Context
Glioblastoma (GBM) is a devastating and incurable neuro-oncologic disease, and issues related to the end of life (EOL) are almost invariably a matter of “when,” not a matter of “if”. Optimizing symptom management and quality of life in later stages of disease is of the utmost priority.
Objectives
To examine the frequency of and factors associated with late acute hospital admission before death in patients with GBM.
Methods
Case-control study comparing patients with GBM admitted to the hospital within one month of death to those without late hospital admission.
Results
Of 385 GBM patients followed to death at Memorial Sloan Kettering Cancer Center, 164 (42.6%) were admitted within a month of death, most frequently (140, or 85%) to manage neurologic decline. Of these, 56 (34%) had ICU care during this admission and 22 (13%), 18 (11%), and 2 (1%) received mechanical ventilation, enteral feeding tubes, or cardiopulmonary resuscitation, respectively. In multivariable analysis, in-hospital chaplaincy consultation and participation in a therapeutic clinical trial, both at any time in the GBM disease course, were significantly associated with late hospital admission.
Conclusions
Late hospitalization is frequent in GBM and often involves ICU care in the management of clinical events that are part of the GBM dying process. Patients with a tendency to utilize religious support and those enrolled in clinical trials may be at greater risk for late hospitalization. Dedicated prospective study is needed to determine predictors of late hospitalization and to examine the impact of late acute medical care upon quality of life in GBM.
Locally advanced breast cancer requires surgical management via lumpectomy or mastectomy with or without systemic therapy followed by chest wall or breast (CW) and comprehensive nodal irradiation (CNI). Radiation (RT) dose constraints for the heart and ipsilateral lung have been developed based on photon RT. Proton therapy (PBT) can deliver significantly lower doses of RT to these organs-at-risk (OARs) and may warrant adjustments to OAR planning goals. Methods and Materials: The RT plans of consecutive patients undergoing adjuvant CW-CNI RT with PBT within a single center were reviewed. A inital treatment volume, comprised of CW/intact breast þ CNI (CTV_init) structure, including the CW and CNI but excluding any boost plans was analyzed. Frequency distributions were generated based on doses received by the heart, lungs, and esophagus for validated dosimetric parameters. Frequency distributions were generated and then stratified by laterality and compared using the Kruskal-Wallis H test. The 75th, 85th, and 95th percentiles for each dosimetric parameter were calculated, overall and by laterality. The 75th percentile (Q3), was used as a suggested primary goal, and the 95th percentile was used as a suggested secondary goal. Results: One hundred and seventy-two plans were analyzed. Forty-nine plans were right-sided, 107 were left-sided, and 16 were bilateral. The overall Q3 of the mean and V25 of the heart were 1.5 Gy and 1.7%, respectively. The mean and V25 to the heart differed significantly by laterality. Pulmonary values were similar to current recommendations. For all lateralites, the median volume of the esophagus receiving 70% prescription dose was 1 cm 3. Conclusions: We present the first dosimetric study providing complete OAR dose-volume histograms data for patients undergoing adjuvant pencil-beam scanning-PBT for locally advanced breast cancer, with detailed information on central tendencies, ranges and distributions of data. We have provided suggested planning goals and metrics for the lungs, heart, and esophagus; the latter 2 differing Sources of support: No outside funding was used in the development of this manuscript.
Background
To determine if the extent of high‐dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16‐positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT).
Methods
We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre‐treatment PET–CT and restaging PET–CT within 4 months following completion of IMPT were analyzed.
Results
Sixty patients were included for analysis with a median follow‐up of 17 months. The median GTV to CTV expansion was 5 mm (IQR: 2 mm). Thirty‐three percent of patients (20 of 60) did not have a GTV to CTV expansion. There was one local failure within the expansion group (3%).
Conclusion
Excellent local control was achieved using IMPT for p16+ OPC independent of GTV expansion. IMPT with minimal target expansions represent a potential harm‐minimization technique for p16‐positive oropharynx cancer.
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