Survival impact of radiotherapy interruption in nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis

Yao, Ji‐Jin; Fan, Zhang; Gao, Tian; Zhang, Wangjian; Lawrence, Wayne R.; Zhu, Bao Ting; Zhou, Guan Qun; Ma, Jingfei; Wang, Si Yang

doi:10.1016/j.radonc.2018.10.018

Cited by 33 publications

(26 citation statements)

References 20 publications

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“…Strict adherence to therapy protocol and timelines should be aimed for, as far as medically reasonable and technically possible, so treatment completion can be achieved without major interruptions. This is supported by literature data and proven for several entities including NSCLC (15)(16)(17)(18)(19). As descriptive analysis demonstrates, approximately one quarter of patients had a major interruption of radiation therapy.…”

Section: Discussionsupporting

confidence: 65%

Consolidation Immunotherapy After Platinum-Based Chemoradiotherapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer—Cross-Sectional Study of Eligibility and Administration Rates

et al. 2020

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IntroductionThe PACIFC trial demonstrated a significant benefit of durvalumab consolidation immunotherapy (CIT) after definitive platinum-based chemoradiotherapy (P-CRT) for survival in stage III non-small cell lung cancer (NSCLC). It is unknown how many patients are eligible in clinical practice to receive CIT according to PACIFIC criteria compared to real administration rates and what influencing factors are.Patients and MethodsWe analyzed 442 patients with unresectable stage III NSCLC who received P-CRT between 2009 and 2019 regarding CIT eligibility rates according to PACIFIC criteria and administration rates since drug approval.ResultsSixty-four percent of 437 patients were male, median age was 63 years [interquartile range (IQR): 57–69]. The most common histologic subtypes were adenocarcinoma (42.8%) and squamous cell carcinoma (41.1%), most tumors were in stage IIIB (56.8%). Mean PD-L1 tumor proportion score (TPS) was 29.8% (IQR: 1–60). The median total RT dose was 60 Gy (IQR: 60–66). Platinum component of P-CRT was evenly distributed between cisplatin (51.4%) and carboplatin (48.6%). 50.3% of patients were eligible for CIT according to PACIFIC criteria. Observed contraindications were progressive disease according to RECIST (32.4%), followed by a PD-L1 TPS < 1% (22.3%), pneumonitis CTCAE ≥ 2 (12.6%) and others (4.9%). One year after drug approval, 85.6% of patients who were eligible according to PACIFIC criteria actually received CIT. Time interval between chemotherapy start and radiation therapy start (OR 0.9, 95% CI: [0.9; 1.0] p = 0.009) and probably cisplatin as platinum-component of P-CRT (OR 1.5, 95% CI: [1.0; 2.4] p < 0.061) influence CIT eligibility. Highly positive PD-L1 TPS (≥50%; (OR 2.4, 95% CI: [1.3; 4.5] p = 0.004) was associated to a better chance for CIT eligibility.ConclusionEighty-five percent of potentially eligible patients received CIT one year after drug approval. Fifty percent of patients did not meet PACIFIC criteria for durvalumab eligibility, this was mainly caused by disease progression during platinum-based CRT, followed by therapy-related pneumonitis and PD-L1 TPS < 1% (in view of the EMA drug approval).

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Section: Discussionsupporting

confidence: 65%

Consolidation Immunotherapy After Platinum-Based Chemoradiotherapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer—Cross-Sectional Study of Eligibility and Administration Rates

et al. 2020

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“…HNSCC usually has a high proliferation rate and it is also associated with a significant tumor-associated symptom burden. Therefore, delay to initiate oncologic treatments or applying treatment interruptions can cause disease progression and may negatively impact survival outcomes [8][9][10]. Although the pandemic scenario is new, the risk of mortality due to COVID-19 is lower than the risk of cancer-related death [11].…”

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confidence: 99%

Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic

Chaves

Castro²,

Marta

et al. 2020

Oral Oncology

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Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic On January 30, 2020, the World Health Organization formally announced that the novel coronavirus disease (COVID-19) caused by SARS-CoV-2 is a worldwide health emergency. Subsequently, all National Health Systems and each medical center faced the exceptional emergency and severe changes in their organizations. Consequently, there were various implications that needed to be addressed for oncology patients. In this sense, there are some practical and important issues in the management of head and neck cancer patients: (i) they are usually older and usually present with medical comorbidities (e.g., COPD and other tobacco-related diseases) that are associated with a higher risk of severe complications associated with COVID-19; (ii) high risk of SARS-CoV-2 exposure (transportation, daily radiation fractions, multiple consultations with multidisciplinary team members); (iii) cancer treatment can potentially and theoretically increase the risk of more severe complications of COVID-19 [1]. Of interest, the main risk factors for head and neck squamous cell carcinoma (HNSCC), tobacco and alcohol, also increase the risk for COVID-19 infection. One Chinese study reported an increased risk of cancer-related deaths associated with notorious difficulties of access to oncologic care. In addition, a nationwide analysis in China indicated that the risk of severe respiratory complications leading to admission to the intensive care unit, invasive ventilation, or death was much higher in cancer patients than in patients without cancer (39% vs. 8%, p = 0.0003). Moreover, patients who underwent chemotherapy or surgery in the past month had a numerically higher risk of clinically severe events than did those not receiving chemotherapy or surgery, irrespective of age, smoking history or co-morbidity (odds ratio 5.34, p = 0.0026) [2-5]. The majority of hospitals will be treating thousands of COVID-19 patients in the next few weeks and thus, there is an urgent need to preserve patient and staff safety. For this reason, the Center for Diseases Control (CDC) in the United States recommends that healthcare facilities interrupt elective care and restrict their activities to providing urgent and emergency visits and procedures. It is recommended that all elective and non-time sensitive procedures and admissions must be rescheduled [6]. There is a critical need to share skills and expertise to propose recommendations for the diagnosis and treatment of HNSCC patients throughout the COVID-19 pandemic. As healthcare professionals and HNSCC experts, we aim to offer emergency guidelines aiming to reduce the risk of patient harm, by reducing their risk of exposure to SARS-CoV-2, without compromising their treatment and outcome. As a disclaimer, this is a general guideline and the following recommendations are suggested to help the multidisciplinary teams in the diagnosis and treatment of HNSCC patients, considering local constraints...

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“…(4,31,32) Treatment package time has signi cant prognostic impact in HNSCC patient outcomes; and timeliness of care delivery is regarded as a major quality metrics of oncologic care. (1,3,(33)(34)(35)(36) This study employs HNSCC as a model to estimate the impact of COVID-19 pandemic on its worldwide cancer mortality considering the reduction of medical care volume during the outbreak. The mortality of those patients with HNSCC is closely related to presenting stage and also to longer time to treatment initiation, both affected when attention is diverted from cancer care.…”

Section: Discussionmentioning

confidence: 99%

The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying – the head and neck cancer model

Matos

Forster

Marta

et al. 2020

Preprint

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Purpose: The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time to treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. Methods: An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. Results: The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time to treatment initiation. Conclusions: This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.

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Survival impact of radiotherapy interruption in nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis

Cited by 33 publications

References 20 publications

Consolidation Immunotherapy After Platinum-Based Chemoradiotherapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer—Cross-Sectional Study of Eligibility and Administration Rates

Consolidation Immunotherapy After Platinum-Based Chemoradiotherapy in Patients With Unresectable Stage III Non-Small Cell Lung Cancer—Cross-Sectional Study of Eligibility and Administration Rates

Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic

The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying – the head and neck cancer model

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