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18F-fluorodeoxyglucose positron emission tomography-computed tomography for suspected recurrent papillary thyroid cancer: early experience at Sunnybrook Health Sciences Centre.

https://arctichealth.org/en/permalink/ahliterature153281
Source
J Otolaryngol Head Neck Surg. 2008 Oct;37(5):712-7
Publication Type
Article
Date
Oct-2008
Author
Max Dahele
Yee C Ung
Lisa Ehrlich
Jay Silverberg
Judith Balogh
C Shun Wong
Author Affiliation
Departmentof Radiation Oncology, University of Toronto, Edmond Odette Cancer Centre,Toronto, Ontario.
Source
J Otolaryngol Head Neck Surg. 2008 Oct;37(5):712-7
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biological Markers - blood
Cancer Care Facilities
Carcinoma, Papillary - pathology - radionuclide imaging - surgery
Cohort Studies
Female
Fluorodeoxyglucose F18 - diagnostic use
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Recurrence, Local - pathology - radionuclide imaging - surgery
Neoplasm Staging
Ontario
Positron-Emission Tomography - methods
Reproducibility of Results
Retrospective Studies
Risk assessment
Sensitivity and specificity
Thyroglobulin - blood
Thyroid Neoplasms - pathology - radionuclide imaging - surgery
Thyroidectomy - methods
Time Factors
Treatment Outcome
Young Adult
Abstract
To report the initial experience with combined 18F-fluorodeoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) imaging for suspected recurrent papillary differentiated thyroid cancer (DTC) at Sunnybrook Health Sciences Centre (SHSC), Toronto.
Single institution retrospective study.
Consecutive patients from SHSC who underwent FDG PET/CT imaging for suspected recurrent DTC over a period of 2.5 years were identified and their charts reviewed.
Qualitative appraisal of FDG PET/CT imaging in suspected recurrent DTC.
Sixteen patients (14F, 2M) were identified accounting for 17 FDG PET/CT scans. Three scans (18%) in 3 different patients were reported as suspicious for recurrent disease in the neck (1-3 lesions) and were considered "positive". All were subsequently confirmed pathologically (4-13 positive lymph nodes post operatively). Prior conventional imaging was abnormal in two patients. Two patients had an elevated non-stimulated thyroglobulin (TG)
PubMed ID
19128681 View in PubMed
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Improving the quality of lung cancer care in Ontario: the lung cancer disease pathway initiative.

https://arctichealth.org/en/permalink/ahliterature114830
Source
J Thorac Oncol. 2013 Jul;8(7):876-82
Publication Type
Article
Date
Jul-2013
Author
William K Evans
Yee C Ung
Nathalie Assouad
Anna Chyjek
Carol Sawka
Author Affiliation
Department of Oncology, McMaster University and the Juravinski Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada. bill.evans@jcc.hhsc.ca
Source
J Thorac Oncol. 2013 Jul;8(7):876-82
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Carcinoma, Non-Small-Cell Lung - therapy
Humans
Lung Neoplasms - therapy
Ontario
Palliative Care
Prognosis
Program Evaluation
Quality Assurance, Health Care
Quality Improvement
Signal Transduction
Survival Rate
Abstract
Before 2008, Cancer Care Ontario (CCO) undertook provincial cancer control quality-improvement initiatives on a programmatic basis. CCO has now added Disease Pathway Management (DPM) to its quality improvement strategy, with the intent of achieving high-quality care, processes, and patient experience across the patient pathway for specific cancers.
The three goals of DPM are: to describe and share evidence-based best practice along the cancer continuum for specific cancers; identify quality-improvement priorities for specific cancers and catalyze action; monitor performance against best practice for specific cancers. The objective of this article is to describe the process by which the CCO lung cancer (LC) DPM was initiated and some of its early successes.
In 2009, LC DPM began with a draft LC disease pathway map and the establishment of five multidisciplinary working groups, each focused on a phase of the LC patient journey: prevention, screening, and early detection; diagnosis; treatment; palliative care, end-of-life care, and survivorship; and patient experience. The working groups held 25 meetings of 2-hour duration and developed concepts for 17 quality-improvement projects across the patient journey. Eight were selected for detailed discussion at a provincial consensus conference, which provided input on priorities for action. A report on the priorities for action was prepared and widely circulated, and regional roadshows were held in all 14 regions of the province of Ontario. Region-specific data on incidence, stage, treatment compliance, and wait times among other issues relevant to LC, were shared with the regional care providers at these roadshows. Funding was provided by CCO to address opportunities for regional improvement based on the data and the priorities identified.
The LC disease pathways were refined through substantial multidisciplinary discussion, and the diagnostic pathway was posted on CCO's Web site in February 2012. The treatment pathways for small-cell LC and non-small-cell LC were posted in November 2012. LC Diagnostic Assessment Units/Programs have been initiated in 14 regions, and educational materials on dyspnea management, including a patient video, are available on CCO's Web site. An audit has been undertaken to better understand the barriers to the uniform uptake of specific evidence-based practices across the province, and the results will be reported shortly. The proportion of LC patients, whose symptoms are assessed at least once a month, using a standardized symptom assessment instrument (Edmonton Symptom Assessment System), has improved through the DPM.
Through CCO's LC DPM initiative, Regional Cancer Programs have become aware of their performance on a range of LC-specific performance and quality metrics and have been motivated to undertake quality-improvement initiatives. Standardized diagnostic and treatment pathways have been developed. Ongoing measurement of a broad range of metrics, including stage-specific survival, guideline concordance, and measures of the patient experience will help determine the benefit of this major initiative.
PubMed ID
23575416 View in PubMed
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Phase II study of accelerated hypofractionated three-dimensional conformal radiotherapy for stage T1-3 N0 M0 non-small cell lung cancer: NCIC CTG BR.25.

https://arctichealth.org/en/permalink/ahliterature103015
Source
J Natl Cancer Inst. 2014 Aug;106(8)
Publication Type
Article
Date
Aug-2014
Author
Patrick Cheung
Sergio Faria
Shahida Ahmed
Pierre Chabot
Jonathan Greenland
Elizabeth Kurien
Islam Mohamed
James R Wright
Helmut Hollenhorst
Catherine de Metz
Holly Campbell
Thi Toni Vu
Anand Karvat
Elaine S Wai
Yee C Ung
Glenwood Goss
Frances A Shepherd
Patti O'Brien
Keyue Ding
Chris O'Callaghan
Author Affiliation
Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada (PC, YCU); Montreal General Hospital, McGill University, Montreal, Quebec, Canada (SF); CancerCare Manitoba, Winnipeg, Manitoba, Canada (SA); Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada (PC); Dr. H. Bliss Murphy Cancer Centre, St John's, Newfoundland, Canada (JG); Tom Baker Cancer Centre, Calgary, Alberta, Canada (EK); BC Cancer Agency-Cancer Centre for the Southern Interior, Kelowna, British Columbia, Canada (IM); Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada (JRW); QEII Centre for Clinical Research Trials, Halifax, Nova Scotia, Canada (HH); Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Ontario, Canada (CdM); Atlantic Health Sciences Corporation, Saint John Regional Hospital, Saint John, New Brunswick, Canada (HC); CHUM - Hopital Notre-Dame, Montreal, Quebec, Canada (TTV); BC Cancer Agency-Fraser Valley Centre, Surrey, British Columbia, Canada (AK); BC Cancer Agency-Vancouver Island Cancer Centre, Victoria, British Columbia, Canada (ESW); Ottawa Health Research Institute-General Division, Ottawa, Ontario, Canada (GG); University Health Network-OCI/Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada (FAS); NCIC Clinical Trials Group, Queen's University, Kingston, Ontario, Canada (PO, KD, CO). patrick.cheung@sunnybrook.ca.
Source
J Natl Cancer Inst. 2014 Aug;106(8)
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Carcinoma, Non-Small-Cell Lung - epidemiology - pathology - radiotherapy
Disease-Free Survival
Dose Fractionation
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Lung Neoplasms - epidemiology - pathology - radiotherapy
Male
Middle Aged
Neoplasm Staging
Prospective Studies
Radiotherapy, Conformal - adverse effects - methods - statistics & numerical data
Treatment Outcome
Abstract
A multi-institutional phase II trial was performed to assess a hypofractionated accelerated radiotherapy regimen for early stage non-small cell lung cancer (NSCLC) in an era when stereotactic body radiotherapy was not widely available.
Eighty patients with biopsy-proven, peripherally located, T1-3 N0 M0 NSCLC were enrolled. Eligible patients received 60 Gy in 15 fractions using a three-dimensional conformal technique without inhomogeneity correction. The gross tumour volume (GTV) was the primary tumor only, and the planning target volume (PTV) margin was 1.0 to 1.5cm. The primary endpoint was the 2-year primary tumor control rate. Toxicities were measured using the Common Terminology Criteria for Adverse Events version 3.0.
The median follow-up of patients was 49 months (range = 21-63 months). The median age of patients was 75.9 years. The actuarial rate of primary tumor control was 87.4% (95% confidence interval [CI] = 76.2% to 93.5%) at 2 years. Overall survival was 68.7% (95% CI = 57.2% to 77.6%) at 2 years. The actuarial rates of developing regional and distant relapse at 2 years were 8.8% (95% CI = 4.1% to 18.7%) and 21.6% (95% CI = 13.5% to 33.5%), respectively. Tumor size greater than 3cm was associated with an increased risk of developing distant relapse (hazard ratio = 3.11; 95% CI = 1.30 to 7.42; two-sided log-rank test P = .007). The most common grade 3+ toxicities were fatigue (6.3%), cough (7.5%), dyspnea (13.8%), and pneumonitis (10.0%)
Conformal radiotherapy to a dose of 60 Gy in 15 fractions resulted in favorable primary tumor control and overall survival rates in patients with T1-3 N0 M0 NSCLC. Severe toxicities were uncommon with this relatively simple treatment technique.
PubMed ID
25074417 View in PubMed
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Randomized, double-blind, placebo-controlled trial of erythropoietin in non-small-cell lung cancer with disease-related anemia.

https://arctichealth.org/en/permalink/ahliterature165058
Source
J Clin Oncol. 2007 Mar 20;25(9):1027-32
Publication Type
Article
Date
Mar-20-2007
Author
James R Wright
Yee C Ung
Jim A Julian
Kathleen I Pritchard
Timothy J Whelan
Column Smith
Barbara Szechtman
Wilson Roa
Liam Mulroy
Leona Rudinskas
Bruno Gagnon
Gord S Okawara
Mark N Levine
Author Affiliation
Juravinski Cancer Center at Hamilton Health Sciences, Hamilton, Ontario, Canada. jim.wright@hrcc.on.ca
Source
J Clin Oncol. 2007 Mar 20;25(9):1027-32
Date
Mar-20-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anemia - blood - drug therapy - etiology
Canada
Carcinoma, Non-Small-Cell Lung - complications - mortality - pathology
Double-Blind Method
Erythropoietin - adverse effects - therapeutic use
Female
Hematinics - adverse effects - therapeutic use
Hemoglobins - metabolism
Humans
Kaplan-Meier Estimate
Lung Neoplasms - complications - mortality - pathology
Male
Middle Aged
Neoplasm Staging
Proportional Hazards Models
Quality of Life
Recombinant Proteins
Thrombosis - chemically induced
Time Factors
Treatment Outcome
Abstract
Previous trials have suggested a quality-of-life (QOL) improvement for anemic cancer patients treated with erythropoietin, but few used QOL as the primary outcome. We designed a trial to investigate the effects of epoetin alfa therapy on the QOL of anemic patients with advanced non-small-cell carcinoma of the lung (NSCLC).
A multicenter, randomized, double-blind, placebo-controlled trial was conducted. The proposed sample size was 300 patients. Eligible patients were required to have NSCLC unsuitable for curative therapy and baseline hemoglobin (Hgb) levels less than 121 g/L. Patients were assigned to 12 weekly injections of subcutaneous epoetin alpha or placebo, targeting Hgb levels between 120 and 140 g/L. The primary outcome was the difference in the change in Functional Assessment of Cancer Therapy-Anemia scores between baseline and 12 weeks.
Reports of thrombotic events in other epoetin trials prompted an unplanned safety analysis after 70 patients had been randomly assigned (33 to the active arm and 37 to the placebo arm). This revealed a significant difference in the median survival in favor of the patients on the placebo arm of the trial (63 v 129 days; hazard ratio, 1.84; P = .04). The Steering Committee closed the trial. Patient numbers compromised the interpretation of the QOL analysis, but a positive Hgb response was noted with epoetin alfa treatment.
An unplanned safety analysis suggested decreased overall survival in patients with advanced NSCLC treated with epoetin alfa. Although infrequent, other similar reports highlight the need for ongoing trials evaluating erythropoietin receptor agonists to ensure that overall survival is monitored closely.
Notes
Comment In: J Clin Oncol. 2007 Mar 20;25(9):1021-317312331
PubMed ID
17312332 View in PubMed
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