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Background To assess correlation of pretreatment specific growth rate (SGR) value of 0.43 × 10‐2 with overall and failure‐free survival of patients with early‐stage non‐small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Methods A retrospective chart review of 160 patients with pathologically confirmed stage I NSCLC treated with SBRT between June 2010 and December 2012 in a large, tertiary cancer institute was undertaken. Both diagnostic and archived planning CT were uploaded to the treatment planning system to determine tumor volume at diagnosis (GTV1) and planning time (GTV2). The time (t) between both CTs was recorded. SGR was calculated using GTV1, GTV2, and t. The median SGR (0.43 × 10‐2) from our previous data was used to group patients into low and high SGR cohorts. Log‐rank test was used to compare overall (OS) and failure‐free survivals (FFS) of SGR groups. Results The median time interval between diagnostic and planning CT scans was 87 days. The median OS was 38 and 66 months for high and low SGR cohorts, respectively (P = 0.03). The median FFS was 27 and 55 months for high and low SGR cohorts, respectively (P = 0.005). High SGR (P, We demonstrated that tumor growth rate (GR) predicts treatment outcome in early‐stage lung cancer patients treated with SBRT. We used specific growth rate (SGR) as a metric for pretreatment GR and its median (0.43 × 10‐2) to group patients into high and low SGR cohorts. In this study, the same median SGR was validated in an independent dataset at a different cancer institution. Patients with high SGR tumors consistently had significantly lower survival and higher regional failure.

To evaluate the implementation of a cervix cancer–specific patient-reported outcome measure, the European Organization for Research and Treatment of Cancer Quality of Life Cervical Cancer module (EORTC QLQ-CX24), into gynecologic oncology clinics. This was a prospective, multi-institutional, cross-sectional study involving cervix cancer patients previously treated with curative intent radiotherapy who were attending routine follow-up appointments. Between January 2017 and August 2018, eligible patients were approached to complete the EORTC QLQ-CX24 prior to their clinical encounter and then review it with their oncologist. Patient and oncologist experience was evaluated using Feedback Questionnaires following the encounter. Descriptive statistics were used to summarize the results of the EORTC QLQ-CX24 and Feedback Questionnaires. Open-ended questions within the Feedback Questionnaires were analyzed to identify themes. Eighty-four patients consented to participate in the study. Of these, 80 (95.2%) completed the EORTC QLQ-CX24 and 76 (90.4%) completed both the EORTC QLQ-CX24 and the Feedback Questionnaires. There were high rates of completion for most items within the EORTC QLQ-CX24 (93–98%), except for items pertaining to vaginal symptoms and sexual health (34–35%). All eligible oncologists participated (n = 9). Overall, patients and oncologists positively endorsed use of the questionnaire during clinical encounters. The majority of patients (80%) and oncologists (89%) reported use of the questionnaire improved communication, including discussion of sensitive topics. Interestingly, only a minority of patients and oncologists stated a perceived preference for electronic completion (18% and 44%, respectively). Implementation of the EORTC QLQ-CX24 in gynecologic oncology clinics was feasible and acceptable according to patients and oncologists.

Objective: To evaluate health care professional (HCP) documentation of elevated patient-reported symptoms and subsequent intervention in gynecologic oncology clinics. Methods: This was a retrospective chart review of gynecologic oncology patients within a single institution. Prior to their clinical encounter, patients complete the validated Edmonton Symptom Assessment System revised (ESAS-r) questionnaire. Patients with any ESAS-r symptom score ≥4 (moderate-severe) were eligible for analysis. A stratified sampling method was used: 100 patients were randomly selected with 20 patients per year from 2012 to 2016. Patient, tumor and treatment characteristics were extracted from medical records. Health care provider (HCP) documentation of elevated symptoms and subsequent intervention were evaluated. Descriptive statistics were used to report symptom prevalence, HCP documentation and intervention. Fisher’s exact test evaluated documentation and intervention rates according to symptom severity and total ESAS-r score. Results: Between January 2012 and December 2016, 5849 patients completed the ESAS-r. Symptoms scores were ≥ 4 in 3216 patients (55%). In our sample of 100, ovarian (42%) and endometrial (34%) malignancies were most common. Median age was 55 years (range 47-63). Median ESAS-r score was 24 (range: 5-84), with tiredness being the most prevalent symptom reported by patients. HCP documented at least one elevated symptom in 50 patients (50%), most commonly for pain (71%) and least commonly for nausea (4%). Subsequent interventions were offered to only 32 patients (32%), most commonly for pain (56%). Higher median total ESAS-r score was associated with higher rate of documentation (p=0.004) and higher rate of intervention (pConclusions: A significant proportion of gynecologic oncology patients report symptom that should prompt an intervention. However, HCPs documented symptoms in only half of patients and reported interventions in only one third. These results highlight gaps and opportunities for improving symptom screening and response in the “real-world” setting.

Brain metastases (BM) are the most common intracranial neoplasm and represent a major clinical challenge across many medical disciplines. The incidence of BM is increasing, largely due to improvements in primary disease therapeutics conferring greater systemic control, and advancements in neuroimaging techniques and availability leading to earlier diagnosis. In recent years, the landscape of BM treatment has changed significantly with the advent of personalized targeted chemotherapies and immunotherapy, the adoption of focal radiotherapy (RT) for higher intracranial disease burden, and the implementation of new surgical strategies. The increasing permutations of options available for the treatment of patients diagnosed with BM necessitate coordinated care by a multidisciplinary team. This review discusses the current treatment regimens for BM as well as examines the salient features of a modern multidisciplinary approach.

AimTo determine the outcome of patients with locally advanced cervix cancer treated with curative intent using external beam radiotherapy (EBRT), without brachytherapy.Materials and methodsA chart review was performed of all patients with cervix cancer who received EBRT alone at our centre from 2000 to 2010. Overall survival and local control were evaluated using Kaplan–Meier survival curves.ResultsIn total, 22 patients were identified. The median age and follow-up were 56 years and 65 months, respectively. The stage included IB to IVB. Main histology was squamous cell carcinoma (82%). Median tumour size was 5·5 cm. Majority treated with 3D conformal techniques and nine patients (41%) were treated with intensity-modulated radiation therapy (IMRT); 14 patients received doses of ≥65 Gy. Most patients (73%) received weekly concurrent cis-platinum. The major reason for not receiving brachytherapy was locally extensive tumour (59%). The 5-year relapse-free survival and overall survival rates were 57 and 50%, respectively. Seven patients (32%) had a component of loco-regional failure, mainly within the cervix. There was a better outcome among the nine patients treated with IMRT to a median dose of 66 Gy with a loco-regional control of 78%.ConclusionsPatients who cannot have brachytherapy may still achieve acceptable rates of loco-regional disease control if high radiation doses (>65 Gy) was delivered.

To evaluate the implementation of a cervix cancer-specific patient-reported outcome measure, the European Organization for Research and Treatment of Cancer Quality of Life Cervical Cancer module (EORTC QLQ-CX24), into gynecologic oncology clinics.This was a prospective, multi-institutional, cross-sectional study involving cervix cancer patients previously treated with curative intent radiotherapy who were attending routine follow-up appointments. Between January 2017 and August 2018, eligible patients were approached to complete the EORTC QLQ-CX24 prior to their clinical encounter and then review it with their oncologist. Patient and oncologist experience was evaluated using Feedback Questionnaires following the encounter. Descriptive statistics were used to summarize the results of the EORTC QLQ-CX24 and Feedback Questionnaires. Open-ended questions within the Feedback Questionnaires were analyzed to identify themes.Eighty-four patients consented to participate in the study. Of these, 80 (95.2%) completed the EORTC QLQ-CX24 and 76 (90.4%) completed both the EORTC QLQ-CX24 and the Feedback Questionnaires. There were high rates of completion for most items within the EORTC QLQ-CX24 (93-98%), except for items pertaining to vaginal symptoms and sexual health (34-35%). All eligible oncologists participated (n = 9). Overall, patients and oncologists positively endorsed use of the questionnaire during clinical encounters. The majority of patients (80%) and oncologists (89%) reported use of the questionnaire improved communication, including discussion of sensitive topics. Interestingly, only a minority of patients and oncologists stated a perceived preference for electronic completion (18% and 44%, respectively).Implementation of the EORTC QLQ-CX24 in gynecologic oncology clinics was feasible and acceptable according to patients and oncologists.

Introduction: There are limited treatment options for patients with prior pneumonectomy and a new lung malignancy. The safety and efficacy of stereotactic body radiotherapy in this subpopulation has not been well defined. Methods: Postpneumonectomy patients treated with lung SBRT were identified from a prospective single institution database. Treatment toxicity was recorded prospectively using the Common Terminology Criteria for Adverse Events version 3.0. Disease recurrences were categorized as local, regional, or distant metastatic disease. Overall survival was calculated using the Kaplan-Meier method. Results: Of 406 patients, 13 postpneumonectomy patients were identified and 14 tumors were treated with SBRT. Median age was 69 years. Three lesions were biopsy confirmed. The SBRT doses were 60 Gy/3 ( n = 1), 54 Gy/3 ( n = 1), 48 Gy/4 ( n = 7), 60 Gy/8 ( n = 2), and 50 Gy/10 ( n = 3). Median follow-up was 24 months. Two patients had grade 3 radiation pneumonitis 3 and 4 months post-SBRT; they died 3 and 1 months later, respectively, one of myocardial infarction and the other of progressive dyspnea thought to be related to congestive heart failure. There were no local failures, one regional failure, and three distant failures. Median survival was 29 months, 1 and 2 year overall survival were 69% (95% confidence interval: 48–100%) and 61% (95% confidence interval: 39–95%), respectively. Conclusions: SBRT in patients with prior pneumonectomy poses challenges because of limited lung reserve. However, local control and long-term survival can be achieved using SBRT in this inoperable population. Careful consideration must be given to radiation planning to minimize the risk of radiation pneumonitis.

To the Editors: For medically inoperable early-stage nonsmall cell lung cancer (NSCLC) patients, stereotactic body radiotherapy (SBRT) is the emerging treatment of choice. SBRT differs from conventional radiotherapy (RT) in that large doses of radiation are employed over a few (usually fewer than five, but sometimes up to 10) fractions to radioablate the tumour. Safe delivery of such profoundly damaging doses requires highly precise RT, in conjunction with image guidance and careful treatment planning. Several prospective clinical trials have confirmed the feasibility, safety and efficacy of SBRT, consistently reporting local control rates of 80–95%, comparable to surgical resection [1–3], although assessment of response is more complicated than it is following surgery [3]. Radiographic changes following SBRT differ from those following conventional RT, suggesting a unique histological response, and characterisation of these changes is a clinical challenge. Little is known of the histology of local recurrence following SBRT, since medically inoperable patients who fail locally cannot be salvaged surgically. Fine-needle aspiration biopsy provides only cytological information and is subject to false-negative results, while very frail patients may not even be able to tolerate the biopsy. Without histological confirmation, local failure (LF) is a clinical rather than a pathological diagnosis. In this report, we review our experience of four patients originally treated with SBRT who were salvaged surgically for their presumed LF. From October 2004 to December 2010, we treated 209 patients with early (T1–2N0M0) NSCLC using SBRT on a prospective institution research ethics board-approved protocol. All patients were deemed medically inoperable by an experienced thoracic surgeon, typically due to medical comorbidities. Standard staging investigations included 2-fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET). Our SBRT technique has previously been described [4,5]. Patients underwent post-treatment PET-computed tomography (CT) and serial CT scans as …