Assuntos
Neoplasias da Mama , Radiocirurgia , Humanos , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Feminino , Radiocirurgia/métodos , Estadiamento de Neoplasias , Probióticos/uso terapêutico , Probióticos/administração & dosagem , Linfonodos/patologia , Axila , Metástase Linfática/patologia , Ultrassonografia/métodosRESUMO
BACKGROUND AND PURPOSE: A retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed. METHODS: We identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013 and 8/2021. Sixty-three patients (61.8%) were treated to the same vertebral level, and 39 (38.2%) to overlapping immediately adjacent levels. Local control was defined as the absence of progression within the treated target volume. The probability of local progression was estimated using a cumulative incidence curve. Death without local progression was considered a competing risk. RESULTS: Most patients had extensive metastatic disease (54.9%) and were treated to the thoracic spine (53.8%). The most common regimen in the first course of stereotactic body radiotherapy was 27 Gy in 3 fractions, and the median time to reSBRT was 16.4 months. At the time of simulation, 44% of lesions had advanced epidural disease. Accordingly, 80% had myelogram simulations. Both the vertebral body and posterior elements were treated in 86% of lesions. At a median follow-up time of 13.2 months, local failure occurred in 10 lesions (9.5%). The 6- and 12-month cumulative incidences of local failure were 4.8% and 6%, respectively. Seven patients developed radiation-related neuropathy, and 1 patient developed myelopathy. The vertebral compression fracture rate was 16.7%. CONCLUSION: In patients with extensive disease involvement, reSBRT of spine metastases with 40 Gy in 5 fractions seems to be safe and effective. Prospective trials are needed to determine the optimal dose and fractionation in this clinical scenario.
Assuntos
Neoplasias da Mama , Neoplasias de Cabeça e Pescoço , Neoplasias Pulmonares , Radiocirurgia , Neoplasias Retais , Humanos , Feminino , Neoplasias Pulmonares/terapia , Neoplasias da Mama/radioterapia , Terapia Neoadjuvante , Radiocirurgia/efeitos adversos , Imunoterapia/efeitos adversos , BiologiaAssuntos
Radiodermite , Radiocirurgia , Neoplasias da Coluna Vertebral , Neoplasias do Colo do Útero , Masculino , Feminino , Humanos , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Próstata , Mastectomia Segmentar , Neoplasias da Coluna Vertebral/cirurgia , Bactérias , Quimioterapia AdjuvanteAssuntos
Braquiterapia , Neoplasias Pulmonares , Radioterapia Guiada por Imagem , Carcinoma de Pequenas Células do Pulmão , Neoplasias do Colo do Útero , Feminino , Humanos , Braquiterapia/efeitos adversos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/patologia , Imageamento por Ressonância Magnética , Neoplasias Pulmonares/radioterapia , Dosagem RadioterapêuticaAssuntos
Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Carcinoma de Célula de Merkel , Neoplasias Pulmonares , Neoplasias Nasofaríngeas , Radiocirurgia , Sarcoma , Neoplasias Cutâneas , Neoplasias de Tecidos Moles , Masculino , Humanos , Neoplasias da Mama/patologia , Carcinoma de Célula de Merkel/radioterapia , Próstata/patologia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Pulmonares/patologiaRESUMO
Importance: Despite federal initiatives encouraging the enrollment of individuals from racial and ethnic minority groups in US clinical trials, no studies to date have specifically examined demographic disparities among participants in phase 1 drug development trials for patients with metastatic cancer. Objective: To assess trends in the enrollment of patients from racial and ethnic minority groups in US phase 1 therapeutic drug trials for metastatic cancer from 2000 to 2018. Design, Setting, and Participants: In this cross-sectional study, ClinicalTrials.gov was queried in July 2021 to identify completed phase 1 drug trials for metastatic cancer in the US from January 1, 2000, to December 31, 2018, with published results, yielding 221 phase 1 trials with 8309 participants aged 18 years or older with metastatic solid tumors. Proportions of each racial and ethnic group of trial participants were compared with that from the North American Association of Central Cancer Registries' Cancer in North America (CiNA) database. Statistical analysis was performed from July 12, 2021, to March 15, 2022. Main Outcomes and Measures: For each racial and ethnic group, the difference between trial and CiNA proportions was examined using a 2-sample test for equality of proportions with continuity correction. Results: The 8309 phase 1 trial participants (4198 men [50.5%]; median age, 59 years) included 23 American Indian or Alaska Native participants (0.3%), 371 Asian or Pacific Islander participants (4.5%), 514 Black participants (6.2%), 401 of 5076 Hispanic or Latinx participants (7.9%), and 7154 White participants (86.1%). Industry funded 165 of the 221 trials (74.7%). White patients were overrepresented overall compared with the corresponding CiNA cohort (7154 of 8309 [86.1%] vs 4â¯113â¯096 of 4â¯891â¯486 [84.1%]; difference, 2.0 percentage points; P < .001). There was an increase in overrepresentation of White patients from 2000 to 2011 (trials, 2780 of 3245 [85.7%]; CiNA, 2â¯378â¯019 of 2â¯800â¯711 [84.9%]; difference, 0.8 percentage points; P = .23) to 2012-2018 (trials, 4374 of 5063 [86.4%]; CiNA, 1â¯735â¯077 of 2â¯090â¯775 [82.9%]; difference, 3.5 percentage points; P < .001) and corresponding worsening representation of American Indian or Alaska Native patients (2000-2011: trials, 10 of 3245 [0.3%]; CiNA, 10â¯905 of 2â¯800â¯711 [0.4%]; difference, -0.08 percentage points; 2012-2018: trials, 13 of 5063 [0.3%]; CiNA, 9484 of 2â¯090â¯775 [0.5%]; difference, -0.20 percentage points), Asian or Pacific Islander patients (2000-2011: trials, 121 of 3245 [3.7%]; CiNA, 75â¯033 of 2â¯800â¯711 [2.7%]; difference, 1.1 percentage points; 2012-2018: trials, 151 of 5063 [3.0%]; CiNA 70â¯535 of 2â¯090â¯775 [3.4%]; difference, -0.75 percentage points), Black patients (2000-2011: trials, 244 of 3245 [7.5%]; CiNA, 322â¯701 of 2â¯800â¯711 [11.5%]; difference, -4.0 percentage points; 2012-2018: trials, 270 of 5063 [5.3%]; CiNA, 255â¯625 of 2â¯090â¯775 [12.2%]; difference, -6.9 percentage points), and Hispanic or Latinx patients (2000-2011: trials, 161 of 1792 [9.0%]; CiNA, 169â¯297 of 2â¯800â¯711 [6.0%]; difference, 3.0 percentage points; 2012-2018: trials, 240 of 3295 [7.3%]; CiNA, 156â¯118 of 2â¯090â¯775 [7.5%]; difference, -0.2 percentage points). Similar disparities were observed when comparing industry-funded and academic center-sponsored trials. Conclusions and Relevance: In this cross-sectional study of participants in phase 1 clinical trials of drugs for metastatic cancer, worsening disparities were observed over time in the accrual of patients from racial and ethnic minority groups. These findings may represent widening inequalities in access to trial sites and worsening systemic biases. More efforts are needed to diversify phase 1 cancer drug trials to improve equity in access to new treatments and to ensure that safety and efficacy findings from early drug trials are generalizable across populations.
Assuntos
Antineoplásicos , Neoplasias , Masculino , Humanos , Pessoa de Meia-Idade , Etnicidade , Grupos Minoritários , Estudos Transversais , Minorias Étnicas e Raciais , Neoplasias/tratamento farmacológico , Desenvolvimento de MedicamentosAssuntos
Radiação Cranioespinal , Neoplasias da Próstata , Antagonistas de Androgênios/farmacologia , Antagonistas de Androgênios/uso terapêutico , Androgênios , Humanos , Linfonodos/patologia , Masculino , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Decúbito Ventral , Próstata/patologia , Antígeno Prostático Específico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Terapia de SalvaçãoAssuntos
Neoplasias Nasofaríngeas , Neoplasias da Próstata , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica , Quimiorradioterapia/métodos , Cisplatino/uso terapêutico , Detecção Precoce de Câncer , Humanos , Imageamento por Ressonância Magnética , Masculino , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/terapia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Neoplasias Retais/patologiaAssuntos
Neoplasias da Mama , Neoplasias Pulmonares , Neoplasias Pancreáticas , Neoplasias da Próstata , Androstenos , Receptores ErbB/genética , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Neoplasias da Próstata/genética , Neoplasias da Próstata/terapia , Neoplasias PancreáticasRESUMO
PURPOSE: Our purpose was to evaluate the effect of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. METHODS AND MATERIALS: A survey was conducted of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. RESULTS: The survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying/timing pregnancy or adoption to accommodate the annual schedule of the 4 qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every 3 respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 32%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% vs 18%, P = .008). Seven women (6%) reported at least a 1-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant effect on achieving academic promotion or professional partnership (52%), annual compensation (54%), and nonclinical professional commitments (58%) - these rates mirror those of surveyed early career male counterparts (n = 101). CONCLUSIONS: The current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.