Cancer Patients Receiving Radical Radiotherapy Research Articles

157 Establishing a multidisciplinary habilitation clinic for lung cancer patients receiving radical radiotherapy

157 Establishing a multidisciplinary habilitation clinic for lung cancer patients receiving radical radiotherapy

An ehealth intervention during radical radiotherapy: Patient-Reported Outcome Side effects (PROSE) study—An emerging approach from sub-Saharan Africa.

6628 Background: PROSE is an electronic patient-reported outcome tool for real-time, remote monitoring of treatment related side-effects. It enables a two way communication between the patient and clinicians. Remote monitoring of treatment related toxicities can eliminate underreporting of side effects (SE), facilitate timely symptom assessment, and improve management of SE. These will thereby reduce morbidity and hospitalization and improve treatment outcomes and quality of life of affected patients. The overarching goal of the study is to enhance the efficiency of the conventional weekly SE clinic using an emerging technology and thereby create evidence for a personalized digital health interventions for cancer patients in Africa. Methods: A prospective study among adult cancer patients receiving radical radiotherapy for head and neck, pelvic, and breast cancers at NSIA-LUTH Cancer Centre in Nigeria between March and October 2022. Eligible (≥18 years, KPS≥75%) and consenting participants were trained on to report their SE daily and receive remote clinical advice on prosecare.com . The PROSE tool was built as an adapted version of the Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). The study participants were monitored throughout their radiotherapy sessions and two weeks thereafter. The cancer care team can review the Patients Reported Outcome (PRO) data through a dedicated log-in portal during the SE clinic. Participants scored their SE daily and EORTC QLQ-30 quality of life surveys were administered thrice during the study and 2 weeks thereafter. SE reports were chosen according to the site of disease; 12 items for head and neck tumors, 9 items for breast tumors, 14 items for female pelvic and 18 items for male pelvic tumors. Patient’s PROSE tool application utilization was defined as >50% daily reporting during study period. Results: A total of 137 participants were screened, of which 120 met the eligibility criteria. Of the 120 patients eligible, 23 had technical issues with the use of the PROSE tool application and 1 died during the study; thus, 96 participants data were analyzed. More than 40,000 SE reports were generated during the study. SE with highest symptom burden include urinary frequency in male pelvic cancers (n=17), radiation dermatitis in breast cancer (n=40), diarrhea in female pelvic cancer (n=19) and xerostomia in head/neck cancers (n=20). The app utilization rate was 58%. Conclusions: There was a moderate utilization (58%) of the PROSE tool application. The PROSE pilot study demonstrated the potential utility of the PROSE application as a promising tool and data resource that offers a great opportunity to improve cancer care and the development of predictive clinical algorithms by engaging patients in their own care and increased SE reporting of acute radiation toxicities.

Metformin for Prevention of Anthropometric and Metabolic Complications of Androgen Deprivation Therapy in Prostate Cancer Patients Receiving Radical Radiotherapy: A Phase II Randomized Controlled Trial

Patients with prostate cancer undergoing treatment with radical radiation therapy (RT) plus androgen deprivation therapy (ADT) experience a constellation of deleterious metabolic and anthropometric changes related to hypogonadism that are associated with increased morbidity and mortality. We assessed the effect of metformin versus placebo to blunt the adverse effects of ADT on body weight, waist circumference, and other metabolic parameters. This phase 2, multicenter, randomized controlled trial (RCT) randomized normoglycemic men with locally advanced prostate cancer receiving radical RT and ADT (18-36 months) in a 1:1 ratio to receive metformin 500 mg by mouth 3 times a day (for 30-36 months) versus identical placebo. From December 2015 to October 2019, 83 men were randomized with median follow-up of 23 months. Baseline mean body mass Index (BMI) of the cohort was 30.2 (range 22.2-52.5). Change in mean weight relative to baseline was lower among men who received metformin compared with placebo at 5 months (-1.80 kg, P=.038), but was not significant with longer follow-up (1 year: +0.16 kg, P=.874). Although participants on ADT had increases in waist circumference in both study arms, metformin did not significantly reduce these changes (1 year: +2.79 cm (placebo) versus +1.46 cm (metformin), P=.336). Low-density lipoprotein (LDL) cholesterol was lower in the metformin arm (-0.32 mmol/L) compared with the placebo arm (-0.03 mmol/L) at 5 months (P=.022), but these differences were not significant with longer follow-up (1 year: -0.17 mmol/L vs -0.19 mmol/L, P=.896). There were no differences in HbA1C, triglyceride, high-density lipoprotein (HDL) cholesterol, and total cholesterol by study arm. Men receiving radical RT and ADT gained weight and had increases in waist circumference over time that metformin did not significantly mitigate. Although this study did not observe any preventive effect of metformin on the anthropometric and metabolic complications of ADT, metformin continues to be studied in phase 3 RCTs in this patient population to assess its potential antineoplastic effects.

85 - Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) ± chemotherapy (CTRT): audit of the first UK departmental guideline

85 - Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) ± chemotherapy (CTRT): audit of the first UK departmental guideline

To improve nutrition of head and neck (H&N) cancer patients receiving radical radiotherapy (RT) in an outpatient setting by establishing a nasogastric (NG) feeding service to reduce lengthy inpatient stays and improve patient outcomes

To improve nutrition of head and neck (H&N) cancer patients receiving radical radiotherapy (RT) in an outpatient setting by establishing a nasogastric (NG) feeding service to reduce lengthy inpatient stays and improve patient outcomes

EP1.16-26 Prehabilitation for Lung Cancer Patients Receiving Radical Radiotherapy

EP1.16-26 Prehabilitation for Lung Cancer Patients Receiving Radical Radiotherapy

P2.17-02 Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy

P2.17-02 Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy

114 - A service evaluation of a newly established dietetic service to the weekly radiotherapy nurse led clinic for lung cancer patients receiving radical radiotherapy

114 - A service evaluation of a newly established dietetic service to the weekly radiotherapy nurse led clinic for lung cancer patients receiving radical radiotherapy

Does one size fit all? Adaptive radiotherapy for bladder cancer: A feasibility study

IntroductionAdaptive techniques to deliver radiotherapy to the bladder may ensure treatment accuracy whilst sparing organs at risk. This study assesses the frequency of when an alternative plan to the current standard may be beneficial and establish the treatment resource implications of adaptive techniques. Assess the variation in accuracy of skeletal surrogate compared to the target. Additionally describes a training package for therapeutic radiographers evaluating CBCT datasets for adaptive techniques. MethodsA library of three plans was created for each patient, small, standard and large. Weekly CBCT and planar imaging data were acquired from 10 bladder cancer patients receiving radical radiotherapy. Bladder volumes from weekly CBCT were compared to the planning scan. Image registration was performed using bone and soft tissue structures on the CBCT images. A database of images was created to develop competency assessment and a training package. ResultsMatching to a skeletal surrogate may under estimate movement of the target. Bladder volume can vary significantly during the course of treatment, even in the presence of bladder preparation protocols. The additional time required to implement this technique is 4 min per fraction compared to standard treatment with planar imaging. ConclusionsThis feasibility study is a useful process to facilitate the implementation of adaptive techniques. However a limitation of this study is the low number of CBCT datasets evaluated. The advent of IGRT and adaptive techniques gives increased confidence to reduce margins, consequently facilitating hypo-fractionation, and may provide a gain in linear accelerator efficiency and reduce the number of hospital visits for the patient. CBCT paired with a development programme for therapeutic radiographers is an effective and efficient means of implementing adaptive radiotherapy.

Randomized phase II exploratory study of prophylactic amifostine in cancer patients who receive radical radiotherapy to the pelvis

BackgroundThis study aimed to investigate the efficacy of prophylactic amifostine in reducing the risk of severe radiation colitis in cancer patients receiving radical radiotherapy to the pelvis.MethodsPatients with pelvic tumours referred for radical radiotherapy who consented participation in this trial, were randomly assigned to receive daily amifostine (A) (subcutaneously, 500 mg flat dose) before radiotherapy or radiotherapy alone (R). Sigmoidoscopy and blinded biopsies were scheduled to conduct prior to initiation and following completion of radiotherapy and again 6 to 9 months later. Radiation colitis was assessed by clinical, endoscopic and histolopathological criteria.ResultsA total 44 patients were enrolled in this trial, the majority with rectal (20 patients) and cervical cancer (12 patients) and were assigned 23 in R arm and 21 in the A arm. In total 119 sigmoidoscopies were performed and 18 patients (18/44, 40.9%) were diagnosed with radiation colitis (15 grade 1 and 2, and 3 grade 3 and 4). Of them, 6 patients belonged to the A group (6/21, 28.6%) and 12 to the R group (12/23, 52.2%). Acute and grade IV radiation colitis was only developed in four patients (17.4%) in the R group. Amifostine side effects were mild. Amifostine treated patients were less likely to develop histologically detectable mucosal lesions, which indicate protection from acute mucosal injury.ConclusionsAmifostine given subcutaneously can lower the risk of acute severe radiation colitis in patients who receive radical radiotherapy to pelvic tumors.

Acute and late effects of radical radiotherapy in elderly head and neck cancer patients

16515 Background: To evaluate the difference between acute and late effects of radical radiotherapy in elderly(above 60 years,Group A) head and neck cancer patients with young patients (below 50 years of age, Group B). Methods: The study was conducted on histologically proven head and neck cancer patients receiving radical radiotherapy (RT),49 patients were in group A and 40 in group B.The acute and late radiation morbidity was assessed using RTOG (phases I,II,&III- Pre RT, During RT & 1 month post RT respectively) and LENT-SOMA scoring systems (phases IV &V-3 & 6 months post RT). Results: In phase II, grade I dermatitis was commonly seen (83.7% in group A,72.5% in group B) and grade II dermatitis was 12.2 % vs 25% of patients.The difference in distribution over age was not significant (p= 0.12 & 0.18 in phase II and III).There was no significant difference in the incidence of late effects between two groups (p=0.91 in phase IV and p=0.99 in phase V).Grade II mucositits was seen in majority of patients in both groups,71.4% vs 72.5% in phase II.The late mucosal changes with worrisome subjective (pain) experiences were observed in 69.4% vs 75% of patients in group A and B, respectively.The difference in distribution over the age was significant (p<0.051) only in phase II.Dryness of mouth was the most common acute and late sequel of RT.The acute salivary gland morbidity was mostly moderate to complete dryness (grade II),seen in phases II and III in 24.5% & 73.5% of patients but the late sequel was seen in 83.37% of patients in group A and 85% in group B and the difference in late effects in both groups was statistically significant except in phase V (p= 0.02). Moderate dysphagia of grade II morbidity was seen in 75.5% vs. 65% in phase II. Grade III dysphagia was seen only 5 patients in group A and one in group B. In phase IV,66.7% patients in group A,72.5% in group B had persistent difficulty in swallowing. Conclusions: Grade I and II mucositis and dermatitis during the course of treatment led to increased morbidity, decreased nutritional intake and pain. Xerostomia is the most common and inevitable acute and late squeal of radical radiotherapy to head and neck cancer region resulting in difficulty in mastication and swallowing. There was no difference in the occurrence of acute and late effects between younger and elderly patients. No significant financial relationships to disclose.

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy.

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.

Radiologically inserted gastrostomies: their use in patients with cancer of the upper aerodigestive tract.

General indications for enteral nutrition include obstructive lesions of the upper gastrointestinal tract, oropharyngeal and oesophageal motility disorders, aspiration and stroke. In oncological practice, stenosing pharyngeal or oesophageal carcinomas and painful radiation mucositis account for most patients requiring enteral feeding [1]. Enteral tubes are also of value in patients with intestinal obstruction, in whom the tubes are used for drainage [2]. Available enteral routes include nasogastric, nasojejunal, gastrostomy, gastrojejunostomy and jejunostomy tubes. Gastrostomy tubes may be surgically, endoscopically or radiologically inserted. Radiologically inserted gastrostomies (RIGs) have been in use for over a decade but the technique is still unknown to many healthcare professionals. The purpose of this article is to illustrate the use of RIGs in head and neck cancer patients receiving radical radiotherapy, who as a group could potentially benefit from more widespread appreciation of the value of this technique.

Temporal assessment of quality of life of head and neck cancer patients receiving radical radiotherapy.

The study was undertaken to evaluate physical, psychological and functional aspects in quality of life (QoL) assessment prospectively in biopsy-proven head and neck cancer patients receiving radical radiotherapy. Fifty male patients were assessed using Karnofsky's Performance Status (KPS), Beck's Depression Inventory (BDI) and the Functional Living Index-Cancer (FLIC). Patient questionnaires were completed before radiotherapy, during 3-4 weeks of radiotherapy and 3 months after radiotherapy. Before the start of radiotherapy, KPS was 91 +/- 10.26, FLIC was 129.98 +/- 33.41 and BDI was 7.10 +/- 4.57. This indicated good performance and functional status with lower depression. In weeks 3-4 of radiotherapy, KPS (71.00 +/- 20.12) and FLIC (81.34 +/- 45.23) decreased, while BDI (16.56 +/- 9.01) increased, indicating impairment in QoL. Three months after radiotherapy, KPS (78.37 +/- 23.0), FLIC (119.51 +/- 43.62) and BDI (9.02 +/- 7.81) improved but were not restored to pre-treatment levels. When patients were scheduled for radical radiotherapy, maximum deterioration in QoL was seen in weeks 3-4. This is the time when maximum supportive care and psychologic counselling is required.