women are under-represented in academic fields and thus less likely to receive grants and funds. Here we assessed the National Institutes of Health (NIH) funding trend in allocation of R401 grants in Genito-urinary oncology (GU) stratified by gender. Methods: The data were retrieved from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditure) using GU-related search terms from 2018-2021. The gender was categorized using Genderize. The number of citations, publications, H-index, and seniority were obtained from Scopus and Web of Science in September 2022. Consumer Price Index was used to adjust funding amount to 2021 equivalent U.S. dollars. Linear regression was used for analysis. Results: A total of 873 NIH-funded R01 grants amounting to $388.5 million were awarded for GU research. Women (n= 206; 23.6% [95% CI: 20.8%-26.4%]) received fewer grants than men (n= 667; 76.4% [95% CI: 73.6%-79.2%]). Trending from 2018 to 2021, there was no significant difference in the number of grants awarded among both men (173 to 181, p=0.78) and women (50 to 53, p=0.92) within their groups. Similarly, there was no significant change in the grant amount (in millions) awarded among men (74.2 to 78.7, p=0.47) and women (23.6 to 22.4, p=0.30). Prostate cancer accounted for the greatest proportion of grants (n=689; 78.9% [95% CI: 76.2%-81.6%]), amounting to 304.4 million in 4 years. Of the 269 co-Principal Investigator (PIs), 240 (89.2% [95% CI: 85.5%-92.9%]) were men and 29 (10.8% [95% CI: 7.1%-14.5%]) were women. Male PIs compared to female PIs had a higher no. of publications (135 vs 106, p<0.01). Funding amount was significantly associated with the number of publications (β=0.05; p<0.01), seniority (β=0.10; p=0.015), institution (p<0.01) and degrees (p=0.03). However, there was no significant association with gender (β=0.05; p=0.17). Conclusions: Our analysis shows continued gender disparity in R01 awards as only 1 in 5 grants were awarded to women during the fiscal years of 2018-2021. Thus, concerted efforts are required to bridge this gap and promote gender equity. [Table: see text]
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Zou, Jun-Bo, Xiao-Fei Zhang, Ya-Jun Shi, Jia Tai, Yu Wang, Yu-Lin Liang, Fang Wang, Jiang-Xue Cheng, Jing Wang, and Dong-Yan Guo. "Therapeutic Efficacy of Kangfuxin Liquid Combined with PPIs in Gastric Ulcer." Evidence-Based Complementary and Alternative Medicine 2019 (September 30, 2019): 1–13. http://dx.doi.org/10.1155/2019/1324969.
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Objective. To evaluate the clinical efficacy and safety of Kangfuxin liquid (KFX) combined with proton pump inhibitors (PPIs) in the treatment of gastric ulcer (GU). Materials and Methods. Electronic databases including PubMed, Wanfang, CNKI, VIP, Embase, Cochrane Library, and CBM were examined for appropriate articles without language limitations on key words before March 10, 2019. RevMan 5.3 software was applied to execute outcome assessment and finish the meta-analysis. Results. 22 articles involving 2,024 patients with a gastric ulcer were selected. Total efficacy rate and efficacy rate of gastroscopy were significantly enhanced for the combination of KFX with PPIs compared to those of PPI treatment alone (OR = 6.95, 95% CI: 4.87, 9.91, P<0.00001; OR = 2.96, 95% CI: 1.98, 4.42, P<0.00001, respectively). Same results were found for different PPIs in combination on total efficacy rate, respectively. The combination also significantly reduced the adverse events (OR = 0.39, 95% CI: 0.22, 0.70, P=0.002). In addition, KFX combined with PPI could suppress the inflammation (MD = −6.11, 95% CI: −7.45, −4.77, P<0.00001), reduce the recurrence rate (OR = 0.31, 95% CI: 0.14, 0.70, P=0.005), and enhance the clearance rate of Helicobacter pylori (HP, OR = 3.76, 95% CI: 1.80, 7.87, P=0.0004). It seemed like the combination would influence immune function by increasing levels of T-lymphocyte subsets CD4 and CD8 but not CD3 (MD = 2.40, 95% CI: 1.25, 3.55, P<0.0001); MD = 25.72, 95% CI: 14.55, 36.90, P<0.00001; MD = 0.72, 95% CI: −0.66, 2.09, P=0.31, respectively). Conclusion. KFX combined with PPIs in treatment of patients with GU could improve the total efficacy rate and efficacy rate of gastroscopy and reduce adverse events and the recurrence rate. However, the results of this study should be handled with care due to the limitations. Several rigorous RCTs are in need to confirm these findings.
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Huddart, Robert Anthony, Ann Henry, Vincent Khoo, John Staffurth, Isabel Syndikus, Vibeke Hansen, Helen McNair, et al. "Results of a randomised phase II study of hypofractionated bladder radiotherapy (RT) with or without image guided adaptive planning (HYBRID - CRUK/12/055)." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 283. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.283.
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283 Background: Muscle invasive bladder cancer (MIBC) incidence increases with age, with many patients (pts) unfit for radical therapy. We aimed to demonstrate feasibility of delivery & acceptable rates of hypofractionated RT toxicity using image guided adaptive techniques for these pts in a multicentre trial. Methods: Pts with T2-T4aN0M0 MIBC had 36 Gray (Gy) in 6 fractions (fr) over 6 weeks & were randomised (1:1) to standard (SP) or adaptive planning (AP). For AP 3 RT plans (small, medium, large) were generated with preRT cone beam (CB) CT used to select best fitting ‘plan of the day’ at each fr. A QA programme aided standardised CBCT image interpretation. The SP group had RT with 1 plan. The aim was to exclude ≥30% grade ≥3 (≥G3) acute (to 3 months (m)) non-genitourinary (GU) toxicity for AP in pts with no MIBC death by 3m (p0=0.7 p1=0.9 α=0.05 β=0.2). Secondary endpoints included 36Gy/6fr acute toxicity in pts who had ≥1 RT fr & proportion of AP fr using small/large plan. Adverse events (AEs) were assessed (CTCAE v4) weekly on RT, 4 weeks & 3m post RT. Blind independent review assessed relatedness of non-GU AEs to RT. Results: Between Apr 2014 & Aug 2016 65 pts were randomised (SP (n=32) AP (n=33)) from 12 UK sites. Median age was 85yrs; 68% male; 92% transitional cell MIBC; 99% grade 3; 25% clinical stage T3 & 6% T4. 58 pts are evaluable to date, ≥G3 acute non-GU adverse reactions (AR) were reported in 2/30 (7%; 90% CI: 1%–20%) AP (G3 hyperkalemia & hyponatremia; G3 diarrhea & dehydration) & 3/28 (11%; 90% CI: 3% –25%) SP pts (G3 fatigue; G3 hyperkalemia, weight loss & anorexia; G3 diarrhoea). 24/65 (37%; 90% CI: 27%-48%) pts who had ≥1 RT fr had ≥G3 acute AEs including G4 hyponatremia (2 AP pts), G5 pneumonia (1 SP, 1 AP), G5 sepsis (1 AP) & G5 renal failure (1 SP) (all G4/5 unrelated to RT). 7/65 pts received <6 fr RT due to toxicity. In the 33 AP pts 40/182 fr (22%) used a small plan & 29/182 (16%) large (adaption rate=38%; 95% CI: 31%-45%). Conclusions: Though overall ≥G3 AE rate was significant, 36Gy/6fr with AP is feasible, met predefined toxicity criteria (<30% ≥G3 acute non-GU ARs) & with >25% fr adapted has potential for benefit. Comparative randomised studies are needed to quantify benefits of AP over SP. Clinical trial information: 18815596.
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Dubinsky, Pavol, Vladimir Vojtek, Katarina Belanova, Natalia Janickova, Noemi Balazova, and Zuzana Tomkova. "Hypofractionated Post-Prostatectomy Radiotherapy in 16 Fractions: A Single-Institution Outcome." Life 13, no. 7 (July 23, 2023): 1610. http://dx.doi.org/10.3390/life13071610.
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Background: The optimal hypofractionated schedule of post-prostatectomy radiotherapy remains to be established. We evaluated treatment outcomes and toxicity of moderately hypofractionated post-prostatectomy radiotherapy in 16 daily fractions delivered with intensity-modulated radiotherapy. The treatment schedule selection was motivated by limited technology resources and was radiobiologically dose-escalated. Methods: One hundred consecutive M0 patients with post-prostatectomy radiotherapy were evaluated. Radiotherapy indication was adjuvant (ART) in 19%, early-salvage (eSRT) in 46% and salvage (SRT) in 35%. The dose prescription for prostate bed planning target volume was 52.8 Gy in 16 fractions of 3.3 Gy. The Common Terminology Criteria v. 4 for Adverse Events scale was used for toxicity grading. Results: The median follow-up was 61 months. Five-year biochemical recurrence-free survival (bRFS) was 78.6%, distant metastases-free survival (DMFS) was 95.7% and overall survival was 98.8%. Treatment indication (ART or eSRT vs. SRT) was the only significant factor for bRFS (HR 0.15, 95% CI 0.05–0.47, p = 0.001) and DMFS (HR 0.16, 95% CI 0.03–0.90; p = 0.038). Acute gastrointestinal (GI) toxicity grade 2 was recorded in 24%, grade 3 in 2%, acute genitourinary (GU) toxicity grade 2 in 10% of patients, and no grade 3. A cumulative rate of late GI toxicity grade ≥ 2 was observed in 9% and late GU toxicity grade ≥ 2 in 16% of patients. Conclusions: The observed results confirmed efficacy and showed a higher than anticipated rate of early GI, late GI, and GU toxicity of post-prostatectomy radiobiologically dose-escalated hypofractionated radiotherapy in 16 daily fractions.
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Tripathi, Nikita, Ahsan Ayaz, Syed Arsalan Ahmed Naqvi, Muhammad Ali Khan, Akshat Saxena, Arifa Bibi, Aneeta Channar, et al. "Secondary primary malignancies among patients with GU cancer." Journal of Clinical Oncology 42, no. 4_suppl (February 1, 2024): 98. http://dx.doi.org/10.1200/jco.2024.42.4_suppl.98.
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98 Background: The risk of secondary primary malignancies (SPM) among the survivors of GU cancer is not well-established. In this study, we attempt to describe the patterns of SPMs in patients diagnosed with GU cancers. Methods: The Surveillance, Epidemiology, and End Results (SEER) database (SEER*Stat 8.4.2) was searched to obtain data on the incidence of SPM in adult patients (age >18 years) diagnosed with GU cancers, including prostate, renal, and bladder cancer. Standardized incidence ratios (SIRs) with a 95% confidence interval (CI) were calculated. SIR was defined as the observed SPMS from each category divided by the expected number of SPMs in the age-matched US population for the same period. The data was further stratified by age (<50y, 50-70y, >70y), race (White, Black, Asian/Pacific Islander), ethnicity (Hispanic, non-Hispanic), chemotherapy, and radiotherapy exposure. Results: A total of 1,041,217 patients were included in this analysis. In patients diagnosed with GU cancer, the incidence of overall SPM was 11%. Particularly, patients with GU cancers were observed to have a high incidence of Endocrine system SPM (1.52; 1.45-1.59), and urinary system SPM (1.51; 1.49-1.53) These results were consistent by different sociodemographic groups. In patients diagnosed with prostate cancer, the incidence of thyroid SPM was increased (1.31; 1.23-1.39). Particularly, prostate cancer patients treated with radiation therapy had increased incidence rates of SPM in the peritoneum, omentum and mesentery (1.57; 0.79-2.81) and urinary bladder (1.36;1.32-1.40) was higher as compared to those with no exposure to radiation therapy (1.11;1.08-1.13 and 1.03;1-1.06 respectively). Bladder cancer patients had an overall increased incidence of SPM in the esophagus (1.21; 1.08-1.35), lung, bronchus, trachea, and other respiratory organs (1.97;1.92-2.01), prostate (3.50;3.4-3.6) and kidney (1.86;1.76-1.97). A higher incidence of renal pelvis, ureter and other urinary organ SPM (11.08;10.48-11.07) was also notable in this population. Similarly, kidney cancer patients had a higher incidence of the endocrine system (3.00;2.74-3.27), prostate (1.24;1.2-1.29) and bladder 1.78;1.68-1.79 SPMs. Conclusions: This population-based study shows an increased risk of SPM development in GU cancer survivors compared to the general population. Clinicians should keep a high index of suspicion for SPMs and initiate appropriate workups at early warning signs.
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Zhang, Yanjia, Atulya Aman Khosla, Sufal Chhabra, Nitya Batra, Mohammad Arfat Ganiyani, Anmol Goyal, Shreyas S. Bellur, et al. "Clustering analysis for predicting racial disparities in genitourinary cancer–related financial burden." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): e13612-e13612. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e13612.
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e13612 Background: Healthcare costs in the United States (US) are significantly impacted by genitourinary (GU) cancers. Prostate cancer treatment alone cost the US more than $22 billion in 2020. We sought to utilize machine learning (ML)-based classification to investigate differences in the total cost of healthcare expenditure among patients with GU cancer in the US. Methods: The study included eligible adult GU cases from the 2019–2021 Medical Expenditure Panel Survey. Renal cell, prostate, urothelial, testicular, and penile cancers were identified using ICD-10 CM codes. Patients were clustered using demographic information such as age, race, sex, marital status, highest degree, insurance status, perceived health status, and perceived mental health status. The analysis accounted for the complex survey design and sampling weights. The cluster groups were taken into account when conducting descriptive and regression analyses. GU cancer cases were divided into low-, medium-, and high-risk healthcare expenditure clusters. Results: The study included a representative sample of 9,061,181 cases of GU cancer in the US between 2019 and 2021. The average age of the sample was 71.6 years (95% CI: 70.7, 72.5). There were 7.9% Hispanic (Hisp), 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% individuals from Asian or other races. Overall, the mean total healthcare expenditures within low-, med-, and high-risk clusters were $17974 (13816, 22133), $20496 (13100, 27893), and $30512 (21389, 39635), respectively. Regression analysis showed that, after adjusting for sampling weight, cluster, gender, family income, age, insurance status, and survey year, the mean total expenditure was higher by $11209.70 and $13100.81 in med- and high-risk clusters when compared to the low-risk cluster (ref.). Within each race or ethnicity, the proportion of Hisp or NHB individuals was higher in med- and high-risk clusters. Med- and high-risk clusters were more likely to contain people with cognitive impairments, poor health status, and financial difficulties in their families. Conclusions: We used an unsupervised clustering algorithm that can distinguish between GU cases with high and low expenditure based solely on sociodemographic variables. We demonstrate that our findings were consistent for all three data cohorts. This approach can predict the disparity in utilization in any insured population. [Table: see text]
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Al Armashi, Abdul Rahman, Marisa Thierheimer, Jorge A. Garcia, and Jason R. Brown. "Racial disparities in genitourinary cancer mortality trends in the United States, 2000-2020: A CDC database study." Journal of Clinical Oncology 42, no. 4_suppl (February 1, 2024): 28. http://dx.doi.org/10.1200/jco.2024.42.4_suppl.28.
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28 Background: Prostate, bladder, and kidney cancers account for substantial burden of cancer incidence and mortality in the United States. In 2020, an estimated 168,000 new cases and 32,000 deaths were attributed to these cancers. Studies examining racial disparities of mortality trends are needed. Methods: We utilized the CDC WONDER database to obtain mortality data for kidney, bladder, and prostate cancers between 2000-2020. Age-adjusted mortality rates per 100,000 persons were calculated and standardized to the Year 2000 US standard population. Rates were stratified by race, including White, Black, Asian/Pacific Islander (API), and American Indian/Alaska Native (AIAN). The National Cancer Institute Joinpoint Regression Program was utilized to calculate average annual percent changes (AAPCs). AAPCs were considered significant if the 95% confidence interval (CI) excluded zero. Results: Over the study period, 318,919 kidney cancer deaths, 150,613 bladder cancer deaths, and 516,508 prostate cancer deaths were identified. Between 2000-2020, amongst all races, mortality from prostate cancer (-1.8%; CI -2.0, -1.6), bladder cancer (-0.3%; CI -0.5, -0.2), and kidney cancer (-1.1%; CI -1.2, -0.9) all significantly declined. Considering racial disparities, prostate cancer mortality fell considerably in all race groups, most significantly among Black (-2.8%, CI -3.2%, -2.4%) and AIAN (-2.4%, CI -2.9%, -1.8%) populations, outpacing reductions in API (-1.7%, CI -2.6%, -0.8%) and White (-1.6%, CI -1.9%, -1.4%) populations. In bladder cancer, the decline in mortality was statistically significant for Black (AAPC: -0.8%, CI -1.1%, -0.6%) and for White, (-0.4%, CI -0.6%, -0.1%), but not for API individuals (-0.3%, CI -0.9%, 0.3%). For kidney cancer, mortality dropped substantially across all examined races, with the steepest decline seen in Black (-1.4%, CI -1.7%, -1.2%) and AIAN (-1.7%, CI -2.5%, -1.0%) compared to White (-1.0%, CI -1.2%, -0.9%) and API (-1.4%, CI -4.2%, 1.6%, non-significant) population. Conclusions: This study represents the most comprehensive population database analysis assessing GU cancer mortality trends. While an overall decline in GU cancer mortality was observed, which was comparatively greater for Black Americans over the past two decades, significant racial disparities continue to persist. Focused and targeted efforts are essential to address these disparities. [Table: see text]
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Pr�fer, Pawe� Edward. "Pu�apka czy dobrodziejstwo immersyjno�ci w bieganiu d�ugodystansowym? Czas wolny aktywnie wype�niany." Studia Humanistyczne AGH 22, no. 1 (2023): 71–86. http://dx.doi.org/10.7494/human.2023.22.1.71.
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Artyku� opisuje, wyja�nia i interpretuje fenomen biegania d�ugodystansowego przez pryzmat kategorii immersyjno�ci. Poj�cie to w naukach spo�ecznych, tak�e w socjologii, raczej nie wyst�puje. Dlatego podj�to pr�b� jego operacjonalizacji. W analizie zastosowano kwerend� materia��w po�wi�conych zjawisku biegania, zamieszczanych g��wnie na w�oskich i polskich portalach internetowych. Zastosowano metod� opisu interpretacji dyskurs�w i tre�ci zawartych w mottach po�wi�conych bieganiu. Uwzgl�dniono przede wszystkim teori� relacyjno�ci oraz tez� o ulokowaniu jednostki w przestrzeni dw�ch mechanizm�w spo�ecznych: determinizmu oraz indywidualnej sprawczo�ci podmiotowej. Opracowano i zaktualizowano problem zar�wno w jego konkretnych przypadkach (narracje i prze�ycia biegaczy, osobiste do�wiadczenia autora w odniesieniu do zjawiska biegania, wznios�e i zdystansowane opinie na temat biegania), jak i w zasi�gu uniwersalnym (opisy i interpretacje pojawiaj�ce si� w badaniach po�wi�conych bieganiu d�ugodystansowemu). Na podstawie przeprowadzonych analiz wywnioskowano, �e fenomen biegania jest w przypadku biegaczy zar�wno wyzwalaj�cy, rekonstruuj�cy ich biografie, jak i immersyjny, to znaczy poch�aniaj�cy, �zniewalaj�cy�.
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Michalski, Jeff M., Jennifer Moughan, James Purdy, Walter Bosch, Jean-Paul Bahary, Harold Y. Lau, Marie Duclos, et al. "A randomized trial of 79.2Gy versus 70.2Gy radiation therapy (RT) for localized prostate cancer." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 4. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.4.
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4 Background: RTOG 0126 is a phase III trial for localized prostate cancer (PC) testing whether dose escalation to 79.2Gy with 3DCRT or IMRT will improve overall survival (OS). Methods: Stage cT1b-T2b with Gleason Score (GS) 2-6 and PSA ≥ 10 and <20 or GS 7 and PSA <15 were eligible and randomized to receive 79.2Gy or 70.2Gy. No androgen withdrawal was used. Treatment was 3DCRT or IMRT to 79.2Gy in 44 fractions or 70.2Gy in 39 fractions. The objective was to detect a 23% reduction in mortality hazard (HR=0.77) for 79.2Gy. ASTRO and Phoenix definition was used for biochemical failure (BF). Time to local progression (LP), distant metastases (DM), PC death, and late GI/GU toxicity was calculated from date of registration. OS was estimated by Kaplan Meier and arms compared with log rank test. BF, LP, DM, time to late GI/GU, and PC death were estimated by cumulative incidence method and arms compared with Gray’s test. Results: 1,532 men were randomized, 763 to 79.2Gy and 769 to 70.2Gy. 1,499 were eligible, 751 and 748 in the 79.2Gy and 70.2Gy arms respectively. Median age was 69, 70% had PSA < 10 ng/ml, 84% with GS 7, 57% had T1 disease, and 66% used 3D-CRT. With a median of 7.0 years follow up, the 5 and 10-yr rates of OS are 88% and 67% with 79.2Gy and 89% and 66% with 70.2Gy (p=0.87; HR (95%CI)=0.98 (0.79,1.21)). The ASTRO (Phoenix) BF rates at 5 and 10 yr are 25% (16%) and 30% (26%) with 79.2Gy and 40% (21%) and 45% (43%) with 70.2Gy (both p<0.0001). The 5 and 10-yr rates of LP are 1% and 4% with 79.2Gy and 2% and 8% with 70.2Gy (p=0.0059; HR (95%CI)=0.46 (0.27,0.81)). The 5 and 10 yr rates of DM are 2% and 5% with 79.2Gy and 3% and 8% with 70.2Gy (p=0.026; HR (95%CI)=0.57 (0.35,0.94)). The high dose arm had lower rate of salvage therapy, 13.5% vs 21%, p=0.0002. The 10 yr rates for time to late grade ≥ 2 GI/GU are 22%/15% with 79.2Gy and 16%/10% with 70.2Gy (p=0.0063/p=0.001). Time to late grade ≥ 3 GI was higher for the 79.2Gy arm (p=0.035) but time to late grade ≥ 3 GU toxicity was not (p=0.14). Conclusions: Despite significant improvement in BF, DM, and LP rates, dose escalation did not improve OS. Patients receiving high dose radiation experience more late toxicity. Clinical trial information: NCT00033631.
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Rahman, Shafia, Juan Trias, Mohammad Barouqa, Margarita Kushnir, and Henny H. Billett. "Retrospective Comparison of Doac with Enoxaparin in Gastrointestinal and Urothelial Cancers." Blood 136, Supplement 1 (November 5, 2020): 21. http://dx.doi.org/10.1182/blood-2020-143409.
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Introduction: Venous thromboembolic disease (VTE) is a common cause of morbidity and mortality in patients with cancer. Cancer associated thrombosis (CAT) is associated with poor prognosis, worse survival and increased care costs. Previous trials demonstrated the non-inferiority of DOACs to LMWH for the treatment of CAT, but there is concern for a possible increased incidence of bleeding, particularly in patients with gastrointestinal (GI) and urothelial (GU) cancers. Current guidelines suggest a preference for enoxaparin with these diagnoses. The aim of our study is to elucidate the safety of DOACs in the treatment of GI and GU cancer associated thrombosis at our institution. Methods: Retrospective chart review of patients with GI or GU cancer associated thrombosis who received either enoxaparin or DOACs (apixaban or rivaroxaban) was performed. The baseline characteristics, duration of anticoagulation (AC) and bleeding events (BEs) were compared between the two groups. The bleeding events were classified according to ISTH categories. Statistical analysis was done using R studio (V1.3.1056). Results: All patients from 01/2001 - 01/2020 with active GI or GU cancer and associated thrombosis who had received enoxaparin or a DOAC were included in the study. Of 262 patients reviewed, 206 (78.6 %) received a DOAC and 56 (21.4%) received enoxaparin. The baseline characteristics between the two groups are depicted in Table 1. Patients in the DOAC group had lower ECOG scores than those on enoxaparin: 79.7% of DOAC and 26.8% of enoxaparin patients had ECOG scores of 1-2. Patients on DOACs were less likely to have metastatic disease (58.7% vs. 78.6%) but were more likely to have additional risk factors for bleeding (p=0.004): 24 patients (11.7%) on DOACs were also on an antiplatelet agent (19 on aspirin, 5 on clopidogrel), compared to 4 patients (7.1%) in enoxaparin group (3 on aspirin, 1 on clopidogrel). Clot distribution was similar between the two groups. The majority of patients, 70.4% in the DOAC group and 73.2% in the enoxaparin group, had no BEs. There was no statistically significant difference in the cumulative incidence (CI) of bleeding between the DOAC and enoxaparin groups (p-value 0.65) Figure 1. In the DOAC group, 109 patients (52.9%) received apixaban and 97 patients (47.1%) received rivaroxaban. There were 26 (23.9%) and 35 (36.8%) BE in the apixaban and rivaroxaban subgroups respectively, Table 2. Of those on apixaban, 13/26 had GI bleeding (12 had underlying GI and 1 patient had GU cancer) and 10/26 had GU bleeding(all with underlying GU cancer). Of those on rivaroxaban 18/35 had GI bleeding (all with underlying GI cancer) and 11/35 had GU bleeding (6 patients had GU and 5 had GI cancer). Conclusion: Our study suggests that physician preferences play a major role in the choice of AC. Most physicians preferred DOACs even for patients with GI/GU cancers when patients had better ECOG scores and non-metastatic disease. However, these were also the same patients that were then more likely to have been exposed to additional risk factors for bleeding. BEs between DOACs and enoxaparin were similar and, between the DOACs, somewhat more favorable with apixaban than rivaroxaban. Randomized clinical trials, controlling for physician choice and bleeding risk factor, are necessary valid comparisons for the best choice of anticoagulation. Disclosures No relevant conflicts of interest to declare.
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Alaber, Omar A., Apoorva K. Chander, Prantesh Jain, Aman Rajpal, Monaliben Patel, Christopher J. Hoimes, Prateek Mendiratta, Pierre Lavertu, and Ankit Mangla. "Increased risk of hypothyroidism in patients with primary head and neck cancer compared to non-head and neck primary malignancies." Journal of Clinical Oncology 38, no. 5_suppl (February 10, 2020): 37. http://dx.doi.org/10.1200/jco.2020.38.5_suppl.37.
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37 Background: Immune related thyroiditis is a common adverse effect of Immune checkpoint inhibitors (ICI). We sought to determine if the incidence of hypothyroidism (HT) in patients with primary head and neck cancers (pHNC) who received ICI, is increased compared to other primary cancers (lung, gastrointestinal (GI), skin melanoma or urinary system(GU). Methods: Data were obtained from a commercial de-identified database (IBM Explorys Solutions, IBM, Inc.). Cases included patients ≥ 18 years with a diagnosis of pHNC and controls included patients with a diagnosis of lung, GI, skin melanoma or GU cancer. All patients received one of 5 ICI (Avelumab, Atezolizumab, Durvalumab, Nivolumab or Pembrolizumab). Incidence of HT was defined as patient with a new diagnosis of HT at least 1 day following initiation of ICI. All patients with diagnosed HT, thyroid cancer (previous/concurrent), lymphomas were excluded. Odds ratios (OR) and confidence intervals (CI) were calculated using chi-square test. Results: There were 238,490 patients with a diagnosis of pHNC, and 616,850 patients with a diagnosis of other cancers in the database. Out of 710 pHNC patients, 80 patients (18.6%) and out of 7420 patients with other primary cancers, 850 (12.57%) had a new diagnosis of HT. When compared to non-HNC patients, HNC cases had a 1.6 (CI = 1.23 - 2.05) times higher odds of developing HT. In subgroup analyses, HNC cases were significantly more likely to develop HT compared to patients with GI or lung cancer, but not with skin melanomas or GU cancers. Overall, male cases and adults aged 18 - 65 years were significantly more likely to develop HT. (Table). Conclusions: The risk of developing HT after ICI is higher in patients with HNC compared to other primary cancers. Men and patients between the ages 18-65 years with pHNC were more likely to become HT. [Table: see text]
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Shaikh, Mohammad Parvez, Matthew M. Harkenrider, and Meng-Jia Wu. "Adjuvant radiotherapy versus wait-and-see strategy for pathologic T3 or margin-positive prostate cancer: A meta-analysis." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 19. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.19.
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19 Background: Optimal management after radical prostatectomy (RP) remains controversial in patients with pathologic T3 or margin-positive prostate cancer with the options being early adjuvant radiotherapy (ART) versus wait-and-see (WS). Methods: A comprehensive Medline search to identify randomized controlled trial (RCT) of ART vs WS was done. Synthesized results from the included studies show Metastasis-Free Survival (MFS) and overall survival (OS) rates at 10 years as well as Grade 2 or greater GI and GU toxicities in the studies. Results were based on the random-effect (RE) model if there was evidence of between-trial heterogeneity, otherwise the fixed-effect (FE) model was used. Results: A total of 3 RCTs (ARO9602/AUO AP09/95, EORTC22911, SWOG8794) were identified with 1,737 patients (ART: n=864, WS: n=873). 10-year estimates of MFS and OS rates were reported for SWOG and EORTC studies, and estimated for ARO 96-02/AUO AP09/95 study from their Kaplan-Meier curves (Table). Pooled 10-year MFS data showed a significant improvement with ART vs WS (OR= 0.77; 95% CI 0.62–0.96, p=0.02, FE). However, pooled 10-year OS was not significantly different (OR= 0.98; 95% CI 0.64–1.49, p=0.91, RE). Grade 2 or greater GI toxicity was reported by all three studies and was significantly higher in ART (2.5%) compared with WS (1.1%), p=0.04. Grade 2 or greater GU toxicity was reported by ARO9602 and EORTC studies and was significantly higher in ART (17.1%) compared with WS (10.3%), p=0.0004. Conclusions: 10-year MFS is significantly improved with ART compared with WS. No benefit in 10-year OS was found. Grade 2 or greater GI and GU toxicities where greater in ART compared with WS. [Table: see text]
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Tamihardja, Jörg, Leonie Zehner, Philipp E. Hartrampf, Sinan Cirsi, Sonja Wegener, Andreas K. Buck, Michael Flentje, and Bülent Polat. "Dose-Escalated Salvage Radiotherapy for Macroscopic Local Recurrence of Prostate Cancer in the Prostate-Specific Membrane Antigen Positron Emission Tomography Era." Cancers 14, no. 19 (October 10, 2022): 4956. http://dx.doi.org/10.3390/cancers14194956.
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Background: The purpose of this study was to access the oncological outcome of prostate-specific membrane antigen positron emission tomography (PSMA PET/CT)-guided salvage radiotherapy (SRT) for localized macroscopic prostate cancer recurrence. Methods: Between February 2010 and June 2021, 367 patients received SRT after radical prostatectomy. Out of the 367 screened patients, 111 patients were staged by PSMA PET/CT before SRT. A total of 59 out of these 111 (53.2%) patients were treated for PSMA PET-positive macroscopic prostatic fossa recurrence. Dose-escalated SRT was applied with a simultaneous integrated boost at a median prescribed dose of 69.3 Gy (IQR 69.3–72.6 Gy). The oncological outcome was investigated using Kaplan-Meier and Cox regression analyses. The genitourinary (GU)/gastrointestinal (GI) toxicity evaluation utilized Common Toxicity Criteria for Adverse Events (version 5.0). Results: The median follow-up was 38.2 months. The three-year biochemical progression-free survival rate was 89.1% (95% CI: 81.1–97.8%) and the three-year metastasis-free survival rate reached 96.2% (95% CI: 91.2–100.0%). The cumulative three-year late grade 3 GU toxicity rate was 3.4%. No late grade 3 GI toxicity occurred. Conclusions: Dose-escalated PSMA PET/CT-guided salvage radiotherapy for macroscopic prostatic fossa recurrence resulted in favorable survival and toxicity rates.
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Apolo, Andrea B., Rosa Nadal, Daniel M. Girardi, Scot A. Niglio, Lisa Ley, Lisa M. Cordes, Seth M. Steinberg, et al. "Phase I Study of Cabozantinib and Nivolumab Alone or With Ipilimumab for Advanced or Metastatic Urothelial Carcinoma and Other Genitourinary Tumors." Journal of Clinical Oncology 38, no. 31 (November 1, 2020): 3672–84. http://dx.doi.org/10.1200/jco.20.01652.
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PURPOSE We assessed the safety and efficacy of cabozantinib and nivolumab (CaboNivo) and CaboNivo plus ipilimumab (CaboNivoIpi) in patients with metastatic urothelial carcinoma (mUC) and other genitourinary (GU) malignances. PATIENTS AND METHODS Patients received escalating doses of CaboNivo or CaboNivoIpi. The primary objective was to establish a recommended phase II dose (RP2D). Secondary objectives included objective response rate (ORR), progression-free survival (PFS), duration of response (DoR), and overall survival (OS). RESULTS Fifty-four patients were enrolled at eight dose levels with a median follow-up time of 44.6 months; data cutoff was January 20, 2020. Grade 3 or 4 treatment-related adverse events (AEs) occurred in 75% and 87% of patients treated with CaboNivo and CaboNivoIpi, respectively, and included fatigue (17% and 10%, respectively), diarrhea (4% and 7%, respectively), and hypertension (21% and 10%, respectively); grade 3 or 4 immune-related AEs included hepatitis (0% and 13%, respectively) and colitis (0% and 7%, respectively). The RP2D was cabozantinib 40 mg/d plus nivolumab 3 mg/kg for CaboNivo and cabozantinib 40 mg/d, nivolumab 3 mg/kg, and ipilimumab 1 mg/kg for CaboNivoIpi. ORR was 30.6% (95% CI, 20.0% to 47.5%) for all patients and 38.5% (95% CI, 13.9% to 68.4%) for patients with mUC. Median DoR was 21.0 months (95% CI, 5.4 to 24.1 months) for all patients and not reached for patients with mUC. Median PFS was 5.1 months (95% CI, 3.5 to 6.9 months) for all patients and 12.8 months (95% CI, 1.8 to 24.1 months) for patients with mUC. Median OS was 12.6 months (95% CI, 6.9 to 18.8 months) for all patients and 25.4 months (95% CI, 5.7 to 41.6 months) for patients with mUC. CONCLUSION CaboNivo and CaboNivoIpi demonstrated manageable toxicities with durable responses and encouraging survival in patients with mUC and other GU tumors. Multiple phase II and III trials are ongoing for these combinations.
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Zelin, J., N. Garrett, J. Saunders, F. Warburton, J. Anderson, K. Moir, M. Symonds, and C. Estcourt. "An evaluation of the performance of OraQuick® ADVANCE Rapid HIV-1/2 Test in a high-risk population attending genitourinary medicine clinics in East London, UK." International Journal of STD & AIDS 19, no. 10 (October 2008): 665–67. http://dx.doi.org/10.1258/ijsa.2008.008132.
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To date, no data have been published on the use of OraQuick® ADVANCE Rapid HIV-1/2 Test (OraQuick) in the UK. We report preliminary findings of an ongoing evaluation of OraQuick in UK genitourinary (GU) medicine clinics. A total of 820 samples from patients in high-risk groups for HIV were tested with OraQuick and results were compared with standard HIV antibody testing. HIV prevalence (enzyme immunoassay [EIA]) was 5.73%, sensitivity of OraQuick was 93.64% (95% CI 82.46–98.66%), specificity 99.87% (99.28–100%), positive predictive value 97.78% (88.27–99.94%) and negative predictive value 99.61% (98.87–99.92%). This includes three false-negatives considered to be due to observer error and now rectified by further training. This has increased test sensitivity to 100%. Our observed test performance of OraQuick compares well with EIA and with other rapid tests. We believe that simple, non-invasive antibody detection tests such as OraQuick can increase HIV testing and diagnosis in UK GU medicine and community settings.
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N., W. H., Fan Chih-lin (Fan Zhi lin), and Wu Keng-shun (Wu Geng shun). "Ch'uan T'ang shih tien-ku tz'u-tien (Shang, hsia) (Quan Tang shi dian gu ci dian) (Shang, xia)." Chinese Literature: Essays, Articles, Reviews (CLEAR) 11 (December 1989): 171. http://dx.doi.org/10.2307/495541.
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Choi, Seong-Woo, Hye-Yeon Kim, Hye-Ran Ahn, Young-Hoon Lee, Sun-Seog Kweon, Jin-Su Choi, Jung-Ae Rhee, et al. "The association of ankle brachial index with left ventricular hypertrophy and left ventricular mass index: the Dong-gu study." Vasa 42, no. 4 (July 1, 2013): 284–91. http://dx.doi.org/10.1024/0301-1526/a000289.
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Background: To investigate the association between ankle-brachial index (ABI), left ventricular hypertrophy (LVH) and left ventricular mass index (LVMI) in a general population. Patients and methods: The study population consisted of 8,246 people aged 50 years and older who participated in the baseline survey of the Dong-gu Study conducted in Korea between 2007 and 2010. Trained research technicians measured LV mass using mode M ultrasound echocardiography and ABI using an oscillometric method. Results: After adjustment for risk factors and common carotid artery intima-media thickness (CCA-IMT) and the number of plaques, higher ABIs (1.10 1.19, 1.20 - 1.29, and ≥ 1.30) were significantly and linearly associated with high LVMI (1.10 - 1.19 ABI: β, 3.33; 95 % CI, 1.72 - 4.93; 1.20 - 1.29 ABI: β, 6.51; 95 % CI, 4.02 - 9.00; ≥ 1.30 ABI: β, 14.83; 95 % CI, 6.18 - 23.48). An ABI of 1.10 - 1.19 and 1.20 - 1.29 ABI was significantly associated with LVH (1.10 - 1.19 ABI: OR, 1.35; 95 % CI, 1.19 - 1.53; 1.20 - 1.29 ABI: OR, 1.59; 95 % CI, 1.31 - 1.92) and ABI ≥ 1.30 was marginally associated with LVH (OR, 1.73; 95 % CI, 0.93 - 3.22, p = 0.078). Conclusions: After adjustment for other cardiovascular variables and CCA-IMT and the number of plaques, higher ABIs are associated with LVH and LVMI in Koreans aged 50 years and older.
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Yu, James B., Pamela R. Soulos, Laura D. Cramer, Kenneth B. Roberts, Jeph Herrin, Arnold L. Potosky, and Cary P. Gross. "Proton radiotherapy for prostate cancer in the Medicare population: Patterns of care and comparison of early toxicity with IMRT." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4651. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4651.
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4651 Background: Proton radiotherapy (PRT) is a costly treatment used for prostate cancer despite little evidence supporting its use. We examined patterns of PRT use in the Medicare program and assessed the short-term toxicity of PRT vs. intensity modulated radiation therapy (IMRT). Methods: Using national Medicare claims from 2008-2009, we identified a sample of prostate cancer patients ages 66-94 who had received PRT or IMRT. We used multivariable logistic regression to identify patient and regional factors associated with receipt of PRT. We searched claims for procedure and diagnosis codes indicative of treatment-related complications and grouped the complications into genitourinary (GU), gastrointestinal (GI), and other complications. To compare the effect of PRT and IMRT on short-term toxicity, we used a Mahalanobis distance approach to match each PRT patient to two IMRT patients, achieving balanced distribution of clinical and sociodemographic characteristics. We compared six-month and one-year outcomes between the two treatment groups using conditional logistic regression. Results: We identified 27,647 men; 421 (2%) received PRT and 27,226 (98%) received IMRT. Patients who received PRT were widely geographically distributed, with some patients traveling >500 miles for treatment. PRT patients were younger, healthier, and of higher socioeconomic status. Although PRT was associated with a significant reduction in GU complications at six-months compared with IMRT (6.1% vs. 12.0%, OR 0.60 [95% CI 0.38-0.96], p=0.03), at one-year post-treatment there was no longer any difference in cumulative complication rates (18.9% vs. 21.9%, OR 0.96 [95% CI 0.61-1.53], p=0.88). There was no significant difference in GI or other complications at six-months or one-year post-treatment. Conclusions: Although PRT remains a scarcely used treatment, some prostate cancer patients traveled great distances for treatment. While PRT was associated with a reduction in six-month GU toxicity, there were no differences in toxicity at one-year. Further study on longer-term effects and other clinical and patient-reported outcomes is needed to inform the widespread application of PRT.
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Caubet, Matthieu, David Pasquier, Aurelie Bertaut, Simon Grobois, Berardino De Bari, Francois Kleinclauss, Antoine Thiery Vuillemin, et al. "The role of whole pelvic nodal radiotherapy compared with prostate bed only radiotherapy after radical prostatectomy for prostate cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 93. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.93.
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93 Background: In international guidelines, target volumes for postoperative radiotherapy (PORT) after radical prostatectomy concern the bed of the prostate and seminal vesicles. The benefit of whole pelvic nodal radiotherapy (WPRT) in the case of PORT remains uncertain. Methods: We reviewed the charts of all patients diagnosed with high-risk prostate cancer after radical prostatectomy who were selected for PORT and treated with adjuvant radiotherapy (n = 242, 43.1%) or early salvage RT (n = 320, 56.9%) between 2002 and 2011. 111 patients (19.8%) who underwent WPRT were compared with 441 patients (80.2%) who had prostate bed radiotherapy only (PBRT). We examined associations between patient, tumor, and treatment characteristics and biochemical progression-free survival (bPFS), disease-free survival (DFS) and overall survival (OS) with uni- and multivariate analyses using Cox models. Acute and late toxicities were also compared between the two groups. Results: We found a significantly lower rate of acute G2+ gastrointestinal (GI) toxicity with PBRT than with WPRT with neither difference in acute G3+ nor on late GI toxicity. Regarding genitoruinary (GU) toxicity, we found no difference in acute G2+ or G3+ toxicity but rates of late G3+ GU toxicity were significantly lower in PBRT (1.55%) than in WPRT patients (p = 0.035). With a median follow-up of 65.2 months [95% CI: 62.8 - 67.9], a deleterious effect of WPRT was observed on OS (HR = 3.27 [95% CI: 1.44 - 7.45], p = 0.009). We found no impact of WPRT on bPFS (HR = 0.79 [95% CI: 0.49 - 1.25], p = 0.31) or DFS (HR = 0.97 [95% CI: 0.63 - 1.49], p = 0.88). Only a positive surgical margin was an independent prognostic factor for better bPFS. Age≥63 years and WPRT (HR = 2.86 [95% CI: 1.20-6.80], p = 0.018) were independent prognostic factors for worse OS. Conclusions: After radical prostatectomy, we found no difference on bPFS or DFS but lower rates of OS with WPRT compared to PBRT. PBRT must remain the standard of care. The results of RTOG NRG Oncology 0534 should shed light on this unresolved issue.
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Kwon, Young Suk, Eric Hsu, Maggie Stein, Alana Christie, Aurelie Garant, Andrew Zhuang Wang, Daniel X. Yang, et al. "Extracranial palliative radiotherapy for metastatic renal cell carcinoma." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): e24156-e24156. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e24156.
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e24156 Background: Radiation therapy (RT) is routinely used for the palliation of metastatic renal cell carcinoma (mRCC) symptoms despite a paucity of literature on RT’s efficacy. Since RCC is considered radioresistant to conventionally fractionated RT, we retrospectively evaluated factors influencing effective symptom palliation with RT for mRCC. Methods: A retrospective review of patients with mRCC between 2011 and 2022 at a high-volume academic radiation center was performed to identify patients with symptomatic extracranial metastatic sites managed with RT. Radiation therapy techniques included three-dimensional conformal RT, intensity-modulated RT, and stereotactic body RT. Symptomatic indications for RT were categorized as pain, neurologic (weakness and numbness), respiratory (hemoptysis and cough), gastrointestinal/genitourinary (GI/GU) bleeding, or multiple. Symptom relief was evaluated from chart reviews at subsequent on-treatment visits or follow-up encounters. Time to symptom alleviation (days) was measured from the RT start date. Descriptive analyses were performed. Results: Of 243 patients included in the study cohort, there were 617 irradiated sites. 560 out of 617 (91.0%) patients were treated for pain, and the other symptoms included neurologic (6.8%), respiratory (3.9%), and GI/GU bleeding (1.5%). The most common RT regimen was 20Gy in 5 fractions (122 lesions; 19.8%) followed by 30Gy in 10 fractions (35 lesions; 5.7%). Symptom relief was observed in 84.9% (95%CI 81.4, 88.1) of patients for pain, 90.8% (95%CI 78.2, 97.6) for neurologic, and 69.9% (95%CI 49.3, 88.0) for respiratory symptoms. The overall proportion of symptom relief was 103/131 (79%) for 20 Gy in 5 fractions versus 27/38 (71%) for 30 Gy in 10 fractions (chi-square P = 0.3). Conclusions: RT is effective for symptom palliation of mRCC. Further studies are required to fully delineate the impact of dose-fractionation and RT modality. [Table: see text]
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Filipek, Małgorzata. "Hiszpania w powie ściach Gordany Kuic." Prilozi za knjizevnost, jezik, istoriju i folklor, no. 76 (2010): 31–44. http://dx.doi.org/10.2298/pkjif1076031f.
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(poljski) Gordana Kuic nale?y do grona tych pisarzy, kt?rym literatura serbska zawdzi?cza obraz Hiszpanii i jej kultury. W siedmiu powie?ciach Miris kise na Balkanu, Cvat lipe na Balkanu, Smiraj dana na Balkanu, Duhovi nad Balkanom, Legenda o Luni Levi, Bajka o Benjaminu Baruhu, Balada o Bohoreti pisarka sk?ada ho?d najbli?szej rodzinie oraz swemu narodowi ?ydom sefardyjskim, kt?rzy wyp?dzeni w 1492 roku z Hiszpanii osiedlili si? na rozleg?ych terenach Imperium Osma?skiego. W ci?gu wiek?w zachowali oni j?zyk i kultur? swojej ojczyzny a dramatyczne do?wiadczenia nie zmieni?y ich pozytywnego stosunku do Hiszpanii. Pisarka ?ledz?c losy bohater?w powie?ci na przestrzeni pi?ciu stuleci (od 1492 do 1991), tworzy obraz, w kt?rym elementy zaczerpni?te z hiszpa?skiej rzeczywisto?ci ??cz? si? ulotnymi wra?eniami zmys?owymi z wywo?ywanymi przez wspomnienia o tym kraju.
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Kwok, Jaime Kirsten, Kevin Martell, Michael Sia, Bimal Bhindi, Tasnima Abedin, Shuang Lu, and Harvey Charles Quon. "Local prostate radiotherapy in metastatic prostate cancer and symptomatic local events." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 111. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.111.
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111 Background: Local prostate radiotherapy (LPRT) is associated with improved overall survival in patients with low metastatic burden (MB) and is now standard of care. However, the role of LPRT in reducing symptomatic local events (SLE) in metastatic prostate cancer (MPC) remains unclear and requires long-term follow-up. The purpose of this study was two-fold: i) identify the risk factors associated with SLE, and ii) evaluate the association between LPRT and SLE in MPC. Methods: We conducted a retrospective, population-based cohort study of patients diagnosed with initial MPC between 2005 and 2016. Patients were identified through the Alberta Cancer Registry and patient, tumour, and treatment characteristics were collected by chart review. Data were linked to physician billing claims between 2004 and 2017 for diagnostic or therapeutic procedures potentially related to genitourinary (GU) and gastrointestinal (GI) SLE including percutaneous nephrostomy (PCN) and ureteric stent insertion (USI), cystoscopy, TURP, TURBT, colonoscopy and proctosigmoidoscopy. Both Andersen-Gill recurrent event and multivariable Cox regression time to first event analyses were conducted to evaluate the effect of LPRT on the occurrence of these procedures. Patients who underwent radical prostatectomy were excluded. LPRT was defined as 40 Gy or higher total dose to the prostate within one year of diagnosis. Patients with a SLE occurring after diagnosis but prior to LPRT were allocated to the control group. MB was defined as per STAMPEDE. Covariates for both models included MB, age at diagnosis, PSA at diagnosis, clinical T- and N-stage, and Gleason score (GS). Results: Of a total cohort of 1363 patients, 745 (54.7%) had high MB and 450 (33%) had low MB. Fifty-four (4%) received LPRT, of which 14.8% had high MB. Of those receiving LPRT, median PSA was 9.4, 79.6% had GS of 8-10, and 59.3% had T3-T4 disease. One or more SLE were observed in 43.5% and 37% of the control and LPRT groups, respectively. Among those with SLE, the median SLE frequency was 2 (interquartile range [IQR], 2-5) and 1 (IQR, 1-2.3) for the control and LPRT groups, respectively. On recurrent event analysis, LPRT was associated with lower risk of composite GU SLE (HR 0.34, 95% CI 0.17-0.67; p = 0.002), PCN and USI (HR 0.20, 95% CI 0.05-0.84; p = 0.027) and cystoscopy (HR 0.38, 95% CI 0.15-0.96; p = 0.041). Risk factors for GU SLE were T4 disease, GS of 8-10 and unknown GS. Risk factors for PCN and USI were T3, TX and N1 disease, GS of 8-10 and unknown GS. On time to first event analysis, there were no statistically significant differences for all outcomes between the control and LPRT groups. MB was not a risk factor for SLE in both analyses. Conclusions: LPRT was associated with lower risk for recurrent GU SLE, PCN and USI, and cystoscopy. The associated benefit in SLE reduction with LPRT warrants further study to determine if this effect is modified by MB and whether there may be a role for LPRT in patients with high MB.
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Moore, Assaf, Zhigang Zhang, Bernard H. Bochner, Timothy F. Donahue, Jonathan E. Rosenberg, Gopa Iyer, Samuel Aaron Funt, et al. "Favorable toxicity of chemoradiation for muscle-invasive bladder cancer in elderly, frail patients." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 507. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.507.
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507 Background: Chemoradiation (CRT) for bladder cancer provides comparable outcomes to radical cystectomy; however, concerns regarding toxicity, particularly in elderly, frail patients limit its utilization. Methods: We identified 150 consecutive patients who underwent definitive CRT for T1-4N0M0 bladder cancer at Memorial Sloan Kettering Cancer Center between 2005 and 2020. Most were men (71.3%), elderly (median age, 77.5 years), had high Charlson Comorbidity Index (CCMI) score (median, 7), were nonsurgical candidates (65.3%), Stage T2 (75.3%) and had a macroscopically complete TURBT (65%). 24% of patients received neoadjuvant platinum-based chemotherapy. Concurrent gemcitabine was used in 98.7%. 116 (77.3%) patients underwent 45Gy to the pelvic lymphatics/whole bladder followed by bladder boost (median total dose, 66.6 Gy) and 34 patients (22.7%) received 55 Gy in 20 fractions to the whole bladder/ urethra only. Fiducial markers for image-guidance were used in 55% (83/150) of cases. Patients were followed post-treatment with toxicity assessment, cytology/cystoscopy and imaging every 3 months year 1, every 6 months for years 2-3 and annually thereafter. Acute (≤3 months) and late ( > = 3 months) gastrointestinal (GI) and genitourinary (GU) toxicities were assessed according to CTCAE v4.0. Complete response (CR) was defined as no evidence of disease at 3-month follow up. Survival outcomes were estimated using the Kaplan-Meier method. Median follow up was 31 months (range, 0-155 months). Results: The majority (94%) completed the prescribed course of radiation. Acute grade 3 GU and GI toxicities occurred in 2% and 5.3% of patients, respectively. No acute grade 4 toxicity was recorded. The most common GU and GI toxicities were radiation cystitis and diarrhea. Late grade ≥2 GU and GI toxicity occurred in 11.2% and 0.7% or cases, respectively. One late grade 4 GI toxicity was recorded (small bowel obstruction 7 months after completion of CRT). 80% (n = 120) of patients achieved a CR. Of complete responders, 30% (36/120) developed recurrent disease at a median time of 13.8 months (range, 3.2- 90.4). Among them, local only vs regional/distant recurrence rates were 72.2% and 27.8%, respectively. Of entire cohort, 40% of patients were alive and 31% had died with no evidence of disease at last follow up. While the estimated 5-year OS was 48% (95% CI, 39%, 59%), the estimated 5-year disease-specific mortality rate was 31% (95% CI, 24%, 40%). On univariate analysis, younger age (p < 0.001), receipt of neoadjuvant chemotherapy (p = 0.006) and surgical candidacy (p = 0.041) were predictive of improved OS. On multivariate analysis, only younger age was significant (p = 0.006). Conclusions: CRT had a favorable toxicity profile and encouraging cancer control outcomes in this unselected, mostly elderly and frail patient cohort.
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Choi, Seong-Woo, Sun-Seog Kweon, Young-Hoon Lee, So-Yeon Ryu, Hae-Sung Nam, and Min-Ho Shin. "Association of liver fibrosis biomarkers with overall and CVD mortality in the Korean population: The Dong-gu study." PLOS ONE 17, no. 12 (December 13, 2022): e0277729. http://dx.doi.org/10.1371/journal.pone.0277729.
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This study evaluated the associations of liver fibrosis biomarkers [non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 (FIB-4), aspartate aminotransferase/platelet ratio index (APRI), and BARD score] with mortality in Korean adults aged ≥50 years. We analyzed 7,702 subjects who participated in Dong-gu Study. The associations of liber fibrosis biomarkers with mortality were investigated using Cox proportional hazards models. Overall mortality increased with increasing NFS level [adjusted hazard ratio (aHR) 4.3, 95% confidence interval (CI) 3.3–5.5 for high risk vs. low risk], increasing FIB-4 level (aHR 3.5, 95% CI 2.9–4.4 for high risk vs. low risk), and increasing APRI level (aHR 3.5, 95% CI 2.1–5.8 for high risk vs. low risk) but not with BARD score. The Harrell’s concordance index for overall mortality for the NFS and FIB-4 was greater than that for the APRI and BARD score. In conclusion, NFS, FIB-4, and APRI showed a significant relationship with the overall mortality, and NFS and FIB-4 showed a significant relationship with the CVD mortality after adjustment for covariates. In addition, the NFS and FIB-4 were more predictive of overall mortality than the APRI and BARD score in Korean adults aged ≥50 years.
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Benziane-Ouaritini, Nicolas, Thomas Zilli, Antoine Giraud, Gianluca Ingrosso, Marco Di Staso, Fabio Trippa, Emmanuel Meyer, et al. "Salvage radiotherapy guided by functional imaging for macroscopic local recurrence following radical prostatectomy: A multicentric retrospective study." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 251. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.251.
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251 Background: For prostate cancer (Pca), salvage radiotherapy (sRT) with or without androgen deprivation therapy (ADT) is currently the only curative treatment option in case of post-radical prostatectomy (RP) biochemical relapse (BR). Functional imaging techniques have shown that macroscopic recurrence (MR) in the prostate bed (PB) are frequent. In this study, we aimed to assess efficacy and safety of sRT in patients with MR inside the PB proven by functional imaging. Methods: A multicenter retrospective study was conducted in 16 European centers. Patients were included if they displayed BR after RP for Pca, with MR only in the PB proven by functional imaging. All patients had to be eligible for sRT. The overall population was divided along 4 groups according to the delivered treatment: dose escalation on MR (A), dose escalation on PB (B), double dose escalation MR+PB (C), no dose escalation (D). The primary endpoint was progression-free survival (PFS). Secondary outcomes included the metastasis-free survival (MFS), biochemical PFS (bPFS) and overall survival (OS). Grade ≥2 genito-urinary (GU) and gastro-intestinal (GI) acute and late toxicities were collected. Results: Between January 2000 and December 2019, 363 patients with isolated MR after RP for Pca were treated by sRT. The median pre-sRT PSA level was 0.63ng/mL (range, 0.2-23.6). At the time of BR, 266 (73%) patients presented MR in the PB proven by magnetic resonance imaging, and 110 (30%) by positron emission tomography. The median follow-up was 53.6 months (range, 47.52; 58.32). The 5-year PFS and MFS were 70% (95%CI [63.8-75.4]) and 83.7% (95%CI [78.4-87.8]), respectively. Grade ≥2 GU and GI late toxicities were found in 43 (12%) and 11 (3%) patients, respectively. A 5-year PFS benefit was highlighted for groups A, B and C (313 patients) when the MR dose was ≥72Gy: 72,8% (95%CI 64.6-79.4) versus 60.3% (95%CI 48,4-70,3), p = 0.03. Conclusions: In a modern series integrating functional imaging data, we confirmed that sRT is effective in the event of MR inside the PB, with an acceptable toxicity profile. Prospective data should further investigate the correlation between MR-targeted dose escalation and PFS.
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Niazi, Tamim, Abdenour Nabid, Redouane Bettahar, Linda S. Vincent, Andre-Guy Martin, Marjory Jolicoeur, Michael Yassa, et al. "Hypofractionated, dose escalation radiotherapy for high-risk prostate cancer: The primary endpoint of a group led phase III trial. (PCS5)." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 123. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.123.
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123 Background: The low α\β ratio of prostate cancer (PCa), 1.5-2, suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of hypofractionated radiation treatment (HFRT). Most available data of moderate HFRT have focused on low, intermediate and/or mixed risk groups. We therefore conducted the first randomized trial of moderately HFRT in high-risk PCa patients and present the primary safety analysis of side effects at 2 years. Methods: We conducted a Canadian multi-centric phase III trial of conventional fractionated radiation therapy (CFRT) vs. intensity-modulated HFRT in men with high-risk PCa as per NCCN definition. From February 2012 to March 2015, 329 patients were randomized in a 1:1 ratio to receive either CFRT or HFRT. All patients received neo-adjuvant, concurrent and adjuvant androgen suppression, with a median duration of 24 months. CFRT consisted of 76 Gy in 2 Gy per fraction to the prostate where 46 Gy was delivered to the pelvic lymph nodes. HFRT consisted of concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate and 45 Gy, in 1.8Gy per fraction to the pelvic lymph nodes. The primary endpoint was to compare the toxicities at 6 months and at 24 months using the CTCAE v.4. Results: Of the329 patients, 164 were randomized to HFRT and 165 to CFRT. The minimum, median and maximum follow-up were 24, 40 and 60 months respectively. At 24 months, 12 patients in the CFRT arm and 15 patients in the HFRT arm had grade 2 or worse gastrointestinal (GI)-related adverse events (HR:1.32 [0.62.2.83] 95% CI; P=NS). Similarly, 11 patients in the CFRT arm and 3 patients in HFRT arm had grade 2 or higher genitourinary (GU) toxicities (HR:0.26 [0.07-0.94] 95% CI; P=0.037). In the HFRT arm, there were 3 grade 3 GI and one grade 3 GU related toxicities. In the CFRT arm there were 3 grade 3 GU and no grade 3 GI related toxicities. There were no grade 4 toxicities in either arm. Conclusions: This is the first hypofractionated dose escalated radiotherapy study in high-risk PCa patients treated with contemporary radiation and androgen suppression. Our results indicate that moderate HFRT to high risk PCa patients is equally well tolerated as CFRT at 2 years. Clinical trial information: NCT01444820.
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Khosla, Atulya Aman, Nitya Batra, Mohammad Arfat Ganiyani, Shreyas S. Bellur, Ahmad Ozair, Karan Jatwani, Rohit Singh, et al. "Impact of race and ethnicity on financial toxicity in patients with genitourinary cancers." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 11077. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.11077.
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11077 Background: Genitourinary (GU) cancers contribute substantially to the cost of healthcare in the United States (US). While advancements in cancer treatment have improved patient outcomes, disparities in healthcare costs persist, exacerbating the financial burden on vulnerable populations. We sought to investigate the disparities in costs of inpatient hospitalizations among patients with GU cancers in the US. Methods: Eligible adult GU cases from the Medical Expenditure Panel Survey (2019–2021) were included in this study. ICD-10 CM codes were utilized to identify renal cell, prostate, urothelial, testicular, and penile cancers. In addition to the total hospital inpatient (IP) facility expenditure, questions about ability to pay for healthcare were included in the analysis after accounting for the complex survey design and sampling weights. Results: The study included a weighted sample size of 9,061,181 (wt SE = 538,502) GU cases in the US between 2019 and 2021. The mean (95% CI) age of the sample was 71.6 (70.7, 72.5) years. The sample consisted of 7.9% Hispanics, 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% Asian or other races (NHA). In 2021, NHB participants reported the lowest annual family income of $51742 (18932, 106185), followed by Hispanics with $65233 (24314, 95859), and NHW with 82035 (36298, 158863). A greater proportion of the elderly NHW population was insured compared to NHB and Hispanics (44.9% vs. 32.5% vs. 19.5%), respectively. Of note, NHB patients had worse self-perceived physical and mental health compared to NHW and Hispanics, with 18.1% reporting fair or poor physical and mental health (vs. 8.1% and 14.3%, respectively). NHB participants reported higher rates of familial financial hardship (2019: 10.2% vs. 3.6%; 2020: 6.2% vs. 3.5%; 2021: 7.1% vs. 3.3%) or not being able to afford medical care (2019: 7.2% vs. 2.1%; 2020: 2.5% vs. 0.6%; 2021: 1.9% vs. 1.7%) when compared to NHW. Overall, mean total hospital IP facility expenses were: Hispanics = $2873.30 (1434.49, 4312.12); NHW = $4213.81 (3241.05, 5186.56); and NHB = $5199.99 (2842.93, 7557.05). After accounting for sample weights, gender, family income, age, insurance status, and survey year, Poisson regression analysis showed significant differences between different racial groups. Hispanics were less likely (𝛽=-0.48; p<0.0001), while NHB (𝛽=0.152; p<0.0001) and NHA (𝛽=0.48; p<0.0001) were more likely to spend for an IP hospitalization when compared to NHW (ref.). Conclusions: Our data revealed racial disparities in the costs of inpatient hospitalizations, highlighting potential financial toxicity among patients with GU cancers. Additional investigation is warranted to elucidate factors contributing to these inequities, aiming to optimize cancer management and alleviate financial burdens. Addressing these disparities is crucial to prioritize equitable healthcare access and promote systemic change.