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1.
In Vivo ; 36(1): 325-329, 2022.
Article in English | MEDLINE | ID: covidwho-1594965

ABSTRACT

BACKGROUND/AIM: Many patients with malignant gliomas are scheduled for radiochemotherapy, which may cause emotional distress associated with sleep problems. This study aimed to determine the prevalence of such sleep problems in these patients and identify risk factors. PATIENTS AND METHODS: Fifty-seven patients scheduled for radiochemotherapy for grade II-IV gliomas were retrospectively investigated for pre-treatment sleep problems. Fifteen characteristics were evaluated including temporal relation to COVID-19 pandemic, age, gender, performance status, comorbidity, (family) history of malignancies, distress score, emotional problems, physical problems, practical problems, involved sites, glioma grade, upfront surgery, and corticosteroids. RESULTS: Nineteen patients stated pre-treatment sleep problems (prevalence=66.7%). Significant associations with sleep problems were found for female gender (p=0.023), presence of emotional problems (p=0.006), and ≥4 physical problems (p<0.001). A trend was found for distress scores ≥5 (p=0.077). CONCLUSION: The prevalence of sleep problems was high. Risk factors were determined that can be used to identify patients who likely benefit from psychological support.


Subject(s)
COVID-19 , Glioma , Sleep Wake Disorders , Chemoradiotherapy , Female , Glioma/complications , Glioma/drug therapy , Glioma/epidemiology , Humans , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2 , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology
2.
JCO Glob Oncol ; 7: 1639-1646, 2021 09.
Article in English | MEDLINE | ID: covidwho-1571950

ABSTRACT

PURPOSE: Cancer treatment during the COVID-19 pandemic represents a challenge. Hospital visits to receive treatment and interaction with health care workers (HCW) represent potential contagious events. We aimed to determine SARS-CoV-2 infection rate among patients with cancer and HCW of a chemoradiotherapy unit localized in a center designated as a COVID-19 priority facility in Mexico City. We also determined the diagnostic performance of a clinical questionnaire (CQ) as a screening tool and anti-SARS-CoV-2 antibody seroconversion rate. METHODS: HCW and patients with solid tumors attending the chemoradiotherapy unit signed informed consent. To determine SARS-CoV-2 infection rate prospectively, a nasopharyngeal swab for SARS-CoV-2 real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed every 2 weeks in asymptomatics. An electronic CQ interrogating COVID-19-related symptoms was sent daily. Anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies were measured at baseline and at the end of the study period. RESULTS: From June to September 2020, we included 130 asymptomatic participants, 44.6% HCW and 55.4% patients with cancer. During a median follow-up of 85 days, 634 nasopharyngeal swabs were performed. Average SARS-CoV-2 monthly incidence was 4.6% (3.15%-7.47%), and cumulative infection rate was 13.8% (18 of 130). Cases were mostly asymptomatic (66%), and no hospitalizations or deaths were recorded. The CQ as a screening tool provided a sensitivity of 27.7%, a positive predictive value of 26.3%, and a positive likelihood ratio of 12. SARS-CoV-2 IgG seroconversion rate was 27.7% among those with a positive RT-PCR. CONCLUSION: Patients with cancer on treatment can have uncomplicated COVID-19 outcomes. Biweekly RT-qPCR testing detects asymptomatic infections, prevents transmission, and should be implemented in units to increase patient safety. CQ increase RT-qPCR diagnostic yield and may prioritize testing in resource-deprived settings. Post-infection IgG seroconversion is unreliable.


Subject(s)
COVID-19 , Neoplasms , Chemoradiotherapy/adverse effects , Health Personnel , Humans , Mexico/epidemiology , Neoplasms/epidemiology , Pandemics , Prospective Studies , SARS-CoV-2
5.
Curr Oncol ; 28(3): 1618-1629, 2021 04 24.
Article in English | MEDLINE | ID: covidwho-1314595

ABSTRACT

Stage III non-small cell lung cancer (NSCLC) comprises a highly heterogenous group of patients with regards to patient fitness and tumour size and distribution, resulting in a wide range of treatment goals and therapy options. Curative-intent multimodality treatment should be considered in all patients with stage III NSCLC. For patients with unresectable disease who are fit, have adequate lung function, and have a disease that can be encompassed within a radical radiation volume, concurrent chemoradiation therapy (cCRT) is the standard of care and can produce cure rates of 20-30%. Recently, consolidation immunotherapy with durvalumab has been recognized as the standard of care following cCRT based on significant improvement rates in overall survival at 4 years. The large heterogeneity of the stage III NSCLC population, along with the need for extensive staging procedures, multidisciplinary care, intensive cCRT, and now consolidation therapy makes the delivery of timely and optimal treatment for these patients complex. Several logistical, communication, and education factors hinder the delivery of guideline-recommended care to patients with stage III unresectable NSCLC. This commentary discusses the potential challenges patients may encounter at different points along their care pathway that can interfere with delivery of curative-intent therapy and suggests strategies for improving care delivery.


Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Canada , Carcinoma, Non-Small-Cell Lung/drug therapy , Chemoradiotherapy , Humans , Lung Neoplasms/drug therapy , Neoplasm Staging
6.
Gynecol Oncol ; 161(2): 414-421, 2021 05.
Article in English | MEDLINE | ID: covidwho-1151485

ABSTRACT

OBJECTIVE: The current coronavirus pandemic caused a significant decrease in cancer-related encounters resulting in a delay in treatment of cancer patients. The objective of this study was to examine the survival effect of delay in starting concurrent chemo-radiotherapy (CCRT) in women with locally-advanced cervical cancer. METHODS: This is a retrospective observational study querying the National Cancer Database from 2004 to 2016. Women with stage IB2-IVA squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix who received definitive CCRT with known wait-time for CCRT initiation after cancer diagnosis were eligible (N=13,617). Cox proportional hazard regression model with restricted cubic spline transformation was fitted to assess the association between CCRT wait-time and all-cause mortality in multivariable analysis. RESULTS: The median wait-time to start CCRT was 6 (IQR 4-8) weeks. In a multivariable analysis, older age, non-Hispanic black and Hispanic ethnicity, recent year of diagnosis, Medicaid and uninsured status, medical comorbidities, and absence of nodal metastasis were associated with longer CCRT wait-time (P<.05). Women with aggressive tumor factors (poorer differentiation, large tumor size, nodal metastasis, and higher cancer stage) were more likely to have a short CCRT wait-time (P<.05). After controlling for the measured covariates, CCRT wait-time of 6.1-9.8 weeks was not associated with increased risk of all-cause mortality compared to a wait-time of 6 weeks. Similar association was observed when the cohort was stratified by histology, cancer stage, tumor size, or brachytherapy use. CONCLUSION: An implication of this study for the current coronavirus pandemic is that in the absence of aggressive tumor factors, a short period of wait-time to start definitive CCRT may not be associated with increased risk of mortality in women with locally-advanced cervical cancer.


Subject(s)
Adenocarcinoma/therapy , COVID-19 , Carcinoma, Adenosquamous/therapy , Carcinoma, Squamous Cell/therapy , Time-to-Treatment , Uterine Cervical Neoplasms/therapy , Adenocarcinoma/secondary , Adult , African Americans/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , Carcinoma, Adenosquamous/secondary , Carcinoma, Squamous Cell/secondary , Chemoradiotherapy , Female , Humans , Lymphatic Metastasis , Medicaid/statistics & numerical data , Medically Uninsured/statistics & numerical data , Middle Aged , Neoplasm Grading , Neoplasm Staging , Proportional Hazards Models , Race Factors , Retrospective Studies , SARS-CoV-2 , Survival Rate , Tumor Burden , United States , Uterine Cervical Neoplasms/pathology
7.
Oncology (Williston Park) ; 34(9): 370-376, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-1231670

ABSTRACT

In an asymptomatic 77-yearold woman, former 55 packyears smoker, a routine X-ray showed a 45-mm superior left lobe lesion. A chest CT scan confirmed a 36-mm superior left lobe lesion and an aortic-pulmonary lymph node enlargement measuring 42 mm, suspicious for neoplasia. A PET-CT scan showed an elevated uptake in the primary lesion, in the aortic-pulmonary lymph node, and in the left hilar lymph node with a standardized uptake value - 40 and 4.3, respectively. CT-guided lung biopsy showed a lung squamous cell carcinoma. An endobronchial ultrasound-guided transbronchial needle aspiration for lymph-node staging was negative for lymph node spread. Brain MRI was negative. Final staging was determined to be a IIIA (T2bN2) squamous cell carcinoma of the lung.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Carcinoma, Squamous Cell/therapy , Coronavirus Infections/diagnosis , Lung Neoplasms/therapy , Pneumonia, Viral/diagnosis , Pneumonia/diagnosis , Aged , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents, Immunological/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Betacoronavirus , COVID-19 , Carboplatin/administration & dosage , Carcinoma, Squamous Cell/diagnostic imaging , Chemoradiotherapy , Consolidation Chemotherapy , Diagnosis, Differential , Female , Humans , Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Paclitaxel/administration & dosage , Pandemics , Pneumonia/chemically induced , SARS-CoV-2
8.
Cancer Invest ; 39(4): 315-320, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1132232

ABSTRACT

Outcomes for patients (pts) with sarcoma and COVID-19 are unknown. This is a single institution retrospective study of adults with sarcoma and COVID-19. Ten pts [median age 60 (range 24-69)] were identified. Five were hospitalized; two died from COVID-19 complications; another died from sarcoma. Time between last systemic treatment dose and COVID-19 diagnosis was 6-41 days in pts who died. 5 underwent prior radiation (RT); time between RT and COVID-19 diagnosis was 20-62 days for pts who died. All three pts with WBC differential data (two died) were lymphopenic. Efforts to capture outcomes for a larger cohort are urgently needed.


Subject(s)
COVID-19/prevention & control , SARS-CoV-2/isolation & purification , Sarcoma/therapy , Soft Tissue Neoplasms/therapy , Adult , Aged , COVID-19/complications , COVID-19/virology , COVID-19 Testing/methods , Chemoradiotherapy/methods , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Sarcoma/complications , Sarcoma/surgery , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/surgery , Survival Analysis , Young Adult
10.
Cancer Treat Res Commun ; 27: 100331, 2021.
Article in English | MEDLINE | ID: covidwho-1064990

ABSTRACT

PURPOSE: To adapt the management of prostate malignancy in response to the COVID-19 pandemic. METHODS: In according to the recommendations of the European Association of Urology, we have developed practical additional document on the treatment of prostate cancer. RESULTS: Low-Risk Group Watchful Waiting should be offered to patients >75 years old, with a limited life expectancy and unfit for local treatment. In Active Surveillance (AS) patients re-biopsy, PSA evaluation and visits should be deferred for up to 6 months, preferring non-invasive multiparametric-MRI. The active treatment should be delayed for 6-12 months. Intermediate-Risk Group AS should be offered in favorable-risk patients. Short-course neoadjuvant androgen deprivation therapy (ADT) combined with ultra-hypo-fractionation radiotherapy should be used in unfavorable-risk patients. High-Risk Group Neoadjuvant ADT combined with moderate hypofractionation should be preferred. Whole-pelvis irradiation should be offered to patients with positive lymph nodes in locally advanced setting. ADT should be initiated if PSA doubling time is < 12 months in radio-recurrent patients, as well as in low priority/low volume of metastatic hormone sensitive prostate cancer. If radiotherapy cannot be delayed, hypo-fractionated regimens should be preferred. In high priority class metastatic disease, treatment with androgen receptor-targeted agents should be offered. When palliative radiotherapy for painful bone metastasis is required, single fraction of 8 Gy should be offered. CONCLUSIONS: In Covid-19 Era, the challenge should concern a correct management of the oncologic patient, reducing the risk of spreading the virus without worsening tumor prognosis.


Subject(s)
Androgen Antagonists/therapeutic use , COVID-19/prevention & control , Prostatic Neoplasms/therapy , Radiation Dose Hypofractionation , SARS-CoV-2/isolation & purification , Aged , COVID-19/epidemiology , COVID-19/virology , Chemoradiotherapy , Disease-Free Survival , Humans , Male , Neoadjuvant Therapy , Pandemics , Prostate-Specific Antigen/analysis , Prostatectomy/methods , Prostatic Neoplasms/diagnosis , Risk Factors , SARS-CoV-2/physiology , Time Factors , Watchful Waiting/methods
11.
Crit Rev Oncol Hematol ; 157: 103189, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1064986

ABSTRACT

This study investigated the clinical management of non small cell lung cancer (NSCLC) patients during the first wave of coronavirus disease 2019 (COVID-19) outbreak in Italy. A 29-questions survey was sent to 95 Italian thoracic oncologists, with 77 % of them declaring significant changes in the outpatients management and treatment. The results of this survey pointed out a significant delay of lung cancer diagnosis along with a relevant reduction of patients' accrual within clinical trials. Telemedicine emerged as a valid support for patient-healthcare interactions. Therapeutic indications followed the guidelines for adjuvant chemotherapy and concurrent chemo-radiation. Clinical indications to first-line therapies were largely confirmed, while major changes regarded the selection of second line treatment options as well as the management of elderly population. This work may represent a valid source of information to improve the clinical management of NSCLC patients during second wave of COVID-19 pandemic.


Subject(s)
COVID-19 , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Aged , COVID-19/epidemiology , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Non-Small-Cell Lung/therapy , Chemoradiotherapy , Humans , Italy/epidemiology , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Lung Neoplasms/therapy , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
13.
BMJ Case Rep ; 13(12)2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-1020885

ABSTRACT

A 67-year-old man presented to his general practitioner with intermittent episodes of unilateral sciatica over a 2-month period for which he was referred for an outpatient MRI of his spine. This evidenced a significant lumbar vertebral mass that showed tight canal stenosis and compression of the cauda equina. The patient was sent to the emergency department for management by orthopaedic surgeons. He was mobilising independently, pain free on arrival and without neurological deficit on assessment. Clinically, this patient presented with no red flag symptoms of cauda equina syndrome or reason to suspect malignancy. In these circumstances, National Institute for Health and Care Excellence guidelines do not support radiological investigation of the spine outside of specialist services. However, in this case, investigation helped deliver urgent care for cancer that otherwise may have been delayed. This leads to the question, do the current guidelines meet clinical requirements?


Subject(s)
Adenocarcinoma/diagnosis , Cauda Equina Syndrome/diagnosis , Prostatic Neoplasms/diagnosis , Spinal Neoplasms/complications , Spinal Stenosis/diagnosis , Adenocarcinoma/complications , Adenocarcinoma/secondary , Adenocarcinoma/therapy , Aged , Cauda Equina/diagnostic imaging , Cauda Equina Syndrome/blood , Cauda Equina Syndrome/etiology , Cauda Equina Syndrome/therapy , Chemoradiotherapy/methods , Humans , Image-Guided Biopsy , Kallikreins/blood , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Male , Palliative Care/methods , Prostate/diagnostic imaging , Prostate/pathology , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Spinal Neoplasms/blood , Spinal Neoplasms/diagnosis , Spinal Neoplasms/secondary , Spinal Stenosis/etiology , Spinal Stenosis/therapy , Ultrasonography, Interventional
14.
Oral Oncol ; 113: 105112, 2021 02.
Article in English | MEDLINE | ID: covidwho-971842

ABSTRACT

There has been increased interest in hypofractionated accelerated chemoradiation for head and neck cancer during the recent first peak of the COVID-19 pandemic. Prospective data regarding this approach from randomised trials is lacking. In the PET NECK study, 564 patients with squamous cell carcinoma of the head and neck receiving definitive chemoradiation were randomised to either planned neck dissection or PET CT scan guided surveillance. In this surgical trial, three radiotherapy fractionation schedules delivered over 7, 6 or 4 weeks were permitted with synchronous chemotherapy. The purpose of this study was to determine efficacy and quality of life outcomes associated with the use of these schedules. Primary local control and overall survival in addition to quality of life measures at immediately post treatment and 6, 12 and 24 months post-treatment were compared between the three fractionation cohorts. In the 525 patients where fractionation data was available, 181 (34%), 288 (55%) and 56 (11%) patients received 68-70 Gy in 34-35 fractions (#), 60-66 Gy in 30# and 55 Gy in 20# respectively. At a minimum follow up of two years following treatment there was no significant difference between the three fractionation schemes in local control, overall survival or any quality of life measure. Despite the obvious limitations of this study, some data is provided to support the use of hypofractionated accelerated chemoradiation to avoid delays in cancer treatment and reduce hospital visits during the peak of a pandemic. Data from on-going randomised trials examining hypofractionated chemoradiation may be useful for selecting fractionation schedules during future pandemics.


Subject(s)
COVID-19/epidemiology , Carcinoma, Squamous Cell/therapy , Chemoradiotherapy/methods , Head and Neck Neoplasms/therapy , Pandemics , Radiation Dose Hypofractionation , SARS-CoV-2 , Aged , COVID-19/virology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neck Dissection , Positron Emission Tomography Computed Tomography , Quality of Life , Treatment Outcome
15.
Chest ; 158(5): e215-e219, 2020 11.
Article in English | MEDLINE | ID: covidwho-891959

ABSTRACT

Diffuse alveolar hemorrhage (DAH) is a severe and potentially life-threatening disease manifestation. In addition to autoimmune diseases such as antineutrophil cytoplasmic antibody-associated vasculitis and anti-glomerular basement membrane syndrome, pulmonary viral infections are known to be culprits of DAH. Health-care providers worldwide in the coronavirus disease 2019 pandemic have been confronted with an unprecedented number of viral lung infections, with great variance in symptoms and severity. Hemoptysis, the key symptom of DAH, is a rare complication. We present two cases of immunocompromised patients with rapidly developing hypoxemic respiratory failure and evidence of DAH in the context of severe acute respiratory syndrome coronavirus 2 infection.


Subject(s)
Coronavirus Infections/complications , Hemorrhage/etiology , Immunocompromised Host , Lung Diseases/etiology , Pneumonia, Viral/complications , Aged , Aortitis/complications , Aortitis/drug therapy , Aortitis/immunology , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/immunology , Betacoronavirus , COVID-19 , Carcinoma, Transitional Cell/complications , Carcinoma, Transitional Cell/immunology , Carcinoma, Transitional Cell/therapy , Chemoradiotherapy , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Cross Infection , Glucocorticoids/therapeutic use , Hemoptysis/etiology , Humans , Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/drug therapy , Hypereosinophilic Syndrome/immunology , Hypoxia/physiopathology , Immunosuppressive Agents/therapeutic use , Male , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Prednisolone/therapeutic use , Respiratory Insufficiency/physiopathology , SARS-CoV-2 , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/therapy
16.
Ann Palliat Med ; 9(5): 3373-3378, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-854830

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) poses an unprecedented challenge to health and epidemic prevention system, especially the healthcare of patients with cancer. We sought to study the impact of COVID-19 on lung cancer patients in our center. METHODS: We initiated a retrospectively study to analyze the impact of COVID-19 on lung cancer patients in our center, who were accepted for routine anticancer treatment before the epidemic and planned to return to hospital in January and February of 2020. RESULTS: A total of 161 cases of lung cancer were included in the final analysis. As of April 15, 95 patients had delayed their return visit, and 47 cases were finally designated as having delayed admission during the epidemic and having to discontinue or delay their regular anticancer treatments. Of these 47 delayed patients, 33 were evaluated for tumor status using a computed tomography scan, 6 of these 33 cases (18.18%) were diagnosed as progressive disease (PD), and 5 cases did not return for visit. CONCLUSIONS: This is the first study investigating impact of COVID-19 on non-COVID-19 lung cancer patients during the pandemic. The study demonstrates the significant impact of the COVID-19 crisis on oncological care, indicating the need for appropriate change of treatment decisions and continued follow-up and psycho-oncological support during this pandemic.


Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Non-Small-Cell Lung/therapy , Coronavirus Infections , Immunotherapy , Lung Neoplasms/therapy , Pandemics , Pneumonia, Viral , Radiotherapy , Small Cell Lung Carcinoma/therapy , Time-to-Treatment/statistics & numerical data , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Chemoradiotherapy , China , Delivery of Health Care , Disease Progression , Female , Humans , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , SARS-CoV-2 , Small Cell Lung Carcinoma/diagnostic imaging
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 359-365, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: covidwho-827753

ABSTRACT

Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.


Subject(s)
Neoadjuvant Therapy , Rectal Neoplasms , Aged , Aged, 80 and over , Chemoradiotherapy , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Rectal Neoplasms/drug therapy , Rectal Neoplasms/therapy , Retrospective Studies , Treatment Outcome
18.
ESMO Open ; 5(5): e000885, 2020 09.
Article in English | MEDLINE | ID: covidwho-788178

ABSTRACT

BACKGROUND: Immunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection. METHODS: From 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed. RESULTS: Overall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25-88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection. CONCLUSION: Rapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses.


Subject(s)
Asymptomatic Infections , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Neoplasms/therapy , Pneumonia, Viral/diagnosis , Triage/standards , Adult , Aged , Aged, 80 and over , Antibodies, Viral/blood , Antibodies, Viral/immunology , Antineoplastic Agents, Immunological/adverse effects , Betacoronavirus/genetics , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Chemoradiotherapy/adverse effects , Chemoradiotherapy/methods , Clinical Laboratory Techniques/economics , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/blood , Coronavirus Infections/economics , Coronavirus Infections/immunology , Coronavirus Infections/virology , Diagnostic Tests, Routine/economics , Diagnostic Tests, Routine/statistics & numerical data , Feasibility Studies , Female , Humans , Male , Middle Aged , Neoplasms/immunology , Pandemics , Patient Admission/economics , Patient Admission/statistics & numerical data , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Practice Guidelines as Topic , RNA, Viral/isolation & purification , Reverse Transcriptase Polymerase Chain Reaction/economics , Reverse Transcriptase Polymerase Chain Reaction/statistics & numerical data , SARS-CoV-2 , Sensitivity and Specificity
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