Radiotherapeutisch Instituut Friesland

Adjuvant chemotherapy in the treatment of endometrial cancer can be difficult to tolerate for older women. This study examined age-related differences in patient preferences for chemotherapy in women with high-risk endometrial cancer. We re-analyzed data from the cross-sectional patient preference study PRETEC-2 to determine the difference between three age groups in minimally desired survival benefit of chemotherapy. For this, patients with high-risk endometrial cancer treated with adjuvant pelvic radiotherapy with or without chemotherapy completed a treatment trade-off questionnaire. Patients also rated the importance they attributed to treatment duration and acute and late side-effects for their decision on chemotherapy, which we analyzed by age group. A total of 171 patients (23% <60years, 40% 60-69years and 37% ≥70years) were included in the analysis. Older patients had a significantly higher median minimally desired survival benefit for preferring chemoradiotherapy (5% for <60years, 8% for 60-69years and 15% for patients ≥70years; (p<0.001)), and had the largest variability in minimally desired survival benefit. For a real-life five-year survival benefit of 5%, fewer older patients preferred the addition of chemotherapy to their treatment regimen (61.5% for <60years, 45.6% for 60-69years and 21.9% for ≥70years; p<0.001). Furthermore, older patients rated both treatment duration (p=0.001) and long-term tingling or numbness (p=0.005) as significantly more important than their younger counterparts. There is more heterogeneity in the desired benefit of chemotherapy among patients aged 70years or more compared to younger patients. This underlines the importance of recognizing individual differences and the need for shared decision-making.

BackgroundEvidence for effectiveness of radiotherapy for Ledderhose disease was demonstrated in the LedRad-study. However, the health economic impact of Ledderhose disease is unclear. Therefore, an economic evaluation alongside the LedRad-study was planned. MethodsThe economic evaluation was performed as a cost-effectiveness and cost-utility analysis from the societal perspective. Primary outcome parameters were pain burden and Quality Adjusted Life Years (QALY), until 12 months after the end of treatment. Secondary analyses were performed with outcomes until 18 months. Incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were calculated to express costs per unit improvement in pain burden and costs per QALY gained, for radiotherapy compared to sham-radiotherapy. Bootstrap replication was used to assess uncertainty surrounding the ratios and to construct cost-effectiveness acceptability curves for QALY gain. ResultsPrevious analysis showed a statistically significant improvement in pain- and QoL scores in favour of radiotherapy at 12 and 18 months. At these timepoints and excluding treatment costs, cumulative total costs were considerably lower in the radiotherapy group. The ICER until 12 months after treatment was 4987 euro per unit of pain burden reduction. The ICUR was 14249 euro per QALY gained. Most of the bootstrap replications were in the upper right quadrant, indicating that health gain can be achieved at higher costs. At increasing levels of willingness to pay for a gain in QALY, the probability of cost-utility gradually increased to approximately 85%. ConclusionsIn patients with symptomatic Ledderhose disease, radiotherapy, at a moderate threshold for willingness to pay, is cost-effective in terms of QoL gain.

Introduction/BackgroundThe endometrial cancer (EC) molecular class is predictive for response to chemotherapy. Little is known about its’ predictive value for response to radiotherapy. We investigated benefit of adjuvant vaginal brachytherapy (VBT) and external beam radiotherapy (EBRT) across the four molecular classes.MethodologyParticipants of the randomized PORTEC-1 (n=714) and PORTEC-2 (n=427) trials were eligible if their EC were molecularly profiled according to the WHO 2020 classification. PORTEC-1 included intermediate risk EC and compared EBRT to no adjuvant treatment. PORTEC-2 included high-intermediate risk EC and compared VBT to EBRT. Locoregional recurrence-free survival (LRFS) was estimated and compared using Kaplan-Meier’s methodology and log-rank tests. Correction for confounding by predefined clinicopathological factors was done using Cox proportional hazards models. 2022-RA-450-ESGO Table 1Multivariable analysis of predictors of locoreginal recurrence-free survival 2022-RA-450-ESGO Figure 1Results881 patients with a median follow-up of 11.3 years were included. Patient and tumour characteristics are presented in table 1. EC were classified as POLE-mutant (POLEmut, 7.3%) mismatch-repair deficient (MMRd, 28.0%), p53-abnormal (p53abn, 9.1%) and non-specific molecular profile (NSMP, 55.6%). Overall, adjuvant radiotherapy significantly improved LRFS (figure 1A). In POLEmut EC no LR were observed (figure 1B). In MMRd EC, VBT and EBRT did not significantly improve LRFS (figure 1C). In p53abn EC, EBRT but not VBT significantly improved LRFS (figure 1D). In NSMP EC, both EBRT and VBT significantly improved LRFS. Adjuvant radiotherapy and molecular class retained significant impact on LRFS after correction for clinicopathological risk factors (table 1).ConclusionBenefit of adjuvant radiotherapy in early-stage endometrioid EC differs between EC molecular classes. Omitting radiotherapy seems safe in early-stage POLEmut EC. Benefit of radiotherapy in MMRd EC is uncertain as only a small, non-significant reduction in LR was observed. In p53abn EC, EBRT significantly improved LRFS, in contrast to brachytherapy and no adjuvant treatment. NSMP EC seem to have a clear benefit of radiotherapy; VBT seems sufficient for locoregional tumour control.

ABSTRACTIn a multi‐center patient study, using different CT scanners, CT‐based finite element (FE) models are utilized to calculate failure loads of femora with metastases. Previous studies showed that using different CT scanners can result in different outcomes. This study aims to quantify the effects of (i) different CT scanners; (ii) different CT protocols with variations in slice thickness, field of view (FOV), and reconstruction kernel; and (iii) air between calibration phantom and patient, on Hounsfield Units (HU), bone mineral density (BMD), and FE failure load. Six cadaveric femora were scanned on four CT scanners. Scans were made with multiple CT protocols and with or without an air gap between the body model and calibration phantom. HU and calibrated BMD were determined in cortical and trabecular regions of interest. Non‐linear isotropic FE models were constructed to calculate failure load. Mean differences between CT scanners varied up to 7% in cortical HU, 6% in trabecular HU, 6% in cortical BMD, 12% in trabecular BMD, and 17% in failure load. Changes in slice thickness and FOV had little effect (≤4%), while reconstruction kernels had a larger effect on HU (16%), BMD (17%), and failure load (9%). Air between the body model and calibration phantom slightly decreased the HU, BMD, and failure loads (≤8%). In conclusion, this study showed that quantitative analysis of CT images acquired with different CT scanners, and particularly reconstruction kernels, can induce relatively large differences in HU, BMD, and failure loads. Additionally, if possible, air artifacts should be avoided. © 2018 Orthopaedic Research Society. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2288–2295, 2018.

BackgroundThe effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown.MethodsWe randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracic-wall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer.ResultsBetween 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median follow-up of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest.ConclusionsIn patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.)