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Judy Thibadeau - One of the best experts on this subject based on the ideXlab platform.
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Bladder Management and Continence Outcomes in Adults with Spina Bifida: Results from the National Spina Bifida Patient Registry, 2009 to 2015
The Journal of Urology, 2018Co-Authors: John S. Wiener, Kristina D. Suson, Jonathan Castillo, Jonathan C. Routh, Stacy T. Tanaka, Elisabeth Ward, Judy Thibadeau, David B. JosephAbstract:Purpose: Most children with spina bifida now survive into adulthood, although most have neuropathic bladder with potential complications of incontinence, infection, renal damage and diminished quality of life. In this study we sought to 1) describe contemporary bladder management and continence outcomes of adults with spina bifida, 2) describe differences from younger individuals and 3) assess for association with socioeconomic factors.Materials and Methods: We analyzed data on bladder management and outcomes in adults with spina bifida from the National Spina Bifida Patient Registry. A strict definition of continence was used. Results were compared to young children (age 5 to 11 years) and adolescents (12 to 19). Statistical analysis compared cohorts by gender, ethnicity, spina bifida type, lesion level, insurance status, educational attainment, employment status and continence.Results: A total of 5,250 Patients with spina bifida were included, of whom 1,372 (26.1%) were adults. Of the adult Patients 45....
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bladder reconstruction rates differ among centers participating in national spina bifida Patient Registry
The Journal of Urology, 2018Co-Authors: Jonathan C. Routh, Michael S Schechter, Elisabeth Ward, Judy Thibadeau, David B. Joseph, Chad M Wallis, John S. WienerAbstract:Purpose: We performed an exploratory analysis of data from the NSBPR (National Spina Bifida Patient Registry) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers.Materials and Methods: We queried the 2009-2014 NSBPR to identify Patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, spina bifida type, functional level, mobility and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors.Results: We identified 5,528 Patients with spina bifida enrolled in the NSBPR. Of these Patients 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgical Patients were more likely older, female, nonHispanic white, with a higher lesion level, myelomeningocele diagnosis, nonambulators (all p <0.001) a...
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The National Spina Bifida Patient Registry: Past, present, and future.
Journal of pediatric rehabilitation medicine, 2017Co-Authors: Judy ThibadeauAbstract:: The National Spina Bifida Patient Registry: Past, Present, and Future" was presented at the Spina Bifida World Congress, March 17, 2017, San Diego, California. This commentary provides a summary of Registry activities including the reason for development, a description of the clinic participants and their Patients who are participating, analytic works and publications. Two specific efforts that are related to the work of the Registry, a urologic protocol to preserve renal function for newborns and young children, and a skin breakdown prevention bundle developed and implemented in Registry clinics, are highlighted.
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Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry
The Journal of Urology, 2017Co-Authors: Lijing Ouyang, Kathleen J. Sawin, John S. Wiener, Jonathan Castillo, Jonathan C. Routh, Judy Thibadeau, Kurt A Freeman, Heidi Castillo, Kathryn A. SmithAbstract:Purpose: Achieving bladder continence in individuals with spina bifida is a lifetime management goal. We investigated bladder continence status through time and factors associated with this status in Patients with spina bifida.Materials and Methods: We used National Spina Bifida Patient Registry data collected from 2009 through 2015 and applied generalized estimating equation models to analyze factors associated with bladder continence status.Results: This analysis included 5,250 participants with spina bifida in a large, multi-institutional Patient Registry who accounted for 12,740 annual clinic visit records during the study period. At last followup mean age was 16.6 years, 22.4% of participants had undergone bladder continence surgery, 92.6% used some form of bladder management and 45.8% reported bladder continence. In a multivariable regression model the likelihood of bladder continence was significantly greater in those who were older, were female, were nonHispanic white, had a nonmyelomeningocele di...
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factors associated with pressure ulcers in individuals with spina bifida
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Elisabeth Ward, Kathleen J. Sawin, Judy Thibadeau, Brad E. Dicianno, Gerald H Clayton, Patricia Beierwaltes, William C Walker, Kathryn SmithAbstract:Objective To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR).
Kathleen J. Sawin - One of the best experts on this subject based on the ideXlab platform.
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Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry
The Journal of Urology, 2017Co-Authors: Lijing Ouyang, Kathleen J. Sawin, John S. Wiener, Jonathan Castillo, Jonathan C. Routh, Judy Thibadeau, Kurt A Freeman, Heidi Castillo, Kathryn A. SmithAbstract:Purpose: Achieving bladder continence in individuals with spina bifida is a lifetime management goal. We investigated bladder continence status through time and factors associated with this status in Patients with spina bifida.Materials and Methods: We used National Spina Bifida Patient Registry data collected from 2009 through 2015 and applied generalized estimating equation models to analyze factors associated with bladder continence status.Results: This analysis included 5,250 participants with spina bifida in a large, multi-institutional Patient Registry who accounted for 12,740 annual clinic visit records during the study period. At last followup mean age was 16.6 years, 22.4% of participants had undergone bladder continence surgery, 92.6% used some form of bladder management and 45.8% reported bladder continence. In a multivariable regression model the likelihood of bladder continence was significantly greater in those who were older, were female, were nonHispanic white, had a nonmyelomeningocele di...
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factors associated with pressure ulcers in individuals with spina bifida
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Elisabeth Ward, Kathleen J. Sawin, Judy Thibadeau, Brad E. Dicianno, Gerald H Clayton, Patricia Beierwaltes, William C Walker, Kathryn SmithAbstract:Objective To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR).
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the national spina bifida Patient Registry profile of a large cohort of participants from the first 10 clinics
The Journal of Pediatrics, 2015Co-Authors: Michael S Schechter, Kathleen J. Sawin, Elisabeth Ward, Judy Thibadeau, William L WalkerAbstract:Objective To use data from the US National Spina Bifida Patient Registry (NSBPR) to describe variations in Contexts of Care, Processes of Care, and Health Outcomes among individuals with spina bifida (SB) receiving care in 10 clinics. Study design Reported here are baseline cross-sectional data representing the first visit of 2172 participants from 10 specialized, multidisciplinary SB clinics participating in the NSBPR. We used descriptive statistics, the Fisher exact test, χ 2 test, and Wilcoxon rank-sum test to examine the data. Results The mean age was 10.1 (SD 8.1) years with slightly more female subjects (52.5%). The majority was white (63.4%) and relied upon public insurance (53.5%). One-third had sacral lesions, 44.8% had mid-low lumbar lesions, and 24.9% had high lumbar and thoracic lesions. The most common surgery was ventricular shunt placement (65.7%). The most common bladder-management technique among those with bladder impairment was intermittent catheterization (69.0%). Almost 14% experienced a pressure ulcer in the last year. Of those ages 5 years or older with bowel or bladder impairments, almost 30% were continent of stool; a similar percentage was continent of urine. Most variables were associated with type of SB diagnosis. Conclusion The NSBPR provides a cross section of a predominantly pediatric population of Patients followed in specialized SB programs. There were wide variations in the variables studied and major differences in Context of Care, Processes of Care, and Health Outcomes by type of SB. Such wide variation and the differences by type of SB should be considered in future analyses of outcomes.
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testing the feasibility of a national spina bifida Patient Registry
Birth Defects Research Part A-clinical and Molecular Teratology, 2013Co-Authors: Judy Thibadeau, Kathleen J. Sawin, Elisabeth Ward, Mark E Swanson, Kurt A Freeman, Heidi Castillo, Karen Rauen, Michael S SchechterAbstract:BACKGROUND The purpose of this study was to describe the development and early implementation of a national spina bifida (SB) Patient Registry, the goal of which is to monitor the health status, clinical care, and outcomes of people with SB by collecting and analyzing Patient data from comprehensive SB clinics. METHODS Using a web-based, SB-specific electronic medical record, 10 SB clinics collected health-related information for Patients diagnosed with myelomeningocele, lipomyelomeningocele, fatty filum, or meningocele. This information was compiled and de-identified for transmission to the Centers for Disease Control and Prevention (CDC) for quality control and analysis. RESULTS A total of 2070 Patients were enrolled from 2009 through 2011: 84.9% were younger than 18 years of age; 1095 were women; 64.2% were non-Hispanic white; 6.5% were non-Hispanic black or African American; and 24.2% were Hispanic or Latino. Myelomeningocele was the most common diagnosis (81.5%). CONCLUSIONS The creation of a National Spina Bifida Patient Registry partnership between the CDC and SB clinics has been feasible. Through planned longitudinal data collection and the inclusion of additional clinics, the data generated by the Registry will become more robust and representative of the population of Patients attending SB clinics in the United States and will allow for the investigation of Patient outcomes. Birth Defects Research (Part A), 2013. © 2012 Wiley Periodicals, Inc.
Michael S Schechter - One of the best experts on this subject based on the ideXlab platform.
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bladder reconstruction rates differ among centers participating in national spina bifida Patient Registry
The Journal of Urology, 2018Co-Authors: Jonathan C. Routh, Michael S Schechter, Elisabeth Ward, Judy Thibadeau, David B. Joseph, Chad M Wallis, John S. WienerAbstract:Purpose: We performed an exploratory analysis of data from the NSBPR (National Spina Bifida Patient Registry) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers.Materials and Methods: We queried the 2009-2014 NSBPR to identify Patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, spina bifida type, functional level, mobility and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors.Results: We identified 5,528 Patients with spina bifida enrolled in the NSBPR. Of these Patients 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgical Patients were more likely older, female, nonHispanic white, with a higher lesion level, myelomeningocele diagnosis, nonambulators (all p <0.001) a...
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rate of uptake of ivacaftor use after u s food and drug administration approval among Patients enrolled in the u s cystic fibrosis foundation Patient Registry
Annals of the American Thoracic Society, 2015Co-Authors: Gregory S Sawicki, Elliott C Dasenbrook, Aliza K Fink, Michael S SchechterAbstract:Rationale: Chronic cystic fibrosis (CF) therapies have variable rates of prescribed use, and therapies are rarely prescribed to more than 80% of eligible Patients. Ivacaftor was approved in the United States in January 2012 for Patients ages 6 years and older with a G551D mutation in their CF gene.Objectives: To examine the rate of uptake and patterns of documented ivacaftor use among U.S. Patients with CF during the first year after approval, to compare eligible Patients with and without reported use, and to describe characteristics of early adopters of ivacaftor use.Methods: A cross-sectional study of Patients in the U.S. Cystic Fibrosis Foundation Patient Registry in 2012 with at least one encounter in which ivacaftor use was documented. Ivacaftor-eligible Patients were defined as any individual 6 years of age or older with a G551D mutation. We performed bivariate and multivariate regression analyses, stratified by age group, to compare clinical and demographic characteristics of (1) eligible Patients ...
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the national spina bifida Patient Registry profile of a large cohort of participants from the first 10 clinics
The Journal of Pediatrics, 2015Co-Authors: Michael S Schechter, Kathleen J. Sawin, Elisabeth Ward, Judy Thibadeau, William L WalkerAbstract:Objective To use data from the US National Spina Bifida Patient Registry (NSBPR) to describe variations in Contexts of Care, Processes of Care, and Health Outcomes among individuals with spina bifida (SB) receiving care in 10 clinics. Study design Reported here are baseline cross-sectional data representing the first visit of 2172 participants from 10 specialized, multidisciplinary SB clinics participating in the NSBPR. We used descriptive statistics, the Fisher exact test, χ 2 test, and Wilcoxon rank-sum test to examine the data. Results The mean age was 10.1 (SD 8.1) years with slightly more female subjects (52.5%). The majority was white (63.4%) and relied upon public insurance (53.5%). One-third had sacral lesions, 44.8% had mid-low lumbar lesions, and 24.9% had high lumbar and thoracic lesions. The most common surgery was ventricular shunt placement (65.7%). The most common bladder-management technique among those with bladder impairment was intermittent catheterization (69.0%). Almost 14% experienced a pressure ulcer in the last year. Of those ages 5 years or older with bowel or bladder impairments, almost 30% were continent of stool; a similar percentage was continent of urine. Most variables were associated with type of SB diagnosis. Conclusion The NSBPR provides a cross section of a predominantly pediatric population of Patients followed in specialized SB programs. There were wide variations in the variables studied and major differences in Context of Care, Processes of Care, and Health Outcomes by type of SB. Such wide variation and the differences by type of SB should be considered in future analyses of outcomes.
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the cystic fibrosis foundation Patient Registry as a tool for use in quality improvement
BMJ Quality & Safety, 2014Co-Authors: Michael S Schechter, Aliza K Fink, Karen Homa, Christopher H GossAbstract:The US Cystic Fibrosis Foundation (CFF) began in 1955 with a mission to support the development of new drugs to fight the disease, improve the quality of life for those with cystic fibrosis (CF), and ultimately to find a cure for this disease.1 The CFF does this by supporting basic science and clinical research in CF, supporting the care of CF Patients through accredited CF centres nationwide and advocating for CF Patients at the state and national level. Recognising the critical role of data collection and measurement of outcomes to better understand the natural history of CF, the CFF created a Patient Registry in 1966, the CFF Patient Registry (CFFPR).2 The CFFPR has evolved over the years from a few demographic variables including vital status to a comprehensive database that gives healthcare providers, researchers, policy makers and change agents data to support epidemiological and clinical research as well as efforts to improve quality of care. The specific purpose of this commentary is to describe the CFFPR and primarily to focus on how the CFFPR and its associated tools are being used for quality improvement (QI) activities, with the hope that it may help CF healthcare teams in the USA who are not familiar with the Registry's capabilities, CF providers outside the USA with registries at various stages of development, and others interested in how a Patient Registry has been used to improve care. The CFFPR contains detailed demographic and diagnostic data dating back to 1986 with current annual and encounter-based data on over 300 unique variables including outcomes (eg, microbiology, lung function and nutritional metrics, CF complications) and care processes (eg, hospitalisations, medications, surveillance measures) for each of its more than 27 000 participants in 2012; in all, there are over 46 000 unique individuals’ data in the Registry.3 …
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testing the feasibility of a national spina bifida Patient Registry
Birth Defects Research Part A-clinical and Molecular Teratology, 2013Co-Authors: Judy Thibadeau, Kathleen J. Sawin, Elisabeth Ward, Mark E Swanson, Kurt A Freeman, Heidi Castillo, Karen Rauen, Michael S SchechterAbstract:BACKGROUND The purpose of this study was to describe the development and early implementation of a national spina bifida (SB) Patient Registry, the goal of which is to monitor the health status, clinical care, and outcomes of people with SB by collecting and analyzing Patient data from comprehensive SB clinics. METHODS Using a web-based, SB-specific electronic medical record, 10 SB clinics collected health-related information for Patients diagnosed with myelomeningocele, lipomyelomeningocele, fatty filum, or meningocele. This information was compiled and de-identified for transmission to the Centers for Disease Control and Prevention (CDC) for quality control and analysis. RESULTS A total of 2070 Patients were enrolled from 2009 through 2011: 84.9% were younger than 18 years of age; 1095 were women; 64.2% were non-Hispanic white; 6.5% were non-Hispanic black or African American; and 24.2% were Hispanic or Latino. Myelomeningocele was the most common diagnosis (81.5%). CONCLUSIONS The creation of a National Spina Bifida Patient Registry partnership between the CDC and SB clinics has been feasible. Through planned longitudinal data collection and the inclusion of additional clinics, the data generated by the Registry will become more robust and representative of the population of Patients attending SB clinics in the United States and will allow for the investigation of Patient outcomes. Birth Defects Research (Part A), 2013. © 2012 Wiley Periodicals, Inc.
Elisabeth Ward - One of the best experts on this subject based on the ideXlab platform.
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Bladder Management and Continence Outcomes in Adults with Spina Bifida: Results from the National Spina Bifida Patient Registry, 2009 to 2015
The Journal of Urology, 2018Co-Authors: John S. Wiener, Kristina D. Suson, Jonathan Castillo, Jonathan C. Routh, Stacy T. Tanaka, Elisabeth Ward, Judy Thibadeau, David B. JosephAbstract:Purpose: Most children with spina bifida now survive into adulthood, although most have neuropathic bladder with potential complications of incontinence, infection, renal damage and diminished quality of life. In this study we sought to 1) describe contemporary bladder management and continence outcomes of adults with spina bifida, 2) describe differences from younger individuals and 3) assess for association with socioeconomic factors.Materials and Methods: We analyzed data on bladder management and outcomes in adults with spina bifida from the National Spina Bifida Patient Registry. A strict definition of continence was used. Results were compared to young children (age 5 to 11 years) and adolescents (12 to 19). Statistical analysis compared cohorts by gender, ethnicity, spina bifida type, lesion level, insurance status, educational attainment, employment status and continence.Results: A total of 5,250 Patients with spina bifida were included, of whom 1,372 (26.1%) were adults. Of the adult Patients 45....
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bladder reconstruction rates differ among centers participating in national spina bifida Patient Registry
The Journal of Urology, 2018Co-Authors: Jonathan C. Routh, Michael S Schechter, Elisabeth Ward, Judy Thibadeau, David B. Joseph, Chad M Wallis, John S. WienerAbstract:Purpose: We performed an exploratory analysis of data from the NSBPR (National Spina Bifida Patient Registry) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers.Materials and Methods: We queried the 2009-2014 NSBPR to identify Patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, spina bifida type, functional level, mobility and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors.Results: We identified 5,528 Patients with spina bifida enrolled in the NSBPR. Of these Patients 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgical Patients were more likely older, female, nonHispanic white, with a higher lesion level, myelomeningocele diagnosis, nonambulators (all p <0.001) a...
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factors associated with pressure ulcers in individuals with spina bifida
Archives of Physical Medicine and Rehabilitation, 2015Co-Authors: Elisabeth Ward, Kathleen J. Sawin, Judy Thibadeau, Brad E. Dicianno, Gerald H Clayton, Patricia Beierwaltes, William C Walker, Kathryn SmithAbstract:Objective To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR).
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the national spina bifida Patient Registry profile of a large cohort of participants from the first 10 clinics
The Journal of Pediatrics, 2015Co-Authors: Michael S Schechter, Kathleen J. Sawin, Elisabeth Ward, Judy Thibadeau, William L WalkerAbstract:Objective To use data from the US National Spina Bifida Patient Registry (NSBPR) to describe variations in Contexts of Care, Processes of Care, and Health Outcomes among individuals with spina bifida (SB) receiving care in 10 clinics. Study design Reported here are baseline cross-sectional data representing the first visit of 2172 participants from 10 specialized, multidisciplinary SB clinics participating in the NSBPR. We used descriptive statistics, the Fisher exact test, χ 2 test, and Wilcoxon rank-sum test to examine the data. Results The mean age was 10.1 (SD 8.1) years with slightly more female subjects (52.5%). The majority was white (63.4%) and relied upon public insurance (53.5%). One-third had sacral lesions, 44.8% had mid-low lumbar lesions, and 24.9% had high lumbar and thoracic lesions. The most common surgery was ventricular shunt placement (65.7%). The most common bladder-management technique among those with bladder impairment was intermittent catheterization (69.0%). Almost 14% experienced a pressure ulcer in the last year. Of those ages 5 years or older with bowel or bladder impairments, almost 30% were continent of stool; a similar percentage was continent of urine. Most variables were associated with type of SB diagnosis. Conclusion The NSBPR provides a cross section of a predominantly pediatric population of Patients followed in specialized SB programs. There were wide variations in the variables studied and major differences in Context of Care, Processes of Care, and Health Outcomes by type of SB. Such wide variation and the differences by type of SB should be considered in future analyses of outcomes.
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testing the feasibility of a national spina bifida Patient Registry
Birth Defects Research Part A-clinical and Molecular Teratology, 2013Co-Authors: Judy Thibadeau, Kathleen J. Sawin, Elisabeth Ward, Mark E Swanson, Kurt A Freeman, Heidi Castillo, Karen Rauen, Michael S SchechterAbstract:BACKGROUND The purpose of this study was to describe the development and early implementation of a national spina bifida (SB) Patient Registry, the goal of which is to monitor the health status, clinical care, and outcomes of people with SB by collecting and analyzing Patient data from comprehensive SB clinics. METHODS Using a web-based, SB-specific electronic medical record, 10 SB clinics collected health-related information for Patients diagnosed with myelomeningocele, lipomyelomeningocele, fatty filum, or meningocele. This information was compiled and de-identified for transmission to the Centers for Disease Control and Prevention (CDC) for quality control and analysis. RESULTS A total of 2070 Patients were enrolled from 2009 through 2011: 84.9% were younger than 18 years of age; 1095 were women; 64.2% were non-Hispanic white; 6.5% were non-Hispanic black or African American; and 24.2% were Hispanic or Latino. Myelomeningocele was the most common diagnosis (81.5%). CONCLUSIONS The creation of a National Spina Bifida Patient Registry partnership between the CDC and SB clinics has been feasible. Through planned longitudinal data collection and the inclusion of additional clinics, the data generated by the Registry will become more robust and representative of the population of Patients attending SB clinics in the United States and will allow for the investigation of Patient outcomes. Birth Defects Research (Part A), 2013. © 2012 Wiley Periodicals, Inc.
James D Kolker - One of the best experts on this subject based on the ideXlab platform.
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stereotactic body radiotherapy sbrt for liver metastasis clinical outcomes from the international multi institutional rssearch Patient Registry
Radiation Oncology, 2018Co-Authors: Anand Mahadevan, Oliver Blanck, Rachelle M Lanciano, Anuj Peddada, Srinath Sundararaman, David J Dambrosio, Sanjeev Sharma, David Perry, James D Kolker, Joanne DavisAbstract:Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in Patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international Patient Registry. Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED10. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test. The study included 427 Patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31–91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of Patients received prior chemotherapy. Median tumor volume was 40 cm3 (1.6–877 cm3), median SBRT dose was 45 Gy (12–60 Gy) delivered in a median of 3 fractions [1–5]. At a median follow-up of 14 months (1–91 months) the median overall survival (OS) was 22 months. Median OS was greater for Patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p < 0.0001). Smaller tumor volumes (< 40 cm3) correlated with improved OS (25 months vs 15 months p = 0.0014). BED10 ≥ 100 Gy was also associated with improved OS (27 months vs 15 months p < 0.0001). Local control (LC) was evaluable in 430 liver metastases from 324 Patients. Two-year LC rates was better for BED10 ≥ 100 Gy (77.2% vs 59.6%) and the median LC was better for tumors < 40 cm3 (52 vs 39 months). There was no difference in LC based on histology of the primary tumor. In a large, multi-institutional series of Patients with liver metastasis treated with SBRT, reasonable LC and OS was observed. OS and LC depended on dose and tumor volume, while OS varied by primary tumor. Future prospective trials on the role of SBRT for liver metastasis from different primaries in the setting of multidisciplinary management including systemic therapy, is warranted. Clinicaltrials.gov: NCT01885299 .
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lung metastases treated with stereotactic body radiotherapy the rssearch Patient Registry s experience
Radiation Oncology, 2017Co-Authors: Anthony Ricco, Srinath Sundararaman, Sanjeev Sharma, David Perry, Joanne Davis, William Rate, Jun Yang, John Pablo, David D Ambrosio, James D KolkerAbstract:To report overall survival and local control for Patients identified in the RSSearch® Patient Registry with metastatic cancer to the lung treated with SBRT. Seven hundred two Patients were identified with lung metastases in the RSSearch® Registry. Of these Patients, 577 Patients had SBRT dose and fractionation information available. Patients were excluded if they received prior surgery, radiation, or radiofrequency ablation to the SBRT treated area. Between April 2004-July 2015, 447 Patients treated with SBRT at 30 academic and community-based centers were evaluable for overall survival (OS). Three hundred four Patients with 327 lesions were evaluable for local control (LC). All doses were converted to Monte Carlo equivalents and subsequent BED Gy10 for dose response analysis. Median age was 69 years (range, 18–93 years). Median Karnofsky performance status (KPS) was 90 (range 25/75% 80–100). 49.2% of Patients had prior systemic therapy. Median metastasis volume was 10.58 cc (range 25/75% 3.7–25.54 cc). Site of primary tumor included colorectal (25.7%), lung (16.6%), head and neck (11.4%), breast (9.2%), kidney (8.1%), skin (6.5%) and other (22.1%). Median dose was 50 Gy (range 25/75% 48–54) delivered in 3 fractions (range 25/75% 3–5) with a median BED of 100Gy10 (range 25/75% 81–136). Median OS for the entire group was 26 months, with actuarial 1-, 3-, and 5-year OS of 74.1%, 33.3, and 21.8%, respectively. Patients with head and neck and breast cancers had longer median OS of 37 and 32 months respectively, compared to colorectal (30 months) and lung (26 months) which corresponded to 3-year actuarial OS of 51.8 and 47.9% for head and neck and breast respectively, compared to 35.8% for colorectal and 31.2% for lung. The median LC for all Patients was 53 months, with actuarial 1-, 3-, and 5-year LC rates of 80.4, 58.9, and 46.3%, respectively. There was no difference in LC by primary histologic type (p = 0.49). Improved LC was observed for lung metastases that received SBRT doses of BED ≥100Gy10 with 3-year LC rate of 77.1% compared to 45% for lung metastases treated with BED 11 cc. (p = 0.005) Two-year LC rates for tumor volumes 27 cc were 72.9, 64.2 and 45.6%, respectively. This correlated with improved OS with 2-year OS rates of 62.4, 60.9 and 46.2% for tumor volumes 27 cc, respectively (p = 0.0023). In a subset of Patients who received BED ≥100Gy10, 2-year LC rates for tumor volumes 27 cc were 82.8, 58.9 and 68.6%, respectively (p = 0.0244), and 2-year OS rates were 66.0, 58.8 and 28.5%, respectively (p = 0.0081). Excellent OS and LC is achievable with SBRT utilizing BED ≥100Gy10 for lung metastases according to the RSSearch® Registry data. Patients with small lung metastases (volumes < 11 cc) had better LC and OS when using SBRT doses of BED ≥100Gy10. Further studies to evaluate a difference, if any, between various tumor types will require a larger number of Patients.