Browsing by Author "Costello, Brian A"
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Item Open Access Active surveillance of metastatic renal cell carcinoma: Results from a prospective observational study (MaRCC).(Cancer, 2021-07) Harrison, Michael R; Costello, Brian A; Bhavsar, Nrupen A; Vaishampayan, Ulka; Pal, Sumanta K; Zakharia, Yousef; Jim, Heather SL; Fishman, Mayer N; Molina, Ana M; Kyriakopoulos, Christos E; Tsao, Che-Kai; Appleman, Leonard J; Gartrell, Benjamin A; Hussain, Arif; Stadler, Walter M; Agarwal, Neeraj; Pachynski, Russell K; Hutson, Thomas E; Hammers, Hans J; Ryan, Christopher W; Inman, Brant A; Mardekian, Jack; Borham, Azah; George, Daniel JBackground
Systemic therapy (ST) can be deferred in patients who have metastatic renal cell carcinoma (mRCC) and slow-growing metastases. Currently, this subset of patients managed with active surveillance (AS) is not well described in the literature.Methods
This was a prospective observational study of patients with mRCC across 46 US community and academic centers. The objective was to describe baseline characteristics and demographics of patients with mRCC initially managed by AS, reasons for AS, and patient outcomes. Descriptive statistics were used to characterize demographics, baseline characteristics, and patient-related outcomes. Wilcoxon 2-sample rank-sum tests and χ2 tests were used to assess differences between ST and AS cohorts in continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to assess survival.Results
Of 504 patients, mRCC was initially managed by AS (n = 143) or ST (n = 305); 56 patients were excluded from the analysis. Disease was present in 69% of patients who received AS, whereas the remaining 31% had no evidence of disease. At data cutoff, 72 of 143 patients (50%) in the AS cohort had not received ST. The median overall survival was not reached (95% CI, 122 months to not estimable) in patients who received AS versus 30 months (95% CI, 25-44 months) in those who received ST. Quality of life at baseline was significantly better in patients who were managed with AS versus ST.Conclusions
AS occurs frequently (32%) in real-world clinical practice and appears to be a safe and appropriate alternative to immediate ST in selected patients.Item Open Access Development and validation of a unifying pre-treatment decision tool for intracranial and extracranial metastasis-directed radiotherapy.(Frontiers in oncology, 2023-01) Kowalchuk, Roman; Mullikin, Trey C; Breen, William; Gits, Hunter C; Florez, Marcus; De, Brian; Harmsen, William S; Rose, Peter Sean; Siontis, Brittany L; Costello, Brian A; Morris, Jonathan M; Lucido, John J; Olivier, Kenneth R; Stish, Brad; Laack, Nadia N; Park, Sean; Owen, Dawn; Ghia, Amol J; Brown, Paul D; Merrell, Kenneth WingBackground
Though metastasis-directed therapy (MDT) has the potential to improve overall survival (OS), appropriate patient selection remains challenging. We aimed to develop a model predictive of OS to refine patient selection for clinical trials and MDT.Patients and methods
We assembled a multi-institutional cohort of patients treated with MDT (stereotactic body radiation therapy, radiosurgery, and whole brain radiation therapy). Candidate variables for recursive partitioning analysis were selected per prior studies: ECOG performance status, time from primary diagnosis, number of additional non-target organ systems involved (NOS), and intracranial metastases.Results
A database of 1,362 patients was assembled with 424 intracranial, 352 lung, and 607 spinal treatments (n=1,383). Treatments were split into training (TC) (70%, n=968) and internal validation (IVC) (30%, n=415) cohorts. The TC had median ECOG of 0 (interquartile range [IQR]: 0-1), NOS of 1 (IQR: 0-1), and OS of 18 months (IQR: 7-35). The resulting model components and weights were: ECOG = 0, 1, and > 1 (0, 1, and 2); 0, 1, and > 1 NOS (0, 1, and 2); and intracranial target (2), with lower scores indicating more favorable OS. The model demonstrated high concordance in the TC (0.72) and IVC (0.72). The score also demonstrated high concordance for each target site (spine, brain, and lung).Conclusion
This pre-treatment decision tool represents a unifying model for both intracranial and extracranial disease and identifies patients with the longest survival after MDT who may benefit most from aggressive local therapy. Carefully selected patients may benefit from MDT even in the presence of intracranial disease, and this model may help guide patient selection for MDT.