Liying Zhang, Ph.D

Background Molecular testing is critical to guiding treatment approaches in patients with metastatic non‐small cell lung cancer (mNSCLC), with testing delays adversely impacting the timeliness of treatment decisions. Here, we aimed to evaluate the time from initial mNSCLC diagnosis to treatment decision (TTD) following implementation of in‐house EGFR, ALK, and PD‐L1 testing at our institution. Methods We conducted a retrospective chart review of 165 patients (send‐out testing, n = 92; in‐house testing, n = 73) with newly diagnosed mNSCLC treated at our institution. Data were compared during the send‐out (March 2017–May 2019) and in‐house (July 2019–March 2021) testing periods. We performed a detailed workflow analysis to provide insight on the pre‐analytic, analytic, and post‐analytic intervals that constituted the total TTD. Results TTD was significantly shorter with in‐house testing (10 days …

PurposeThe aim of this work is to report on the results of a phase 2 randomized trial of moderately hypofractionated (MH) versus conventionally fractionated (CF) radiation therapy to the prostate with elective nodal irradiation.Methods and MaterialsThis was a single-center, prospective, phase 2 randomized study. Patients with high-risk disease (cT3, prostate-specific antigen level >20 ng/mL, or Gleason score 8-10) were eligible. Patients were randomized to either MH using a simultaneous integrated boost (68 Gy in 25 fractions to prostate; 48 Gy to pelvis) or CF (46 Gy in 23 fractions with a sequential boost to the prostate of 32 Gy in 16 fractions), with long-term androgen deprivation therapy. The primary endpoint was grade ≥2 acute gastrointestinal (GI) and genitourinary (GU) toxicity (Common Terminology Criteria for Adverse Events version 3.0). Secondary endpoints included late GI and GU toxicity, quality of life …

Purpose. Consolidation with durvalumab is standard of care in the management of unresectable stage 3 non-small-cell lung cancer (NSCLC) postchemoradiation, and pneumonitis is an independent potential treatment complication of both treatment strategies. This study seeks to determine the timing of radiation pneumonitis (RP) by receipt of durvalumab. In addition, we reviewed the preventative strategies guided by pathophysiology of pneumonitis. Methods. We identified patients with unresectable Stage 3 NSCLC who developed grade ≥2 RP after chemoradiotherapy. Time-to-RP was defined from date of completion of radiotherapy to date of radiological diagnosis of RP and accompanying clinical symptoms. Early RP was defined as RP within 2 months of completion of radiotherapy. Differences in time-to-RP by receipt of durvalumab were evaluated using Wilcoxon rank-sum test. Differences in those who had early vs late RP by receipt of durvalumab was evaluated using Fisher’s exact test. Logistic regression was used to evaluate patient and treatment factors associated with early RP. Results. Of the 144 patients with Stage 3 NSCLC who had definitive chemoradiotherapy, 31 (22%) developed grade ≥2 RP and were included in the study. There was one patient with grade 5 RP. The median age of the cohort was 67 years (range 41–87). The mean lung dose, V5Gy, and V20Gy were 15.8Gy (SD = 1.56), 60.14% (SD 2.73), and 29.96% (SD 1.82), respectively. Twelve (39%) patients received durvalumab. The median time-to-RP was 3.4 months (range: 1.7–7.2) and 2.3 months (range: 0.6–9.6) in patients who had durvalumab and no …

PurposeTo report clinical outcomes for patients with metastatic disease to the head and neck (HN) treated with stereotactic body radiation therapy (SBRT).MethodsA retrospective review of patients treated with SBRT to HN sites from 2012 to 2020 was conducted. Treatment indications included the following: oligometastases, oligoprogression, and control a dominant area of progression (DAP). Kaplan–Meier method was used to estimate local control (LC), regional control (RC), overall survival (OS), and progression-free survival (PFS). Univariable (UVA) and multivariable analyses (MVA) were performed. Grade 3–4 acute and late toxicities were reported by the Common Terminology Criteria for Adverse Events v5.0.ResultsFifty-six patients (58 lesions) were analysed with a median follow-up of 16 months. Primary sites included lung (25.0%), kidney (19.6%), breast (19.6%) and other (35.8%). SBRT indications were …

Red cell transfusion thresholds in outpatients with myelodysplastic syndromes: Combined results from two randomized controlled feasibility studies Red cell transfusion thresholds in outpatients with myelodysplastic syndromes: Combined results from two randomized controlled feasibility studies Am J Hematol. 2024 Mar;99(3):473-476. doi: 10.1002/ajh.27181. Epub 2023 Dec 21. Authors Rena Buckstein 1 , Jeannie Callum 2 , Anca Prica 3 , David Bowen 4 , Richard A Wells 1 , Brian Leber 5 , Nancy Heddle 6 , Lisa Chodirker 1 , Matthew Cheung 1 , Lee Mozessohn 1 , Karen Yee 3 , Jennifer Gallagher 1 , Anne Parmentier 1 , Erin Jamula 5 , Zoe McQuilten 7 , Erica M Wood 7 , Robert Weinkov 8 , Liying Zhang 9 , Alex Mamedov 1 , Simon J Stanworth 10 11 12 , Yulia Lin 13 Affiliations 1 Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2 Department of …

Simple Summary Question: Is stereotactic body radiation therapy an effective and safe treatment option for patients with oligometastatic cancer from a head and neck primary? Findings: In this systematic review and meta-analysis, stereotactic radiation demonstrated high rates of local control at 1 and 2 years (86.9% and 77.9% respectively), with no grade 4 or 5 toxicities reported. Overall survival was 80.1% and 60.7% at 1 and 2 years, respectively. Included studies were heterogeneous and of poor quality, highlighting a need for prospective studies with longer follow-up and homogeneous treatments. Meaning: Stereotactic body radiation therapy offers excellent local control and promising survival rates with acceptable toxicities for patients with oligometastatic head and neck cancers. Abstract Introduction: Stereotactic body radiotherapy (SBRT) is increasingly used to treat disease in the oligometastatic (OM) setting due to mounting evidence demonstrating its efficacy and safety. Given the low population representation in prospective studies, we performed a systematic review and meta-analysis of outcomes of HNC patients with extracranial OM disease treated with SBRT. Methods: A systematic review was conducted with Cochrane, Medline, and Embase databases queried from inception to August 2022 for studies with extracranial OM HNC treated with stereotactic radiotherapy. Polymetastatic patients (>five lesions), mixed-primary cohorts failing to report HNC separately, lack of treatment to all lesions, nonquantitative endpoints, and other definitive treatments (surgery, conventional radiotherapy, and radioablation …

Purpose/Objective(s)Radiation with concurrent chemotherapy (CRT) represents standard definitive therapy for anal cancer. CRT protocols result in good local control, but are associated with significant acute and late morbidity. Whether radiation dose escalation beyond 55-60 Gy improves local control remains unknown. Most anal cancers are associated with HPV infection. Patients with HPV positive (+) cancers have better outcomes compared to those with HPV negative (-) disease. HPV+ anal cancer patients may not benefit from standard CRT.Materials/MethodsSince 2019, we have instituted a REB-approved prospective registry study that tailored CRT for anal cancer according to HPV status in addition to disease stages. Patients with HPV+ T1, T2 and T3/T4 disease received a total dose of 45, 50.4 and 55.8 Gy respectively. Elective nodal radiation dose was 30.6 Gy. For HPV- disease, total doses for T1, T2 and …

PurposeThis is the first report of the 2SMART Phase II trial evaluating the safety of two-fraction stereotactic ablative radiotherapy (SABR) with focal boost to magnetic resonance imaging (MRI) defined dominant intra-prostatic lesion (DIL) for localised prostate cancer.Materials and methodsMen with low or intermediate risk prostate cancer were eligible for the study. The gross tumour volume (GTV) was MRI-defined DIL, and the clinical target volume (CTV) was entire prostate gland. The planning target volume (PTV) was a 2 mm expansion anteroposterior and lateral, and 2.5 mm superoinferior. The prescribed dose was 32 Gy to GTV, and 26 Gy to CTV. Primary endpoint was minimal clinically important change (MCIC) in quality of life (QOL) within 3-months of SABR, assessed using the EPIC-26 questionnaire. Secondary endpoints were acute and late toxicities (assessed using CTCAEv4), PSA nadir, and biochemical …

Background And Aims: Infections are a major cause of morbidity and mortality in myelodysplastic syndrome (MDS). We aim to describe the prevalence and severity of infectious complications in a Canadian cohort of MDS patients.Methods: We included all MDS patients from the Canadian MDS registry between 2006 and 2022. The registry prospectively and longitudinally collects patient, disease, treatment and outcome data.Results: Across 15 sites, we identified 1,115 MDS patients. The mean patient age was 71.4 (standard deviation 10.6) years, and 36% were female. 56%(n= 529) of patients had lower-risk MDS (IPSS-R/= 0.5× 10 9/L. Patients with higher-risk MDS experienced more frequent infections/fevers (36% vs 29%; p= 0.049), hospitalizations for infection/fever (24% vs. 14%; p< 0.0001) and death due to infection (11% vs. 7%; p= 0.06).Conclusions: Hospitalization due to fever/infection is common among …

PurposeThis systematic review and meta-analysis aimed to evaluate the efficacy of Mepitel film in preventing or treating acute radiation dermatitis (RD) in patients with breast cancer in randomized controlled trials (RCTs).MethodsEmbase, APA PsychInfo, Journals@Ovid Full Text, Ovid MEDLINE, PubMed, and Cochrane Trials were searched until December 12, 2022, to identify RCTs on the use of Mepitel film for preventing or treating acute RD from breast cancer radiotherapy. Per-protocol analysis was used to compare outcomes, calculate pooled effect sizes, odds ratio (OR), and 95% confidence intervals (CI), and to create forest plots using random effects analysis in RevMan 5.4.ResultsThree RCTs were included in this review. Mepitel film significantly reduced the incidence of grade 3 RD (OR 0.15 95% CI 0.06, 0.37, p<0.0001) and grade 2 or 3 RD (OR 0.16 95% CI 0.04, 0.65, p=0.01) as scored on either the …

PurposeThe purpose of this study was to identify factors associated with unanticipated radiation therapy (RT) replanning in stage III non-small cell lung cancer (NSCLC).Methods and MaterialsPatients from a single institution with newly diagnosed stage III NSCLC treated with radical RT from January 1, 2016, to December 31, 2019, were retrospectively analyzed. The frequency and reasons for replanning were determined. Logistic regression analysis was used to identify factors associated with replanning.ResultsOf 144 patients included in this study, 11% (n = 16) required replanning after the start of RT. The reason for replanning in these 16 patients was changes in the target detected by cone beam computed tomography (shift in 10 patients, shrinkage in 5 patients, and growth in 1 patient). Larger planning target volume (primary and nodal) was statistically predictive of replanning (odds ratio, 2.5; 95% CI, 1.2-5.4; P …

PurposeFocal boost to dominant intraprostatic lesion (DIL) is an approach for dose escalation in prostate radiation therapy. In this study, we aimed to report the outcomes of 2-fraction SABR ± DIL boost.Methods and MaterialsWe included 60 patients with low- to intermediate-risk prostate cancer enrolled in 2 phase 2 trials (30 patients in each trial). In the 2STAR trial (NCT02031328), 26 Gy (equivalent dose in 2-Gy fractions = 105.4 Gy) was delivered to the prostate. In the 2SMART trial (NCT03588819), 26 Gy was delivered to the prostate, with up to 32 Gy boost to magnetic resonance imaging–defined DIL (equivalent dose in 2-Gy fractions = 156.4 Gy). The reported outcomes included prostate-specific antigen (PSA) response (ie, <0.4 ng/mL) at 4 years (4yrPSARR), biochemical failure (BF), acute and late toxicities, and quality of life (QOL).ResultsIn 2SMART, median DIL D99% of 32.3 Gy was delivered. Median follow …

PurposeWith the increasing use of stereotactic body radiation therapy (SBRT) for primary and metastatic cancer, use of multitarget thoracic (MTT) SBRT is rising. Given the limited safety and efficacy data, we report the experience of this strategy from a large academic center.Methods and MaterialsBetween 2012 and 2021, patients who received SBRT for ≥2 thoracic targets separated by ≤1 year were retrospectively reviewed. The primary endpoint was clinically significant radiation pneumonitis (CSRP) requiring steroids, oxygen, or intubation. Secondary endpoints included local failure (LF), initiation or change of systemic therapy (ICST), progression-free survival, and overall survival. Competing risk analysis was used to evaluate the cumulative incidence of CSRP, LF, and ICST. Univariate and multivariable analyses were performed to look for clinical and dosimetric predictive factors of CSRP and LF.ResultsOne …

The theoretical ideas behind supportive care in oncology have evolved along with changes in technology, from focusing on anti-cancer therapies to considering comorbidities, toxicities, and quality of life. The introduction of new therapies, such as oral agents and targeted therapies, gave physicians new ways of providing supportive care [1, 2]. Founded in 1990, the Multinational Association of Supportive Care in Cancer (MASCC) was established to further advance supportive care in cancer though improving management of adverse effects of anti-cancer therapies and treatment of such adverse events [3]. In 1998, MASCC joined hands with the International Society of Oral Oncology (ISOO), an organization which connects oral health and oncology to address issues which arise from cancer treatments [4]. This manuscript aims to examine the changes in MASCCISOO meetings over a 5-year period by comparing the …

Background and purposeRegional nodal irradiation (RNI) is commonly administered in patients with breast cancer with node-positive disease to prevent cancer recurrence. The purpose of this study is to identify whether RNI is associated with greater acute symptom burden from baseline to 1 to 3 months post completion of radiotherapy (RT) when compared to localized RT.Materials and methodsPatient and treatment characteristics were collected prospectively for breast cancer patients with and without RNI from February 2018 to September 2020. The Edmonton Symptom Assessment System (ESAS) and Patient-Reported Functional Status (PRFS) tool were completed by patients at baseline, weekly during RT, and at a 1- to 3-month follow-up visit. The Wilcoxon rank-sum or Fisher exact tests were used to compare variables between patients with or without RNI.ResultsA total of 781 patients were included in the …

Background and purposeAs breast cancer radiotherapy (RT) has been shown to give rise to adverse pulmonary outcomes, such as radiation pneumonitis, trends in patient-reported shortness of breath (SOB) associated with RT were investigated. Adjuvant RT is commonly administered for local and/or regional control of breast cancer and was therefore included.MethodsThe Edmonton Symptom Assessment System (ESAS) was used to observe changes in SOB during RT, up to 6 weeks after RT completion, and one to three months post-RT. Patients with at least one completed ESAS were included in the analysis. Generalized linear regression analysis was performed to identify associations between demographic factors and SOB.ResultsA total of 781 patients were included in the analysis. There was a significant association between ESAS SOB scores and adjuvant chemotherapy when compared to neoadjuvant …

Purpose/Objective(s)We report the treatment outcomes of palliative Stereotactic Body Radiation Therapy (SBRT) in patients with primary mucosal head and neck cancer (HNC) who were not eligible to receive conventional radiation therapy (RT).Materials/MethodsThis is a retrospective study that reviewed the medical records of patients with primary SCC mucosal HNC who were treated with SBRT between 2011 and 2022. Patients with other histologies, skin cancer, parotid tumors, or recurrent previously irradiated tumors were excluded from the study.ResultsA total of 74 patients and 77 tumors were treated with SBRT in this cohort. The median age in the study was 81 (52-97) years and the median follow-up was 7.2 months. The most common site of HNC was the oral cavity (62%), followed by the oropharynx (18%), hypopharynx (8%), larynx (5%), nasal cavity/sinonasal cancer (3%), and unknown primary (1%). T3 …

BackgroundTime is a valuable commodity that impacts hospital flow, patient experience and economic resources. This study aims to identify factors that affect daily treatment time over a course of radiation therapy (RT) in patients who underwent adjuvant breast RT.MethodsIn all adjuvant breast/chestwall RT patients treated from October 2017 to May 2018, daily set-up, beam delivery time, and overall treatment times were collected. A multivariable linear regression analysis was conducted to identify significant predictive factors related to treatment time. A general linear regression model was used to determine whether there was a learning curve effect throughout the course of treatment that decreased treatment time as patient and staff familiarity with the treatment procedure increased.ResultsA total of 567 patients were included with a median age of 61 years. The average overall treatment time for 2-field and 4-field …

349Background: Prostate stereotactic ablative radiotherapy (SABR) for localised prostate cancer is commonly delivered over 5 fractions. Focal boost to the dominant intraprostatic lesion (DIL) seen on multiparametric magnetic resonance imaging (mpMRI) is an approach for dose-escalation in prostate SABR. This is the first report of the outcomes of the 2SMART trial, a phase 2 single-arm study using 2-fraction prostate SABR with DIL boost. Methods: Men with low to intermediate risk prostate cancer were enrolled in the study. Three gold fiducial markers were inserted for image guidance. The clinical target volume (CTV) included the prostate gland, and the planning target volume (PTV) was a 2mm expansion antero-posterior and laterally, and 2.5mm supero-inferiorly. The DIL was contoured on fused mpMRI. The prescribed dose was 26Gy in 2 fractions (EQD2 110Gy, α/β of 1.4) to the CTV, and up to 32Gy in 2 …

PurposeThis systematic review and meta-analysis evaluates the efficacy of Mepitel Film in preventing acute radiation dermatitis (RD) in patients with head and neck cancer (HNC) across randomized controlled trials (RCTs).MethodsEmbase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched on 5 March 2023 to identify relevant RCTs. RD assessment tools and outcomes were compared across studies. Pooled effect sizes and 95% confidence intervals (CI) were estimated based on random-effects analysis using RevMan 5.4.ResultsThree RCTs conducted between 2018 and 2020 were included. Mepitel Film decreased RD severity when compared to Sorbolene or Biafine but not when compared to mometasone. A per-protocol analysis of two of the trials revealed that, overall, Mepitel Film significantly reduced the incidence of grade 2–3 RD (odds ratio (OR), 0.24; 95% CI, 0.09–0.65; p = 0 …