Curative Intent Versus Palliative Intent Radiation Oncology

2013 ◽  
pp. 31-42
Author(s):  
Vassilios Vassiliou ◽  
Haris Charalambous
Keyword(s):  
Radiation Oncology ◽  
Curative Intent ◽  
Palliative Intent

scholarly journals Determining lines of therapy in patients with solid cancers: a proposed new systematic and comprehensive framework

2021 ◽  
Author(s):  
Kamal S. Saini ◽  
Chris Twelves
Keyword(s):  
Cancer Therapies ◽  
Clinical Progression ◽  
Curative Intent ◽  
Palliative Intent ◽  
Solid Malignancies ◽  
Anti Cancer ◽  
Progression Of Disease ◽  
Uniform Manner ◽  
Comprehensive Framework ◽  
Key Terms

AbstractThe complexity of neoplasia and its treatment are a challenge to the formulation of general criteria that are applicable across solid cancers. Determining the number of prior lines of therapy (LoT) is critically important for optimising future treatment, conducting medication audits, and assessing eligibility for clinical trial enrolment. Currently, however, no accepted set of criteria or definitions exists to enumerate LoT. In this article, we seek to open a dialogue to address this challenge by proposing a systematic and comprehensive framework to determine LoT uniformly across solid malignancies. First, key terms, including LoT and ‘clinical progression of disease’ are defined. Next, we clarify which therapies should be assigned a LoT, and why. Finally, we propose reporting LoT in a novel and standardised format as LoT N (CLoT + PLoT), where CLoT is the number of systemic anti-cancer therapies (SACT) administered with curative intent and/or in the early setting, PLoT is the number of SACT given with palliative intent and/or in the advanced setting, and N is the sum of CLoT and PLoT. As a next step, the cancer research community should develop and adopt standardised guidelines for enumerating LoT in a uniform manner.

Outcomes of isolated distant lymph node metastases in colorectal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 84-84
Author(s):  
Vinod Kalapurackal Mathai ◽  
Soe Yu Aung ◽  
Vanessa Wong ◽  
Catherine Dunn ◽  
Jeremy David Shapiro ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Locoregional Therapy ◽  
Curative Intent ◽  
Palliative Intent ◽  
Radical Treatment ◽  
Node Metastases ◽  
Systemic Therapies

84 Background: The optimal management of isolated distant lymph node metastases (IDLNM) in metastatic colorectal cancer (mCRC) is not clearly established. Small case series and prior data from the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) registry support the use of radical treatment with curative intent (local resection, chemo-radiation or stereotactic radiotherapy), which may lead to better outcomes in mCRC patients with IDLNM. Aims: This study investigates the clinical characteristics and outcomes of mCRC patients with IDLNM treated with systemic therapies plus locoregional therapy with curative intent versus systemic therapies with palliative intent. Methods: Clinical data were collected and reviewed from the TRACC registry, a prospective, comprehensive registry for mCRC from multiple tertiary hospitals across Australia from 01/07/2009 to 30/06/2020. Clinicopathological characteristics, treatment modalities and survival outcomes were analyzed in patients with IDLNM and compared to patients with other organ metastases. Fisher exact test was used for significance tests and Kaplan Meier curves for survival analyses. Results: Of 3408 mCRC patients with a median follow-up of 38.0 months, 93 (2.7%) were found to have IDLNM. Compared to mCRC with other organ metastases, patients with IDLNM were younger (mean age: 62.1 vs 65.6 years, p=0.0200), more likely to have metachronous disease (57.0% vs 38.9%, p=0.0005), be KRAS wild-type (74.6% vs 53.9%, p=0.0012) and BRAF mutant (12.9% vs 6.2%, p=0.0100). There was no overall survival difference between with IDLNM and those with other organ metastases (median OS 27.24 vs 25.92 months, p=0.2300). Twenty-four patients (25.8%) with IDLNM received treatment with curative intent, with a trend towards improved overall survival compared to those with other organ metastases treated with curative intent (73.5 vs 62.7 months, p=0.8200). Amongst mCRC patients with IDLNM, those who received treatment with curative intent had a significantly better overall survival than those treated with palliative intent (73.5months vs 23.2 months, p=0.0070). Conclusions: Our findings suggest that there are differences in the patterns of presentation of IDLNM and other organ metastases. Radical treatment with curative intent options should be considered for mCRC patients with IDLNM where appropriate.

Paediatric relapsed acute leukaemia: curative intent chemotherapy improves quality of life

2021 ◽  
pp. bmjspcare-2020-002722
Author(s):  
Carmen Salaverria ◽  
Erin Plenert ◽  
Roberto Vasquez ◽  
Soad Fuentes-Alabi ◽  
George A Tomlinson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Health ◽  
Acute Leukaemia ◽  
Self Report ◽  
Curative Intent ◽  
Palliative Intent ◽  
Paediatric Patients ◽  
Induction Failure ◽  
The Impact

ObjectivesPaediatric patients with leukaemia with relapse or induction failure have poor prognosis. Anticipated quality of life (QoL) is important in treatment decision making. The objective was to determine if curative intent at relapse or induction failure, when compared with palliative intent, was associated with child’s physical health, pain or general fatigue and parents’ QoL over time among patients with paediatric leukaemia in El Salvador.MethodsThis was a prospective observational cohort study. Children 2–18 years with acute leukaemia at first relapse or induction failure were eligible. Assessments occurred every 2 months for up to 2 years using validated proxy report and self-report scales, where guardians were the primary respondents. Initial curative or palliative intent was categorised at enrolment by physicians. The impact of initial intent on QoL was assessed using linear mixed effects models and interaction between QoL and time.ResultsOf the 60 families enrolled, initial treatment intent was curative in 31 (51.7%) and palliative in 29 (48.3%). During the 2-year observation period, 44 children died. Initial curative intent significantly improved child’s physical health (estimate=8.4, 95% CI 5.1 to 11.6), pain (estimate=5.4, 95% CI 1.5 to 9.2) and fatigue (estimate=6.6, 95% CI 3.2 to 9.9) compared with palliative intent, but not parents’ QoL (estimate=1.0, 95% CI −0.8 to 2.8).ConclusionsAmong paediatric patients with acute leukaemia at relapse or induction failure, initial curative intent treatment plan was associated with better physical health, pain and fatigue when compared with palliative intent. A curative approach may be a reasonable option for patients with acute leukaemia even when prognosis is poor.

From palliative to curative intent: PET/CT findings in the light of breast cancer intrinsic subgroup

2019 ◽  
Vol 105 (6) ◽  
pp. NP79-NP82
Author(s):  
Maxime Brunet ◽  
Anne-Laure Cazeau ◽  
Houda Ben Rejeb ◽  
Vittorio Catena ◽  
Thomas Grellety
Keyword(s):  
Breast Cancer ◽  
Liver Lesion ◽  
Luminal A ◽  
Curative Intent ◽  
Palliative Intent ◽  
Ct Findings ◽  
Positron Emission ◽  
Pet Ct ◽  
Cancer Subtype ◽  
Contrast Ultrasound

Purpose: Among breast cancer subgroups, Luminal A is the subgroup with the best prognosis. We report the case of a young woman presenting with a localized luminal A breast cancer with a suspicious liver lesion on initial positron emission tomography (PET)/computed tomography (CT) scan staging. Case description: A 31-year-old woman presented with localized breast cancer accessible to curative treatment. However, PET/CT staging revealed an increase of focal activity in the liver, suspicious of a secondary malignant localization, changing the care towards palliative intent. Discrepancy between breast cancer luminal A subtype and the liver lesion led to further investigations (contrast ultrasound, magnetic resonance imaging, and biopsy), excluding a malignant process, and were in favor of toxic hepatitis, probably secondary to herbal tea consumption. Conclusions: Questioning PET/CT findings in light of the cancer subtype enabled us to rectify the diagnosis and allow this patient to be treated with curative intent.

P125 HEALTH-RELATED QUALITY OF LIFE ONE YEAR AFTER THE DIAGNOSIS OF OESOPHAGEAL AND JUNCTIONAL CANCER: A POPULATION-BASED STUDY FROM THE SWEDISH NATIONAL REGISTRY FOR ESOPHAGEAL AND GASTRIC CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Sunde Berit ◽  
Lindblad Mats ◽  
Malmström Marlene ◽  
Hedberg Jakob ◽  
Lagergren Pernilla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Population Based ◽  
Health Related Quality ◽  
Definitive Chemoradiotherapy ◽  
Curative Intent ◽  
Palliative Intent ◽  
Related Quality ◽  
Health Related ◽  
One Year

Abstract Aim The aim of this study is to describe and analyse patient reported HRQoL one year after the diagnosis of oesophageal and junctional carcinoma in an unselected cohort comprising both palliative and curative intent patients. Background & Methods Short and long-term health-related quality of life (HRQoL) has been extensively described in operated oesophageal cancer patients in several population-based studies. However, the knowledge of HRQoL in patients with palliative intent management is not well described, and further, documentation of HRQoL in curative intent patients treated with definitive chemoradiotherapy is also quite scarce. A nation-wide population-based cohort, of patients diagnosed between 2009 and 2016 collected in the Swedish National Registry for Esophageal and Gastric Cancer (NREV) with prospectively registered exposure data and Health-related quality of life (HRQoL) outcome data. Validated instruments from the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 were used, and data was analysed with means and adjusted mean differences. Results In patients alive one year after diagnosis, 1,156 responded to the HRQOL questionnaires and were included in the analyses. Both curative and palliative intent patients reported severe symptoms of problems in oesophageal specific domains. In the comparison between the curative and palliative intent groups, more prominent symptoms among palliative patients were detected regarding dysphagia (MD 11; 95% ci: 7-15) and anxiety (MD 10; 95% ci: 6 -15). Levels of anxiety were reported with high levels in all groups analysed and problems with dysphagia was also more common in patients treated with definitive chemoradiotherapy compared with surgically treated patients (MD 11; 95% ci: 4 -18) diagnosed in locally advanced disease stages. Conclusion One year after diagnosis high levels of anxiety were reported in all subgroups of oesophageal and junctional cancer patients, and problems with dysphagia are a major problem in the palliative intent subcohort and in patients treated with definitive chemoradiotherapy.

Unanticipated hospital admissions in patients undergoing radiotherapy with or without concurrent chemotherapy: Incidence and predictive factors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6093-6093
Author(s):  
Nabeel H. Arastu ◽  
Ronald C. Chen ◽  
Marianne Jackson ◽  
Rebecca L. Green ◽  
Bahjat F. Qaqish ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Hospital Admissions ◽  
External Beam Radiotherapy ◽  
Multivariable Analysis ◽  
Concurrent Chemotherapy ◽  
Unplanned Admission ◽  
Curative Intent ◽  
Palliative Intent ◽  
Prophylactic Measures ◽  
Unanticipated Admission

6093 Background: Unanticipated admissions are burdensome for patients and the healthcare system. An improved understanding of their frequency and predictive factors can inform initiatives to prevent such admissions and mitigate their associated human and financial costs. Methods: Electronic medical records of 500 patients undergoing external beam radiotherapy (RT) at our center in 2010 were reviewed. Unanticipated admission within 90 days of initiating RT, and associated clinical factors, were recorded. Chi-squared and uni- and multivariate logistic regression was used to examine factors associated with admission. Results: Unanticipated admissions occurred in 20% (101/500) of patients, mean length of stay was 4 days (range 1-16), and the mean interval between the start of RT and admission was 32 days (0-86 days). The most common indications for admissions were pain (19% of admissions), respiratory distress (15%), and neurologic symptoms (13%). On univariable analysis, 33% of patients treated for palliative intent were admitted (vs. 16% of curative intent patients, p<0.001), as were 26% of patients receiving concurrent chemotherapy (vs. 17% receiving RT alone, p=0.02). Multivariable analysis showed treatment intent, chemotherapy, and marital status to be associated with unplanned admissions (Table). A highly variable rate of unanticipated admission per diagnosis was observed (e.g. 4% for breast, 19% for GI/GU/GYN/ENT, and 37% for metastatic sites). Conclusions: Rates of unanticipated admissions are ≈20% in patients undergoing RT. Approximately 1/3 of patients receiving palliative RT, and more than 1/4 receiving concurrent chemoradiation, experienced an unplanned admission. Prophylactic measures should be studied in these high-risk patients to reduce admission rates, as unplanned admission may be an important quality of care indicator in oncology. [Table: see text]

scholarly journals Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

2020 ◽  
Vol 35 (4) ◽  
pp. 527-532
Author(s):  
Renzo Pinto-Carta ◽  
Jaime Solano Mariño ◽  
Luis Felipe Cabrera Vargas ◽  
Erika Johana Benito Flórez
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Third World ◽  
Extrahepatic Bile Duct ◽  
Bile Leakage ◽  
Current Treatment ◽  
Curative Intent ◽  
Palliative Intent ◽  
First Case ◽  
Duodenal Invasion

The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent, the surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia a third-world country in Latin America of a cholecystogastrostomy guided by EUS in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT stent AXIOS; Xlumena Inc., Mountain View, CA, USA) 15mm x 10mm.EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc., Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

scholarly journals Changes in Cancer Management due to COVID-19 Illness in Patients with Cancer in Northern California

2020 ◽  
pp. OP.20.00790
Author(s):  
Julie Tsu-Yu Wu ◽  
Daniel H. Kwon ◽  
Michael J. Glover ◽  
Solomon Henry ◽  
Douglas Wood ◽  
...  
Keyword(s):  
San Francisco ◽  
Curative Intent ◽  
Palliative Intent ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Bay Area ◽  
Treatment Intent ◽  
The University ◽  
The Impact ◽  
Active Cancer

PURPOSE: The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area. MATERIALS AND METHODS: Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups. RESULTS: A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; P = .0497). This difference was not seen among patients treated with curative intent during the same timeframe. CONCLUSION: We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.

Patterns of care according to treatment intent for metastatic colorectal cancer (mCRC): A two-year review of routine practice.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 682-682 ◽  
Author(s):  
Kathryn Maree Field ◽  
Jayesh Desai ◽  
Jeanne Tie ◽  
Suzanne Kosmider ◽  
Susie Bae ◽  
...  
Keyword(s):  
Management Strategies ◽  
Single Agent ◽  
Treatment Strategies ◽  
Dominant Strategy ◽  
Response To Treatment ◽  
Routine Practice ◽  
Curative Intent ◽  
Palliative Intent ◽  
Operative Strategies ◽  
Treatment Intent

682 Background: Cure is potentially achievable in select patients (pts) with mCRC with limited metastatic disease to liver and/or lung. To date the peri-operative strategies undertaken by oncologists in routine practice for such pts have not been well documented. Methods: A clinical database recording information on all pts diagnosed with mCRC since July 2009 from 5 hospitals was analysed. Management strategies where a curative-intent resection had occurred; was planned; or was a potential option were compared with those managed with palliative intent. Results: Status at the time of first review regarding systemic chemotherapy (CT) was documented for 280 pts. 11 (4%) had already undergone curative-intent resection; 31 (11%) had a resection planned; 27 (10%) were considered potentially resectable if their response to treatment was good; and 207 (74%) were treated with palliative intent. No pts already resected or planned for resection were >ECOG 1, compared with 11% (3/27) potentially resectable and 17% (36/207) palliative pts. CT was delivered in 9 (82%) already-resected, 26 (84%) planned for resection, 26 (96%) potentially-resectable and 159 (77%) palliative-intent pts. Combination CT was the dominant strategy, although 7 of 11 (66%) already-resected pts received single agent treatment. No already-resected pts received bevacizumab with CT, compared with 27% (n=14) of planned or potentially-curative pts and 55% (n=88) of those treated with palliative intent. At the time of analysis 13 pts (42%) with a planned resection and 8 (30%) considered potentially curative have had surgery, while 3 (1.4%) where treatment was initially considered palliative have had curative-intent surgery. Conclusions: Treatment strategies for pts with mCRC differ significantly based on the treatment intent, and may be affected by surgical preference and referral pattern. Bevacizumab was less likely to be used for already-resected pts and the use of single agent therapy in this group was also not uncommon. Many pts initially considered resectable do not ultimately undergo resection, whereas occasional ‘palliative’ pts may become resectable, confirming the importance of continued consideration of this option.

Peer-review of radiation treatment planning in a provincial radiation oncology program: A survey of current practice.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 211-211
Author(s):  
Thomas S. McGowan ◽  
Sophie Foxcroft ◽  
Michael Donald Brundage ◽  
Michael Sharpe ◽  
Eric Gutierrez ◽  
...  
Keyword(s):  
Peer Review ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Organs At Risk ◽  
Critical Mass ◽  
Individual Case ◽  
Free Text ◽  
Curative Intent ◽  
Quality Improvement Process ◽  
The Individual

211 Background: The use of peer-review activities in oncology is not well described as a quality improvement process. We sought to describe current patterns of practice of radiation oncology peer-review across a large Provincial Cancer program and to identifiy barriers to its use. Methods: Ontario cancer centres were surveyed. Survey item responses were typically scored using a 10-point Likert scale. The survey was administered electronically with follow-up reminders as required. The use of free-text for comments elaborating on responses was encouraged. Results: Fourteen (100%) centres responded. All rated the importance of peer-review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest-rated benefits of peer-review (each median 9/10). Four centres (29%) conducted peer-review in more than 80% of cases treated with curative intent; six (43%) peer-reviewed at least 50% of curative cases. Five centres (36%) reported “always” or “almost always” conducting peer-review prior to the initiation of treatment. Variation was seen in which aspects of a case were typically reviewed (e.g., GTV “almost always” reviewed in 67%; contouring of organs at risk in 50%). Five centres (46% of those with regular peer-review) reported that 5% to 9% of peer-reviewed cases were flagged as requiring a change, whereas 3 centres (27%) reported that < 2% of peer-reviewed cases required a change to be made. Five centres (36%) recorded the outcomes of peer-review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; the two factors rated as most limiting to expanding peer-review were a critical mass of radiation oncologists (median score 6/10), and prioritization of peer review by the program overall (median 5/10). Conclusions: Peer review in radiation oncology practices it is now widely used as a quality assurance activity in Ontario, identifies changes to improve quality in the individual case, and improves departmental process. The development of guidelines and standards for peer-review activities, coupled with effective knowledge translation activities are recommended.

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