Value of thoracic multidisciplinary clinic (TMDC) in determining appropriate treatment of stage III non-small cell lung cancer (NSCLC).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 82-82 ◽  
Author(s):  
Eliot L Friedman ◽  
Michael F Szwerc ◽  
Robert Kruklitis ◽  
Michael J Weiss
Keyword(s):  
Clinical Pathway ◽  
Initial Treatment ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Clinical Status ◽  
Stage Iii ◽  
Definitive Treatment ◽  
Mediastinal Staging ◽  
Multidisciplinary Clinic ◽  
Stage Iii Nsclc

82 Background: Treatment of stage III NSCLC involves surgery, radiation therapy and chemotherapy. Treatment depends on the size and location of the primary tumor and lymph nodes as well as clinical status of the patient. Evaluation of these patients should take place in a multidisciplinary clinic, where treating physicians and pulmonary medicine provide a unified treatment plan. Methods: All patients with Stage III NSCLC seen at the Lehigh Valley Health Network (LVHN) between March of 2010 and March of 2012 were analyzed retrospectively. We compared initial treatment of out-patients seen in our TMDC with those out-patients seen outside the TMDC. Results: Thirty-five patients were seen in TMDC (34 treated at LVHN) and 44 patients were seen outside TMDC (34 treated at LVHN). Eleven patients were treated elsewhere or were not treatable. Of patients with stage III NSCLC, 37.5% were seen in TMDC year 1 (March 2010 – March 2011) compared to 61% of patients year 2 (March 2011 – March 2012) (p = 0.05). Patients were seen by physicians from at least two specialties 100% of the time when seen in TMDC, but only 64.7% of the time when seen outside TMDC (p < 0.001). Mediastinal staging (EBUS or mediastinoscopy) was performed more frequently in patients seen in TMDC; 58.9% compared to 23.5% outside TMDC (p = 0.009). The LVHN clinical pathway for stage III NSCLC recommends initial therapy with concomitant chemoradiation, either in the neo-adjuvant setting or as definitive treatment. Eighty-eight percent of patients seen in TMDC followed our clinical pathway while 46% of patients seen outside TMDC conformed to the clinical pathway (p < 0.001). The time from first contact with a treating physician to initiation of treatment was reduced by almost 30% (29.03 days outside TMDC; 20.62 days at TMDC). Conclusions: All patients with stage III NSCLC should be seen in a multidisciplinary setting. At LVHN we saw an increase in these patients being referred to our TMDC over time. These patients were more likely to have mediastinal staging and enjoyed quicker initiation of their therapy. They were more likely to have at least two physicians involved in their initial treatment plan and were more likely to conform to our clinical pathways.

scholarly journals Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5923
Author(s):  
Isabel F. Remmerts de Vries ◽  
Merle I. Ronden ◽  
Idris Bahce ◽  
Femke O. B. Spoelstra ◽  
Patricia F. De Haan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Treatment Plan ◽  
Intensity Modulated Radiotherapy ◽  
Multimodality Treatment ◽  
Stage Iii ◽  
Quality Improvement Process ◽  
Planning Strategy ◽  
Continuous Quality ◽  
Stage Iii Nsclc ◽  
The Relationship

Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (n = 64) and (2) sCRT/RT (n = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process.

scholarly journals Application Analysis Based on Big Data Technology in Stroke Rehabilitation Nursing

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
WeiHua Xu ◽  
LiangJin Liu ◽  
JiuXia Zhang
Keyword(s):  
Data Mining ◽  
Big Data ◽  
Ischemic Stroke ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Science And Technology ◽  
Medical Institution ◽  
Level 3 ◽  
Big Data Technology

According to the statistical analysis, the incidence of stroke disease has gradually increased, particularly in recent years, which poses a huge threat to the safety of human life. Due to the advancement in science and technology specifically big data and sensors, a new research dome known as data mining technology has been introduced, which has the potential value from the perspective of large amount of data analysis. Information has become a new trend of science and technology, and data mining has been used in various application areas to analyze and predict strokes at home and abroad. In this study, big data technology is utilized to collect potential information and explores clinical pathways of level-3 rehabilitation in certain regions of China. Moreover, application effects of data mining in the rehabilitation of patients with the first ischemic stroke have been evaluated and reported. For this purpose, fifty (50) first-time ischemic stroke patients have been screened through big data and were nonartificially assigned to level-3 clinical pathway and conventional rehabilitation groups, respectively, specifically through software. The first group of patients enters the clinical path of the corresponding level according to the way of three-level referral. These patients were analyzed based on the collected results of completing the unified rehabilitation treatment plan of the three-level rehabilitation medical institution in the patient record form. The second group was selected according to the routine rehabilitation model and method of the medical institution where the patients visited were divided into four stages: before treatment, three weeks after treatment, nine weeks after treatment, and seventeen weeks after treatment. For this purpose, a simplified Fugl-Meyer analysis (FMA), recording of various functions of limb movement, and modified Barthel index (MBI) scale were used to analyze and evaluate the ability of daily activities and compare their effects. The final results showed that FMA and MBI scores of the two groups were improved in the three stages after treatment. The FMA and MBI scores of the clinical pathway group on 3rd and 9th weekends were significantly different from those of the conventional rehabilitation group (which is p < 0.05 ). Moreover, difference in FMA and MBI scores between the two at the 17th weekend was not significant. The total cost of the clinical pathway group, particularly at the ninth weekend, was higher than that of the conventional rehabilitation group, but the cost-benefit ratio was better and the incidence of complications was lower than that of the other group.

scholarly journals Can concordance between actual care received and a pathway map be measured on a population level in Ontario? A pilot study

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
K. Forster ◽  
K. Tsang ◽  
S. Li ◽  
L. Ieraci ◽  
P. Murray ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
A Priori ◽  
Population Level ◽  
Population Based ◽  
Stage Ii ◽  
Stage Iii ◽  
Administrative Databases ◽  
Actual Care

Background Clinical pathways are associated with improved adherence to clinical guidelines; however, most studies have evaluated pathways for a single intervention at a single institution. The objective of the present study was to develop and evaluate a method of measuring concordance with a population-based clinical pathway map to determine if that method could be feasible for assessing overall health system performance.Methods Patients with stage ii or iii colon cancer diagnosed in 2010 were identified, and clinical data were obtained through linkages to administrative databases. Pathway concordance was defined a priori based on receipt of key elements of the Ontario Health (Cancer Care Ontario) colorectal pathway maps. For stages ii and iii colon cancer alike, concordance was reported as the proportion of patients receiving care that followed the predefined key elements of the pathway map. Regression analysis was used to identify predictors of concordant care.Results Our study identified 816 patients with stage ii and 800 patients with stage iii colon cancer. Of the patients with stage ii disease, 70% (n = 571) received concordant care. Of the patients with stage iii disease, results showed high concordance for all key elements except receipt of chemotherapy, leading to an overall concordance rate of 39% for that cohort.Conclusions Our method of measuring concordance was feasible on a population-based level, but future studies to validate it and to develop more sophisticated methods to measure concordance in larger cohorts and various disease sites are necessary. Measurement of clinical pathway concordance on a population-based level has the potential to be a useful tool for assessing system performance.

366 A randomized double-blind placebo-controlled phase III study evaluating perioperative toripalimab combined with platinum-based doublet chemotherapy in resectable stage III NSCLC

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A391-A391
Author(s):  
Wenxiang Wang ◽  
Lin Wu ◽  
Wei Zhang ◽  
Shun Lu ◽  
Haohui Fang ◽  
...  
Keyword(s):  
Small Cell ◽  
Pathological Response ◽  
Phase Iii ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Double Blind ◽  
Free Survival ◽  
Phase Iii Study ◽  
Stage Iii Nsclc ◽  
Doublet Chemotherapy

BackgroundSurgery remains the mainstay of treatment for resectable stage III non-small cell lung cancer (NSCLC). The preliminary results from some pilot trials have shown that neoadjuvant immunotherapy in NSCLC is safe and tolerable.1 2Hypothesizing that neoadjuvant toripalimab (a humanized anti-PD-1 antibody) plus chemotherapy can improve the outcome in resectable NSCLC, we are conducting a randomized, double-blind, placebo-controlled, phase III study to evaluate the efficacy and safety of toripalimab plus platinum-based doublet chemotherapy as neoadjuvant/adjuvant therapy for patients with resectable stage III NSCLC.MethodsThis ongoing study enrolls patients aged 18–70 years with treatment-naïve, histopathologically confirmed resectable stage III NSCLC without EGFR mutation or ALK translocation, ECOG PS 0–1, and adequate organ function. Eligible subjects are randomized (1:1) into experimental or control group, to receive perioperative toripalimab 240 mg or placebo combined with chemotherapy for 4 cycle in total (Docetaxel 60–75 mg/m2 or Paclitaxel 175 mg/m2 with platinum [squamous histology] or Pemetrexed 500 mg/m2 with platinum [non-squamous histology]) every 3 weeks for three cycles followed by surgery, and one more cycle after surgery, then monotherapy of toripalimab 240 mg or placebo every 3 weeks up to 13 cycles is delivered. Adjuvant radiotherapy is allowed. Randomization is stratified by tumor stage(IIIA vs IIIB), pathological type (squamous vs non-squamous), PD-L1 expression (PD-L1≥1% vs <1% or not evaluable) and planned surgical procedure (pneumonectomy vs lobectomy). Radiographic response is assessed within 4–6 weeks after last dose of neoadjuvant therapy, at 30 days after surgery and every 12 weeks thereafter. Primary endpoints are major pathologic response (MPR) rate evaluated by blind independent central pathology review (BIPR-MPR) and event-free survival evaluated by investigator (INV-EFS). Secondary endpoints include pathologic complete response (pCR) rate evaluated by BIPR and investigators (BIPR-pCR and INV-pCR), disease-free survival (DFS), 2–3 years OS rate, OS, safety, and feasibility of surgery. Exploratory endpoints are potential correlations between biomarkers and efficacy. A stratified Cochran Mantel Haenszel method will be used to assess binary endpoints. A Kaplan-Meier method, a stratified log-rank test and a stratified Cox proportional hazards model will be used to assess survival endpoints.Planned enrollment is 406 patients. The study is actively enrolling at 52 Chinese sites.ResultsN/AConclusionsN/AAcknowledgementsN/ATrial RegistrationThe Clinical trials. gov no NCT04158440Ethics ApprovalThis study was approved by the Ethics Board of all the involved sites; Approval number of Shanghai Chest Hospital: LS1936ConsentN/AReferencesForde PM, Chaft JE, Smith KN, et al. Neoadjuvant PD-1 blockade in resectable lung cancer N Engl J Med 2018;378:1976–1986Hellmann MD, Chaft JE, William WN Jr, et al. Pathological response after neoadjuvant chemotherapy in resectable non-small-cell lung cancers: proposal for the use of major pathological response as a surrogate endpoint. Lancet oncol 2014;15:e42–50.

scholarly journals 87P Impact of chemoradiotherapy on the survival of patients with stage III NSCLC

2021 ◽  
Vol 16 (4) ◽  
pp. S743
Author(s):  
R. Basto ◽  
J. Correia Magalhães ◽  
M.J.P. de Sousa ◽  
J.C. Monteiro ◽  
I. Domingues ◽  
...  
Keyword(s):  
Stage Iii ◽  
Stage Iii Nsclc

scholarly journals Planning target volume as a predictor of disease progression in inoperable stage III non-small cell lung cancer patients treated with chemoradiotherapy and concurrent and/or sequential immune checkpoint inhibition

2021 ◽  
Author(s):  
Julian Taugner ◽  
Lukas Käsmann ◽  
Monika Karin ◽  
Chukwuka Eze ◽  
Benedikt Flörsch ◽  
...  
Keyword(s):  
Planning Target Volume ◽  
Immune Checkpoint ◽  
Target Volume ◽  
Continuous Variable ◽  
Stage Iii ◽  
Checkpoint Inhibition ◽  
Immune Checkpoint Inhibition ◽  
Platinum Based Chemotherapy ◽  
Stage Iii Nsclc ◽  
Nsclc Patients

SummaryBackground. The present study evaluates outcome after chemoradiotherapy (CRT) with concurrent and/or sequential Programmed Cell Death 1 (PD-1) or Ligand 1 (PD-L1) immune checkpoint inhibition (CPI) for inoperable stage III NSCLC patients depending on planning target volume (PTV). Method and patients. Prospective data of thirty-three consecutive patients with inoperable stage III NSCLC treated with CRT and sequential durvalumab (67%, 22 patients) or concurrent and sequential nivolumab (33%, 11 patients) were analyzed. Different PTV cut offs and PTV as a continuous variable were evaluated for their association with progression-free (PFS), local–regional progression-free (LRPFS), extracranial distant metastasis-free (eMFS) and brain-metastasis free-survival (BMFS). Results. All patients were treated with conventionally fractionated thoracic radiotherapy (TRT); 93% to a total dose of at least 60 Gy, 97% of patients received two cycles of concurrent platinum-based chemotherapy. Median follow-up for the entire cohort was 19.9 (range: 6.0–42.4) months; median overall survival (OS), LRFS, BMFS and eMFS were not reached. Median PFS was 22.8 (95% CI: 10.7–34.8) months. Patients with PTV ≥ 900ccm had a significantly shorter PFS (6.9 vs 22.8 months, p = 0.020) and eMFS (8.1 months vs. not reached, p = 0.003). Furthermore, patients with PTV ≥ 900ccm and stage IIIC disease (UICC-TNM Classification 8th Edition) achieved a very poor outcome with a median PFS and eMFS of 3.6 vs 22.8 months (p < 0.001) and 3.6 months vs. not reached (p = 0.001), respectively. PTV as a continuous variable also had a significant impact on eMFS (p = 0.048). However, no significant association of different PTV cut-offs or PTV as a continuous variable with LRPFS and BMFS could be shown. The multivariate analysis that was performed for PTV ≥ 900ccm and age (≥ 65 years), gender (male), histology (non-ACC) as well as T- and N-stage (T4, N3) as covariates also revealed PTV ≥ 900ccm as the only factor that had a significant correlation with PFS (HR: 5.383 (95% CI:1.263–22.942, p = 0.023)). Conclusion. In this prospective analysis of inoperable stage III NSCLC patients treated with definitive CRT combined with concurrent and/or sequential CPI, significantly shorter PFS and eMFS were observed in patients with initial PTV ≥ 900ccm.

Sign in / Sign up

Export Citation Format

Share Document