Changing Role of PET/CT in Cancer Care With a Focus on Radiotherapy

Vijayakumar, Srinivasan; Yang, Johnny; Nittala, Mary R; Velazquez, Alexander E; Huddleston, Brandon L; Rugnath, Nickhil A; Adari, Neha; Yajurvedi, Abhay K; Komanduri, Abhinav; Yang, Christopher; Duggar, William N; Berlin, William P; Duszak, Richard; Vijayakumar, Vani

doi:10.7759/cureus.32840

Cited by 6 publications

(8 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the improvement in the outcomes of cervix cancer was achieved with the introduction of chemoradiotherapy, four major advances in the radiotherapeutic management of non-distant-metastatic cervix cancer have occurred. These are a) the recognition of the importance of staging using PET/CT and its use in external RT planning [ 31 ], b) the use of IMRT in the EBRT improving the therapeutic ratio, c) the use of MRI-based brachytherapy [ 13 ], and d) finally, the observation that the RTT is still important despite the other improvements listed above. The last item was well documented in the recent paper from the University of Pittsburgh Medical Center’s retrospective analysis that looked at the importance of high HRCTV volumes in influencing poorer outcomes despite delivering higher doses with brachytherapy, that became possible with the use of MRI-based brachytherapy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Patient and System Factors on the Radiotherapy Treatment Time in the Treatment of Non-metastatic Cervical Cancer Patients in a Rural and Resource-Lean State’s Safety-Net Hospital: Benefits of Strategic Planning

Vijayakumar¹,

Nittala²,

Duggar³

et al. 2023

Cureus

Self Cite

View full text Add to dashboard Cite

Objective To decrease radiotherapy treatment time (RTT), measured from the day of initiation of radiotherapy to the day of its completion, specific strategies were initiated in early 2020 in the only academic safety-net medical center in a rural, resource-lean state. The factors that can succeed and those that need further improvements were analyzed in this initial assessment phase of our efforts to shorten the RTT. Methods This is an analysis of 28 cervix cancer patients treated with magnetic resonance imaging (MRI)-guided brachytherapy (February 2020-November 2021). The relationship between independent and dependent variable were analyzed by simple linear regression, and p-values ≤ 0.05 were considered statistically significant. SPSS software version 28.0 (IBM, Armonk, NY, USA) was used for statistical analysis. Results Two RTT groups (≤ 60 (32.1%) vs . > 60 days {67.9%}) with median RTT of 68 days (range, 51 to 106 days) were analyzed. Caucasians represented 66.7% of the RTT ≤ 60 days group. Four ‘issues’ were identified that increased the RTT: non-compliance, learning curve (early days of implementation of MRI-guided brachytherapy in the department), stage IV comorbidities, and with more than one issue mentioned; 77.8% with no issues had ≤ 60 days RTT vs . 26.3% for the > 60 days group. The breakdown of the no-issues factor by calendar year showed the RTT of ≤ 60 days was achieved higher in 2021 (85.7% vs. 20.0%; p=0.023) compared to 2020. For this entire cohort, the RTT of ≤ 60 days was achieved higher in 2021 (50.0% vs. 8.3%; p=0.019) compared to 2020. Data also showed improvement in RTT of ≤ 60 days for every sequential six months. ‘Non-compliance’ and ‘learning curve’ were the most important factors among patients having the longest RTTs. Conclusion The RTT can be further decreased. As a result of this preliminary analysis of the our strategic planning approach of ‘circular’ “See it,” “Own it,” “Solve it,” and “Do it” and go back to the first step again, we plan to implement the following strategies in the immediate future to shorten the RTTs further and, in turn, improve our overall outcomes (local/regional control, disease-free survival, and overall survival): (a) Interdigitate MRI-guided brachytherapy during external beam radiotherapy (EBRT); patients who can not get the interdigitated brachytherapy procedures performed during the course of EBRT for any reason will receive two brachytherapy procedures per week; (c) attempt to add a cervix cancer care navigator to our staff to help patients having social issues, thus leading to compliance problems; (d) finally, in a year or two after these new strategic implementations, the RTT data will be reanalyzed.

show abstract

Section: Discussionmentioning

confidence: 99%

The Influence of Patient and System Factors on the Radiotherapy Treatment Time in the Treatment of Non-metastatic Cervical Cancer Patients in a Rural and Resource-Lean State’s Safety-Net Hospital: Benefits of Strategic Planning

Vijayakumar¹,

Nittala²,

Duggar³

et al. 2023

Cureus

Self Cite

View full text Add to dashboard Cite

show abstract

“…One small group can address only some of the issues. So, the current series of papers aims to show how precision population cancer medicine (PPCM) and PPM, as defined by us previously [ 8 ] can make a difference. Even in this small step to address the vast challenges, we aim to inform and educate students about healthcare improvement - medicine, nursing, pharmacy, health administration, public health, population health, political science, and so on [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…PM tailors the treatment to the individual rather than just the stage of the disease. PM focuses on the specificity of the patient’s genes, environment, and lifestyle to personalize the treatment, aiming for improved outcomes [ 8 ]. To take patient care a step further, we will incorporate population-level assessment, screening, and prevention through the lens of PPM to create a comprehensive view of CC.…”

Section: Introductionmentioning

confidence: 99%

“…PPM utilizes a larger-scale approach than PM by bringing in population data, epigenetics, and telehealth methods, which were not previously appreciated in the original PM. PPM will be able to assess high-risk individuals in the population, detect cancers earlier, and be utilized to create more effective treatment plans [ 8 ]. In support of using PPM, genomics, the “cornerstone of precision medicine studies,” has been used successfully to treat patients, for example, by matching drugs to the patients’ genomes to produce improved responsiveness to the medication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Precision Population Cancer Medicine in Cancer of the Uterine Cervix: A Potential Roadmap to Eradicate Cervical Cancer

Nittala,

Yang,

Velazquez

et al. 2024

Cureus

Self Cite

View full text Add to dashboard Cite

With the success of the Human Genome Project, the era of genomic medicine (GM) was born. Later on, as GM made progress, there was a feeling of exhilaration that GM could help resolve many disease processes. It also led to the conviction that personalized medicine was possible, and a relatively synonymous word, precision medicine (PM), was coined. However, the influence of environmental factors and social determinants of diseases was only partially given their due importance in the definition of PM, although more recently, this has been recognized. With the rapid advances in GM, big data, data mining, wearable devices for health monitoring, telemedicine, etc., PM can be more easily extended to population-level health care in disease management, prevention, early screening, and so on.and the term precision population medicine (PPM) more aptly describes it. PPM’s potential in cancer care was posited earlier,and the current authors planned a series of cancer disease-specific follow-up articles. These papers are mainly aimed at helping emerging students in health sciences (medicine, pharmacy, nursing, dentistry, public health, population health), healthcare management (health-focused business administration, nonprofit administration, public institutional administration, etc.), and policy-making (e.g., political science), although not exclusively. This first disease-specific report focuses on the cancer of the uterine cervix (CC). It describes how recent breakthroughs can be leveraged as force multipliers to improve outcomes in CC - by improving early detection, better screening for CC, potential GM-based interventions during the stage of persistent Human papillomavirus (HPV) infection and treatment interventions - especially among the disadvantaged and resource-scarce populations. This work is a tiny step in our attempts to improve outcomes in CC and ultimately eradicate CC from the face of the earth.

show abstract

“…Furthermore, PET/CT aids radiotherapy planning by incorporating tumor volumetric and radiobiological properties. These advancements have contributed to better patient outcomes, including survival rates, disease management, and quality of life [ 13 ]. A practical example could be the application of PET/CT in non-small cell lung cancer (NSCLC) where an accurate staging is the key for optimal patient management and the selection of treatment strategies.…”

mentioning

confidence: 99%