Analytic Scale Research Articles

Tolerability of Concurrent Chemoradiation Therapy With Gemcitabine (GemX), With and Without Prior Neoadjuvant Chemotherapy, in Muscle Invasive Bladder Cancer

The aim of this study is to assess the tolerability of concurrent chemoradiation therapy with gemcitabine (GemX) in muscle invasive bladder cancer following neoadjuvant chemotherapy (neoGemX) by use of patient- and provider-reported outcomes. Seventy-eight patients were treated with GemX. Thirty-eight received prior neoadjuvant chemotherapy (NAC). Patients were prospectively assessed during treatment and at 6weeks and 12months after treatment completion. Radiation therapy was given to a total dose of 52.5Gy in 20 fractions with weekly concurrent gemcitabine chemotherapy, 100mg/m2. Toxicity was assessed by the care provider and by a patient-reported outcome questionnaire collecting scores on the late effects in normal tissues-subjective, objective, management, and analytic scales and was statistically compared at baseline and 12months, as well as between the neoGemX and GemX groups. The median duration of follow-up was 15.9months. The radiation therapy completion rate was 95%, and 96% of patients completed at least 3 cycles of gemcitabine. Bowel toxicity of grade 3 or greater was reported in 7 of 38 patients (18%) in the neoGemX group and 5 of 25 (20%) in the GemX group. Three GemX and two neoGemX patients had grade 3 or greater urinary toxicity. Forty-nine patients completed questionnaires and were included in the analysis. Scores on the late effects in normal tissues-subjective, objective, management, and analytic scales showed an expected peak by week 4 of treatment. There was no statistically significant difference between mean scores at baseline and 12months after treatment completion or between the neoGemX and GemX groups. This study demonstrates that GemX, alone or following NAC, has manageable toxicity and acceptable treatment completion rates. Allowing for small patient numbers and the nonrandomized nature of this study, these results do not suggest any additional toxicity from the use of NAC prior to GemX.

Center Places and Cherokee Towns: Archaeological Perspectives on Native American Architecture and Landscape in the Southern Appalachians

Center Places and Cherokee Towns serves as an excellent example of using multiple lines of evidence to examine phenomena of diachronic change in archaeological research. Using archaeological and primary documentary data as well as nineteenth-century Cherokee oral history, Christopher B. Rodning examines the correlations between social relationships and spatial configurations of Native towns during the precontact and contact eras. At Coweeta Creek and other Cherokee sites across southern Appalachia, “center places” were created through the construction of earthen mounds, formalized architecture, and carefully placed and maintained hearths. Together, the components of central places anchored people to a social landscape and identity.Rodning argues that social and historical dimensions of places can be discerned through anthropological examination of how the built environment reflects cultural conceptions of landscape and community in Cherokee settlements, ethnohistory, and myth. The conclusions presented in this book derive from extant archaeological data of twentieth-century excavations at Coweeta Creek, a site that offers unique value to the diachronic study of Cherokee spatial and social organization because it spans the precontact and contact periods, has been extensively excavated, and represents the characteristics of other Cherokee sites in the region. Most chapters begin with a historical vignette from figures such as Alexander Longe and James Mooney, who recorded details about the Cherokee during the colonial period, and each chapter describes a different analytic scale of Cherokee center places. After a succinct introduction to Coweeta Creek in chapter 1, Rodning organizes his work from the top down with a regional perspective on Cherokee settlements in chapter 2. He describes the manifestations of center places in public architecture, such as town houses, and domestic architecture in chapters 3 and 4; outlines the important symbolism of hearths as center places (particularly the hearths of town houses, which are considered center places of towns) in chapter 5; and discusses burials under structures at Coweeta in chapter 6 as tools of social memory and ties to structure, place, and community. Chapter 7 considers the evidence of abandonment and resettlement at Coweeta Creek during the sixteenth and seventeenth centuries, and chapter 8 concludes by contextualizing the site within the larger Cherokee landscape of southern Appalachia. Each chapter makes a significant contribution to the conceptual framework of center places but could also effectively stand alone.Though excavations at Coweeta Creek have been ongoing for decades and several publications about the site precede this one, Center Places offers several novel contributions to the study of Cherokee towns, including new evidence for a seventh construction stage of the Coweeta Creek town house, for which only six stages have been supposed. More important, Rodning’s work is a testament to the epistemological development within anthropological archaeology, which values ethnohistorical documents and oral traditions not just as supplementary resources with limited objective value but also as principal lines of evidence. Rodning injects his analysis of center places in Cherokee towns with samples of similar patterns seen in the archaeology, ethnohistory, and oral history of other regions, namely, the Southwest and Iroquoia, situating Coweeta Creek and other Cherokee settlements in a broader discourse concerning the relationships between people and place, the built environment of past settlements, and the manifestations of center places and center symbolism in archaeological, historical, and mythological data.Archaeological and historical analyses of pluralistic environments and culture contact necessitate a comparison of scale between the situated actions of individuals and the broader patterns of history. Center Places and Cherokee Towns provides that comparison in a style that is accessible and free of jargon, making it an ideal reference for undergraduate students. Instructors of undergraduate and graduate courses and researchers whose interests concern culture contact, archaeological analytic scale, Native studies, or ethnohistorical methods are sure to find Rodning’s book a valuable contribution to their repertoire.

On the Construct Validity of an Analytic Rating Scale for Speaking Assessment

The analytic rating scale is often used in the assessment of learners’ speaking ability. Compared with holistic ratingscale, the analytic rating scale can provide much more information about the test takers. But the studies in this fieldare not so fruitful. This paper aims to study the construct validity of an analytic rating scale for speaking assessment.The Multi-facet Rasch Modeling method and the correlations analysis are combined to investigate the constructvalidity. The MFRM analysis shows that there is a good reliability between raters in terms of severity andconsistency; the analytic rating scale can reflect the students’ speaking ability. But the correlation analysis indicatesthat there is no good discriminant validity for the four rating criteria, but excellent convergent validity. This studygives some implication in the design of rating criteria and the rater training as well.

Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer.

IntroductionTo identify potential risk factors for the development of jaw osteoradionecrosis (ORN) after 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) among patients with newly diagnosed head and neck cancer.Material and methodsThis study included 776 patients who underwent 3D-CRT or IMRT for head and neck cancer at the Department of Radiotherapy at the University Hospital Halle-Wittenberg between 2003 and 2013. Sex, dental status prior to radiotherapy, tumor site, bone surgery during tumor resection, concomitant chemotherapy, and the development of advanced ORN were documented for each patient. ORN was classified as grade 3, 4, or 5 according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer classification or grade 3 or 4 according to the late effects in normal tissues/subjective, objective, management, and analytic scale. The cumulative incidence of ORN was estimated. Cox regression analysis was used to identify prognostic risk factors for the development of ORN.ResultsFifty-one patients developed advanced ORN (relative frequency 6.6 %, cumulative incidence 12.4 %). The highest risk was found in patients who had undergone primary bone surgery during tumor resection (hazard ratio [HR] = 5.87; 95 % confidence interval [CI]: 3.09–11.19) and in patients with tumors located in the oral cavity (HR = 4.69; 95 % CI: 1.33–16.52). Sex, dentition (dentulous vs. edentulous), and chemotherapy had no clinically relevant influence.Discussion and conclusionIn contrast to most previous studies, we noted a low cumulative incidence of advanced ORN. Patients with tumors located in the oral cavity and those who undergo bone surgery during tumor resection prior to RT may be considered a high-risk group for the development of ORN.

On the Dynamics of the Formation of the Kelvin Cat’s-Eye in Tropical Cyclogenesis. Part I: Climatological Investigation

Abstract Motivated by Dunkerton et al., a climatological study of 54 developing easterly waves in 1998–2001 was performed. Time-lagged composites in a translating reference frame following the disturbances indicate a weak meridional potential vorticity (PV) gradient of the easterly jet and a cyclonic critical layer located slightly to the south of the weak PV gradient, consistent with previous findings in the marsupial paradigm. Using a closed PV contour as a criterion for the formation of the cat’s-eye, it was shown that on average it takes ~2.6 days for open PV contours to transform to a closed coherent structure. Bootstrap analysis was then applied to determine the reliability of the easterly wave–like pattern in the composite perturbation PV analysis. It is suggested that the coexistence of a nonlinear critical layer and a region of weak meridional PV gradient over several days, found to occur in only ~25% of the easterly waves, might be a major factor to distinguish developing and nondeveloping disturbances. This finding may explain why only a small fraction of easterly waves contribute to tropical cyclogenesis. Additionally, an analytic time scale of the form was obtained, where Q is the mass sink, ε is the amplitude of the initial disturbance, and τ is the cat’s-eye formation time that governs the onset of nonlinearity for forced disturbances on a parabolic jet critical layer. This time scale is consistent with that found in 54 cases of easterly waves that developed into named storms, highlighting the importance of nonlinear and diabatic processes in cat’s-eye formation.

The Effect of Teachers’ Written Corrective Feedback (WCF) Types on Intermediate EFL Learners’ Writing Performance

Written Corrective Feedback (WCF) is a controversial topic among theorists and researchers in L2 studies. Ellis, Sheen, Murakami, and Takashima (2008) identify two dominant dichotomies in this regard, that is focused vs. unfocused WCF and direct vs. indirect WCF. This study considered both dichotomies in a matrix format, resulted in the recognition of four types of operationally defined WCF, and aimed at: (1) investigating the effects of four types of WCF (i.e., focused direct CF, unfocused direct CF, focused indirect CF, and unfocused indirect CF) on intermediate EFL learners’ writing performance; (2) finding out the most effective type of WCF for intermediate EFL learners’ writing performance; (3) determining learners’ attitudes toward the effectiveness of using WCF and the types which they had received. After conducting Nelson English Language Test (Test 300 D), out of 140 male and female Iranian EFL learners, 120 of them were selected as intermediate learners, aging from 14-18. The subjects were then assigned randomly to four homogeneous groups (each group including 30 participants). The pre-test and post-test both included a writing test which assessed learners’ writing performance, and then their scores were analyzed by using analytic marking scale. The results indicated that, learners outperformed in all of the four groups, validating WCF as an effective technique which can be used in EFL classes. A clear implication of the study is that WCF types (specially unfocused direct CF) should be emphasized as an essential tool for developing writing ability of intermediate EFL learners. Keywords : Written Corrective Feedback (WCF), Focused CF, Unfocused CF, Direct CF, Indirect CF, Writing Performance, Intermediate EFL Learners

Comparison of Native and Non-native English Language Teachers’ Evaluation of EFL Learners’ Speaking Skills: Conflicting or Identical Rating Behaviour?

<p>Assessing speaking skills is regarded as a complex and hard process compared with the other language skills. Considering the idiosyncratic characteristics of EFL learners, oral proficiency assessment issue becomes even more important. Keeping this situation in mind, judgements and reliability of raters need to be consistent with each other. This study aims to compare native and non-native English language teachers’ evaluation of EFL learners’ speaking skills. Based on the oral proficiency scores in the final exam conducted at a state university in Turkey, the study analysed the scores given by native and non-native English language teachers to 80 EFL students attending preparatory classes in the 2014-2015 academic year. 3 native and 3 non-native English language teachers participated in the study. Data were collected through an analytic rating scale and analysed with the help of <em>independent samples t-test</em> and <em>Pearson product-moment correlation test</em>. Pearson product-moment correlation test (calculated as 0,763) indicated that the raters had high inter-rater reliability coefficients. T-test results revealed that there is no statistically significant difference in the total scores given by both groups of teachers. The study also investigated the different components of speaking skills such as fluency, pronunciation, accuracy, vocabulary, and communication strategies with regard to the existence of significant difference between the scores. The only component which created a statistically significant difference was found to be pronunciation, which was expected prior to the research. In line with the overall findings of the study, it can be concluded that native and non-native English language teachers display almost identical rating behaviour in assessing EFL students’ oral proficiency.</p>

Late rectal toxicity determined by dose-volume parameters in computed tomography-based brachytherapy for locally advanced cervical cancer.

The aim of this study was to observe the relationship between dose–volume histogram (DVH) parameters and rectal late side effects (LSE) in computed tomography (CT)‐based brachytherapy (BT) for patients with locally advanced cervical cancer. In total, 144 cervical cancer patients received external beam radiotherapy and CT‐based BT. The data from 111 survival cases with pelvic local control (LC) were used to analyze the relationship between DVH parameters and rectal LSE. The total doses, manifesting 2, 1, and 0.1 cm3 (D2cc, D1cc, and D0.1cc) of the rectum, and D90 for high‐risk clinical target volume (HR CTV) were computed and normalized to 2 Gy fractions (EQD2) using a linear‐quadratic model. The rectal LSE were evaluated by the late effects in normal tissues‐subjective, objective, management, and analytic (LENT‐SOMA) scale. A dose–response relationship was evaluated by probit analyses. For all patients, the total rate of rectal LSE was 56%, and the rate of ≥Grade 2 LSE was 27.4%. For the 111 survival cases with pelvic LC, the total mean for D2cc was 71.23 ± 5.54 Gy for the rectum, and the D2cc, D1cc, and D0.1cc values for Grades 2 and 3 were higher than those for Grades 0 and 1. In addition, the number of complications increased, and the complications became more severe as the dose increased, with a dose of 73.5 Gy resulting in a 10% probability of ≥Grade 3 LSE. In conclusion, DVH parameters could predict the incidence and grades of rectal LSE in CT‐based BT. D2cc showed an excellent predictive value, and 73.5 Gy for D2cc of the rectum might be considered as an alternative dose limit.

Patient and treatment-related risk factors for osteoradionecrosis of the jaw in patients with head and neck cancer

The purpose of this study was to evaluate risk factors for and the incidence of osteoradionecrosis (ORN) of the jaw in patients with head and neck cancer. This study was a retrospective analysis of the risk for ORN and outcome for 149 of 540 patients with head and neck cancer of the oral cavity (65%), oropharynx (26%), or other head and neck sites (9%) treated with radiotherapy between 2004 and 2009. ORN was graded according to Late Effects of Normal Tissues/Somatic Objective Management Analytic Scale (LENT/SOMA) criteria. Within a median follow-up of 41 months (95% confidence interval: 27.4-54.6), 38 patients (25.5%) had developed ORN, 37 patients (25%) had a local recurrence, and 53 patients (36%) had died. The median time to diagnosis of ORN was 14.5 months (range: 3-80), and 79% were diagnosed within 2 years of RT. Eleven of these patients had undergone previous mandibular surgery. Univariate significant risk factors for ORN were any comorbidity, poor oral hygiene, pre-radiotherapy osteotomy, close tumor-to-bone proximity, post-radiotherapy dentoalveolar surgery (DAS), DAS without sufficient wound closure, alcohol consumption, and denture pressure sores. In multivariate analysis, comorbidities, pre-radiotherapy mandibular surgery, poor oral hygiene, and insufficient DAS remained significant. Reducing the risk of ORN calls for maintaining optimal oral hygiene, ensuring good denture fit, receiving proper training in DAS, and helping patients to stop drinking and smoking.

An Analytic Creativity Assessment Scale for Digital Game Story Design: Construct Validity, Internal Consistency and Interrater Reliability

Mobile technology has rapidly made digital games a popular entertainment to this digital generation, and thus digital game design received considerable attention in both the game industry and design education. Digital game design involves diverse dimensions in which digital game story design (DGSD) particularly attracts our interest, as the literature needs more information, especially the creativity assessment of DGSD. Existing measuring tools do not adequately address the characteristics of game-story duality. Thus, an analytic creativity assessment scale of DGSD (CAS-DGSD) based on literature and original ideas was developed in our previous work. This study aims to statistically examine its construct validity, internal consistency reliability, and interrater reliability to verify its effectiveness. Three commercial games of 3 different game genres (action, puzzle, and role-play) were rated by 32 student raters and 4 expert raters. Statistical results show acceptable construct validity, internal consistency reliability, and interrater reliability of the CAS-DGSD. The CAS-DGSD not only helps evaluators like teachers identify which aspects of DGSD are short of creativity, but also serves as a guideline for digital game story designers like design students and product developers to tailor creative and entertaining game stories.

Developing an analytic scale for assessing undergraduate students’ consecutive interpreting performances

This article reports on the process of developing an analytic rating scale for assessing undergraduate students’ consecutive interpreting performances. The development process was divided into three phases. First, a total of 42 criteria for interpreter performance assessment were identified from the related literature and grouped into three categories: ‘content’, ‘form’ and ‘delivery’. Second, these criteria were rated by importance in a questionnaire survey of 31 interpreter trainers. In this phase a total of 20 criteria were removed due to statistical concerns, while 22 criteria — seven criteria for content, seven for form, and eight for delivery — were retained to construct a draft rating scale. Third, to determine the appropriate weighting for each category, two interpreter trainers used the 22-item draft scale to rate 33 consecutive interpretations by Korean undergraduate students. A statistical analysis of these assessments showed that the content category should be assigned an effective weight of 2, while the other categories need not be weighted (i.e., weighting value: 1).

An Experiment in the Ability of Raters to Evaluate Lexis in Writing

Abstract For many years, people have considered lexis and grammar separately in the context of teaching and learning English. In the assessment of second language writing, lexis and grammar continue to be considered separately. However, recent corpus studies have questioned this approach and argued that lexis and grammar are fundamentally inseparable. While the assessment of lexis and grammar as two distinct qualities lends face validity to assessment criteria, the corpus literature suggests that raters may not be able to accurately distinguish the two. The current study examines the ability of raters to separate lexis and grammar when using an analytic rating scale to assess timed essays. In this experiment, the lexical content of 27 essays was manipulated before rating in order to determine the effect of lexical accuracy, lexical variation and lexical richness on lexis and grammar scores. From the results, it seems that raters are sensitive to lexical accuracy, but not lexical variation nor lexical richness. In addition, the manipulation of lexical qualities had a significant effect on grammar scores but not on lexis scores, supporting the idea that raters find it challenging to distinguish lexis from grammar

Development of an English Speaking Skill Assessment Model for Grade 6 Students by Using Portfolio

It has been found from language assessment that the results were lower in terms of reliability compared to other aspects. Therefore, the development of a reliable model on English speaking skill assessment is very important and it will hopefully bring about English language teaching improvement. The objectives of this research were to study the steps and the components of a portfolio on English speaking skill assessment as well as to develop the English speaking skill assessment criteria for grade 6 students. The research methods used include a review of documents and interviews of nine experts on English language teaching and language assessment. The data was analysed using content analysis method. The results found that the component of the portfolio on English speaking skill assessment for grade 6 students comprises three parts: 1) Introduction 2) Contents and 3) Assessment criteria. There are 7 steps in using a portfolio in assessment: 1) planning 2) preparation for students 3) evidence collecting 4) progress monitoring 5) improvement of performance 6) reflection and 7) displaying the works. The tasks involved in English speaking skill assessment include interviewing, oral presentation, storytelling, making picture description. Analytic rating scale was applied as scoring criteria on vocabulary, syntax, cohesion, pronunciation ideational function and fluency.

A Comparison of EFL Raters’ Essay-Rating Processes Across Two Types of Rating Scales

This study used think-aloud protocols to compare essay-rating processes across holistic and analytic rating scales in the context of China’s College English Test Band 6 (CET-6). A group of 9 experienced CET-6 raters scored the same batch of 10 CET-6 essays produced in an operational CET-6 administration twice, using both the CET-6 holistic essay-rating scale and an analytic rating scale designed specifically for the study, while providing think-aloud protocols. The findings indicated that important differences in both rating strategies adopted and the specific aspects of essays attended to existed across the scales. Specifically, raters were found to use more self-monitoring-interpretation strategies, the strategy of considering local language features, as well as certain self-monitoring-judgment strategies when rating holistically. They were found to use more frequently self-monitoring-judgment strategy, error-classifying strategy, and quality-assessing strategy when applying the analytic scale. As for the differences in text focus across the scales, it was found that the use of the holistic scale led to raters paying more attention to the general quality of language use and non-scale-related language features. Meanwhile, the application of the analytic scale resulted in raters giving more attention to coherence and grammar.

Do the Processes of Psychoanalytic Work Lead to Benefit? Studies by the APS Research Group and the Psychoanalytic Research Consortium

There is a need for careful study of the relationships between the psychoanalytic/psychodynamic processes and their outcomes, yet the raw data to accomplish this study (i.e., psychoanalyses and psychoanalytic psychotherapies fully recorded and transcribed, and empirical instruments for assessing from an analytic perspective both the processes and results of these treatments) have been limited. Two related strategies to solve this deficit have been developed over the past 30 years by the Psychoanalytic Research Consortium (PRC): (1) the collection of an increasing database currently holding 31 fully recorded psychoanalyses and a number of long-term psychoanalytic psychotherapies safeguarded, confidentialized, and made available to the field; and (2) the development of new measures for assessing processes and outcomes of treatments from an analytic point of view, such as the Analytic Process Scales (APS), the Dynamic Interaction Scales (DIS), and the Personality Health Index (PHI) with RADIO categories. This article summarizes the history of the PRC and some of the findings of the research conducted with the APS, DIS, and PHI on the PRC cases.

ENGLISH SPEAKING SKILLS ASSESSMENT FOR GRADE 6 THAI STUDENTS: AN APPLICATION OF MULTIVARIATE GENERALIZABILITY THEORY

Background and Purpose. This research studies an analytic rating scale for an English speaking skills assessment designed for Grade 6 Thai students learning English as a foreign language. Material and Methods . A rating scale was developed, validated, and then piloted using assessment results from 101 students attending a government school in Bangkok, Thailand. The analytic rating scale developed for the assessment is composed of 6 components: vocabulary, syntax, cohesion, pronunciation, ideational function and fluency. The reliability of the rating scale was examined with different numbers of speaking tasks and raters. Multivariate generalizability theory (G theory) was utilized for the data analysis. Results. The results showed that fluency was the greatest variance component of the composite score of the analytic rating scale, followed by ideational function, cohesion, vocabulary and syntax, and pronunciation respectively. Reliability of the composite score for the speaking analytic rating scale was high (over .80). It was found that the reliability coefficients for each compo- nent would be reliable (over .80) when six or more tasks are used and the number of raters is from 6–10 and above. The dependability increased more when the number of tasks increased and when the number of raters increased. It was also found that a reliable high Phi Coefficient (over .80) could be obtained using only 6 tasks and 3 raters. Conclusion. The main results were then discussed in more detail.

Development of a Spanish generic writing skills scale for the Colombian Graduate Skills Assessment (Saber Pro)

While many higher education institutions list the generic skills their graduates are intended to acquire during a course of study (Barrie, 2006), the relevant skills are rarely directly assessed at graduation. In Colombia, exit assessment is compulsory for all post-secondary training and education. To this end, a Spanish-language version of the Australian Graduate Skills Assessment (GSA) was developed for the Colombian context. However, problems were identified with the reliability of the Spanish version of the GSA writing scale. This paper describes the process of replacing the original version of the Spanish-language version of the GSA scale (an intuitively based writing scale) with an empirically based scale developed using a question tree method. Forty raters constructed two holistic (combined trait) and three analytic (individual trait) writing scales using benchmarked scripts from a previous test administration. The five scales were then trialled. Comparison of the scales showed the eight-level holistic scale provided the widest distribution of scores. This research provides insights into generic writing skill testing for higher education graduates in Colombia. In addition, the study uniquely provides a detailed description of the development of empirically-based analytic and holistic scales for assessing the writing of Spanish-L1 speaking graduates in Colombia.

Dosimetric Inhomogeneity Predicts for Long-Term Breast Pain Following Breast-Conserving Therapy

The objective of this cross-sectional questionnaire study was to characterize long-term breast pain in patients undergoing breast conserving surgery and radiation (BCT) and to identify predictors of this pain. We identified 355 eligible patients with Tis-T2, N0, M0 breast cancer who underwent BCT in 2007-2011, without recurrent disease. Patients with invasive disease were required to have a negative sentinel lymph node biopsy with ≤5 nodes removed. Patients who received radiation therapy (RT) with a separate nodal field, high tangents, partial breast plan, or prone positioning and those who received chemotherapy were excluded. A questionnaire with 10 items derived from the Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) scale detailing the severity, frequency, duration, and impact of pain or discomfort in the treated breast over the previous 2 weeks was mailed to all eligible women. A logistic regression model was built to identify predictors of long-term breast pain based on survey results and patient, disease, and treatment data. Questionnaire response rate was 80% (N = 285). Median time from RT was 50.3 months. A total of 135 patients (47%) reported pain in the treated breast; 19 (14%) had pain constantly or at least daily, and 15 (11%) had intense pain. Pain interfered with daily activities in 11 patients (8%), with 6 (4%) taking analgesics for this pain. Fourteen (10%) reported that the pain affected their quality of life. Ninety-three (69%) noted their pain had been present for at least 1 year. Sixty-eight (50%) reported that the pain was not changing with time, while 16 (12%) stated that the pain was getting worse. On univariable analysis, volume of breast tissue treated to ≥105% of the prescribed dose (OR = 1.001 per cc, 95% CI = 1.000-1.002; p = 0.045), volume of breast tissue treated to ≥110% of the prescribed dose (OR = 1.009 per cc, 95% CI = 1.002-1.016; p = 0.012) and hormone therapy (OR = 1.98, 95% CI = 1.13-3.48; p = 0.02) predicted for long-term breast pain. There was no impact of hypofractionation (n = 41). On multivariable analysis, volume ≥110% (OR = 1.01 per cc, 95% CI = 1.003-1.017; p = 0.007), shorter time since treatment (OR = 0.98, 95% CI = 0.96-0.997; p = 0.03) and hormone therapy (OR = 1.91, 95% CI = 1.08-3.40; p = 0.03) were independent predictors of pain. Volume ≥105% was not included in the multivariable model with volume >110% due to a high degree of collinearity, but was also independently associated with breast pain in a model with time since treatment and hormone therapy. Long-term breast pain was common after BCT. While nearly half of patients had pain, most considered it tolerable. Dosimetric inhomogeneity independently predicted for pain and should be minimized to the greatest extent possible.

Dosimetric Inhomogeneity Predicts for Long-Term Breast Pain After Breast-Conserving Therapy

The objective of this cross-sectional study was to characterize long-term breast pain in patients undergoing breast-conserving surgery and radiation (BCT) and to identify predictors of this pain. We identified 355 eligible patients with Tis-T2N0M0 breast cancer who underwent BCT in 2007 to 2011, without recurrent disease. A questionnaire derived from the Late Effects Normal Tissue Task Force (LENT) Subjective, Objective, Management, Analytic (SOMA) scale was mailed with 7 items detailing the severity, frequency, duration, and impact of ipsilateral breast pain over the previous 2 weeks. A logistic regression model identified predictors of long-term breast pain based on questionnaire responses and patient, disease, and treatment characteristics. The questionnaire response rate was 80% (n=285). One hundred thirty-five patients (47%) reported pain in the treated breast, with 19 (14%) having pain constantly or at least daily; 15 (11%) had intense pain. The pain interfered with daily activities in 11 patients (8%). Six patients (4%) took analgesics for breast pain. Fourteen (10%) thought that the pain affected their quality of life. On univariable analysis, volume of breast tissue treated to ≥105% of the prescribed dose (odds ratio [OR] 1.001 per cc, 95% confidence interval [CI] 1.000-1.002; P=.045), volume treated to ≥110% (OR 1.009 per cc, 95% CI 1.002-1.016; P=.012), hormone therapy use (OR 1.95, 95% CI 1.12-3.39; P=.02), and other sites of pain (OR 1.79, 95% CI 1.05-3.07; P=.03) predicted for long-term breast pain. On multivariable analysis, volume ≥110% (OR 1.01 per cc, 95% CI 1.003-1.017; P=.007), shorter time since treatment (OR 0.98 per month, 95% CI 0.96-0.998; P=.03), and hormone therapy (OR 1.84, 95% CI 1.05-3.25; P=.03) were independent predictors of pain. Long-term breast pain was common after BCT. Although nearly half of patients had pain, most considered it tolerable. Dosimetric inhomogeneity independently predicted for pain and should be minimized to the greatest extent possible.

Patient-reported Outcomes and Health-related Quality of Life in Prostate Cancer Treated with a Single Fraction of High Dose Rate Brachytherapy Combined with Hypofractionated External Beam Radiotherapy

AimsHigh dose rate (HDR) brachytherapy offers a highly conformal approach to radiotherapy delivery, enabling dose escalation. We report our experience using a combined HDR boost and external beam radiotherapy (EBRT) approach and its associated toxicity and effect on quality of life. Materials and methodsPatients with intermediate- or high-risk prostate cancer were treated with a single fraction HDR boost and EBRT between July 2008 and March 2010. Patient-reported toxicity data were collected at baseline and regular intervals after radiotherapy using International Prostate Symptom Score and Late Effects in Normal Tissues-Subjective, Objective, Management and Analytic scales (LENT-SOMA) questionnaires; health-related quality of life data were captured by the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. ResultsNinety-five patients received an HDR boost of 12.5 Gy followed by EBRT delivered as 37.5 Gy in 15 fractions over 3 weeks. The International Prostate Symptom Score peaked 6 weeks after radiotherapy (median value: 9). The LENT-SOMA bladder/urethra mean baseline score was 0.35 and peaked 6 weeks after radiotherapy (mean = 0.59). Difficulties with urinary flow and frequency were the most common reported symptoms. LENT-SOMA rectum/bowel mean scores at baseline were 0.24 and peaked after 6 months (mean = 0.37). Bowel urgency was the most common reported toxicity. EPIC urinary scores returned to baseline values at 6 months and bowel median scores recovered after 24 months. There were no statistically significant associations between patient or dosimetric parameters and patient-reported outcomes. ConclusionA combined HDR boost and hypofractionated EBRT regimen offers a well-tolerated method of dose escalation with acceptable levels of patient-reported toxicity.