ABSTRACT
Objective. To comparatively assess the early toxicity of treatment, its tolerability, 1-, 2-, 3-year overall survival, and local regional control rates in a group of patients receiving a radical cycle of accelerated or conventional fractionation chemoradiotherapy. Subjects and methods. The paper presents the interim results of a prospective study that included 115 patients with locally advanced cancer of the oropharynx, tongue root, and larynx who received a radical cycle of conformal chemoradiotherapy using accelerated (the single focal dose (SFD) was 2.4 Gy for 25-26 fractions) or conventional (SFD was 2.0 Gy for 32-33 fractions) fractionation in the period from 2015 to 2020. Results. An analysis comparing the study group with the control one revealed no statistically significant differences in the level of early toxicity of treatment (p=0.41). Complete tumor reversal was achieved in 57 (86.3%) patients in the study group and in 39 (79.5%) in the comparison group (p=0.23). The 1-, 2-, and 3-year local regional control rates in the accelerated fractionation group was 78.3+/-5.3%;65.9+/-6.8%, and 54.5+/-9.2%, respectively. The 3-year overall survival rate was 80.4+/-7.4%. These rates did not differ statistically from those in the conventional radiotherapy group (p=0.12-0.82);53 (80.3%) patients in the study group and 37 (75.5%) in the standard fractionation group received a radiation cycle without a forced interval. The treatment interval in the patients of both groups reduced the 2-year local regional control rates by 30.2% compared to that in the continuous cycle group (p=0.02). Conclusion. Accelerated fractionation chemoradiotherapy (SFD was 2.4 Gy for 25-26 fractions, the daily focal dose was 60.0- 62.4 Gy) is a procedure comparable with conventional radiation in its direct efficiency and safety. During the COVID-19 pandemic, this regimen can be considered to be a mainstay for patients with locally advanced oropharyngeal cancer in order to preserve the previous volumes of specialized healthcare.Copyright © A.V. SEMENOV I.A. GULIDOV O.G. LEPILINA M.U. RADZHAPOVA F.E. SEVRYUKOV K.B. GORDON.
ABSTRACT
Background. Vaccine attitudes of healthcare providers (HCPs) influence patient vaccine acceptance. We sought to characterize vaccine knowledge, attitudes, and practices (KAP) among HCPs in NYS. Methods. An electronic survey was developed to assess vaccine KAP among HCPs. The questionnaires were sent to members of various national medical organizations via local chapter administrators. Results. 864 surveys were returned from 672 (78%) physicians and 192 (22%) mid-level practitioners (MLPs). 624/724 (86%) of HCPs report always recommending routine vaccines to eligible patients, yet only 76% recommend influenza vaccine (IV) and 77% strongly recommend HPV vaccine at 11-12 yrs. MLPs had a higher mean agreement level that recommending vaccines (4.6 vs 4.2 p < 0.01) or promoting HPV vaccine (4.2 vs. 3.9 p < 0.05) is within their scope of practice. Physicians had a higher mean agreement level that: vaccine benefits outweigh risks (4.9 vs 4.6 p < 0.01), HPV vaccine prevents cancer (4.7 vs 4.5 p < 0.01), and COVID-19 vaccine is safe (4.8 vs 4.5 p < 0.01) and effective (4.8 vs 4.7 p < 0.01). 82% (680/825) of HCPs knew that vaccines should not be deferred for mild illness. 14/836 (2%) believed that HPV vaccine could increase sexual activity, while 273/705 (39%) knew that the most common HPV associated malignancy is oropharyngeal cancer. HCPs who correctly answered >= 5/7 questions (462/507 91%) were more likely to recommend all vaccines to eligible patients than HCPs with lower scores (22/40 50% p < 0.05). Routine IV recommendation was more likely among HCPs who: strongly disagree that influenza is not serious enough for vaccination (292/397 (74%) vs 137/249 (55%) p < 0.01), strongly agree that it prevents severe disease (267/352 (76%) vs 162/294 (55%) p < 0.01), and receive annual IV (423/629 (67%) vs 6/17 (35%)) p < 0.01). HPV vaccine recommendation at 11-12 years was more likely among HCPs who strongly agree that the vaccine prevents cancer (273/326 (84%) vs 48/86, 56% p < 0.01) and those who stated that vaccination does not increase risk of unprotected sex (316/392 (79%) vs 3/12 (25%) p < 0.01). Conclusion. Vaccine recommendation practices are influenced by HCP vaccine misperceptions and hesitancy. Interventions to reduce misperceptions and improve vaccine confidence are needed.