Showing papers by "Andrea Bezjak published in 2007"
TL;DR: In-room volumetric imaging, such as CBCT, is essential for target localization accuracy in lung stereotactic body radiotherapy and imaging that relies on bony anatomy as a surrogate of the target may provide erroneous results in both localization and verification.
Abstract: Purpose: Cone-beam computed tomography (CBCT) in-room imaging allows accurate inter- and intrafraction target localization in stereotactic body radiotherapy of lung tumors Methods and Materials: Image-guided stereotactic body radiotherapy was performed in 28 patients (89 fractions) with medically inoperable Stage T1-T2 non–small-cell lung carcinoma The targets from the CBCT and planning data set (helical or four-dimensional CT) were matched on-line to determine the couch shift required for target localization Matching based on the bony anatomy was also performed retrospectively Verification of target localization was done using either megavoltage portal imaging or CBCT imaging; repeat CBCT imaging was used to assess the intrafraction tumor position Results: The mean three-dimensional tumor motion for patients with upper lesions ( n = 21) and mid-lobe or lower lobe lesions ( n = 7) was 42 and 67 mm, respectively The mean difference between the target and bony anatomy matching using CBCT was 68 mm (SD, 49, maximum, 303); the difference exceeded 139 mm in 10% of the treatment fractions The mean residual error after target localization using CBCT imaging was 19 mm (SD, 11, maximum, 44) The mean intrafraction tumor deviation was significantly greater (53 mm vs 22 mm) when the interval between localization and repeat CBCT imaging ( n = 8) exceeded 34 min Conclusion: In-room volumetric imaging, such as CBCT, is essential for target localization accuracy in lung stereotactic body radiotherapy Imaging that relies on bony anatomy as a surrogate of the target may provide erroneous results in both localization and verification
319 citations
TL;DR: A clinicians' guide may be provided for estimating the minimal important difference (MID) when empiric estimates are not available, and what magnitude of change in a patient‐reported outcome score is clinically meaningful is determined.
Abstract: BACKGROUND.
The goal of this study was to determine what magnitude of change in a patient-reported outcome score is clinically meaningful, so a clinicians' guide may be provided for estimating the minimal important difference (MID) when empiric estimates are not available.
METHODS.
Consecutive laryngeal cancer patients (n = 98) rated their quality of life (QOL) relative to other patients. These comparisons were contrasted with arithmetic differences in scores on the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scale, Functional Assessment of Cancer Therapy-General (FACT-G) scale, 2 utility measures (the time tradeoff [TTO] and Daily Active Time Exchange [DATE]), and performance status (Karnofsky) scores.
RESULTS.
The FACT-HN TTO 5% (95% CI, 0%–11%) and 6% (95% CI, 0%–10%); DATE 5% (95%CI, 2%–9%) and 14% (95% CI, 0%–5%); Karnofsky 4% (95% CI, 1%–6%) and 10% (95% CI, 7%–13%). In each case, the minimal important difference (MID) was about 5% to 10% of the instrument range.
CONCLUSIONS.
One rule of thumb for interpreting a difference in QOL scores is a benchmark of about 10% of the instrument range. Patients appear to be more sensitive to favorable differences, so an improvement of 5% may be meaningful. This simple benchmark may be useful as a rough guide to meaningful change. Cancer 2007. © 2007 American Cancer Society.
250 citations
TL;DR: The presence of N2 disease negatively affects the prognosis of patients with malignant pleural mesothelioma and Mediastinoscopy seems to have a limited role in patient selection for extrapleural pneumonectomy.
75 citations
TL;DR: Chemoradiation before pulmonary resection in carefully selected patients with surgically resectable stage IIIA (N2) non-small cell lung cancer can lead to improved overall and disease-free survival.
71 citations
TL;DR: Paracentesis provides symptom relief that can be measured by existing questionnaires as well as future clinical trials of symptomatic ascites, and the QLQ-C30 or the EORTC Core Quality of Life Questionnaire with the addition of the 26-item pancreatic cancer module could be used.
Abstract: Symptomatic malignant ascites is a problem for patients with advanced intra-abdominal malignancy. Although the goal of paracentesis, the most common therapeutic intervention, is symptom palliation, the best method of assessing symptom improvement is unknown. The aim of this study was to assess the ability of existing symptom and quality-of-life questionnaires to detect change in symptoms after paracentesis. Patients with symptomatic ascites completed four questionnaires before and 24 hours after paracentesis. These tests were Edmonton Symptom Assessment System–Ascites Modification (ESAS:AM), Memorial Symptom Assessment Scale–Short Form, European Organization for the Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), and the EORTC Core Quality of Life Questionnaire, 26-item pancreatic cancer module (QLQ-PAN26). Sensitivity, validity, reliability, and responsiveness of the questionnaires were evaluated. Sixty-one patients completed the baseline and 44 the follow-up questionnaire. Most patients had ovarian (41%) or gastrointestinal cancer (25%); Eastern Cooperative Oncology Group performance status was 2 (26%) and 3 (49%). Patients reported major symptoms at baseline; symptom scores were highest for the clinically recognized symptoms of ascites. Most patients (78%) reported that their symptoms improved after paracentesis. All questionnaires showed strong sensitivity, validity, and reliability. Subscales that included the most distressing symptoms were most responsive; great improvement was seen in abdominal bloating (42% to 54%), anorexia (20% to 37%), dyspnea (33% to 43%), insomnia (29% to 31%), fatigue (14% to 17%), and mobility (25%). The amount of fluid removed (median, 3.5 L; range, .3% to 9.7 L) did not correlate with symptom improvement (r = .29, P = −.10). Paracentesis provides symptom relief that can be measured by existing questionnaires. For future clinical trials of symptomatic ascites, the QLQ-C30 and the ESAS:AM together, or the QLQ-C30 with the addition of the QLQ-PAN26 ascites and abdominal pain subscales could be used.
42 citations
28 citations
TL;DR: A randomized study to compare symptom response between the two treatment arms, and a prospective longitudinal study to obtain information on symptom response and outcome regardless of the treatment given.
22 citations
7 citations
5 citations
TL;DR: The overall survival of pts contributing QOL data, and the effect of adjuvant chemotherapy, was not different from the entire study population.
Abstract: 7585 Background: Adjuvant chemotherapy for early stage NSCLC is now standard of care, but its impact on QOL is not known. We report the final QOL analysis of JBR.10, a North American intergroup ran...
4 citations
TL;DR: A total of 60 patients were suitable candidates for tri-modality therapy for malignant pleural mesothelioma between 01/2001 and 01/2007 and three patients died within 30 days of surgery.
Abstract: 7708 Background: Examine the results of tri-modality therapy for malignant pleural mesothelioma (MPM). Methods: Protocol consisted of induction cisplatin-based chemotherapy, followed by extrapleura...
TL;DR: A pooled analysis from two randomized trials, whole brain radiation therapy (RT) plus MGd prolonged time to neurologic progression (TNP) in NSCLC patients (pts) with brain metastases (BM).
Abstract: 2010 Background: In 2 randomized trials, whole brain radiation therapy (RT) plus MGd prolonged time to neurologic progression (TNP) in NSCLC patients (pts) with brain metastases (BM). In this repor...