Armitage, James

Bierman, Philip

Bociek, Gregory

Coutu, Brendan

Enke, Charles

Kallam, Avyakta

Lunning, Matthew

Vose, Julie

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Volume 2 Issue 1 Article 16 September 2020 Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma Brendan Coutu et al Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Coutu, B. Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1). https://digitalcommons.unmc.edu/gmerj/vol2/iss1/16 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol2/iss1/16 Sept. 2020  |  Vol. 2  |  Issue 1 Oral Presentations 29*Names in bold type indicate presenting author.Trends in Intraoperative Opioid Analgesic Use Among Patients Undergoing Laparoscopic Cholecystectomy Allison Bell1, Wanying Pei2, Blaine Schlawin1, Peter Pellegrino1, Zhaohui Hu1, Apollo Stack1, Jason Lau1, Katie Berky1, Kelsey Neuhalfen1,  Rachel Quandahl1, Sagar Bansal1, Andrea Dutoit1, Amy Duhachek-Stapelman1, Katie Goergen1, Tricia LeVan2, Lorena Baccaglini21University of Nebraska Medical Center, Department of Anesthesiology 2University of Nebraska Medical Center, College of Public HealthMentor: Andrea DutoitProgram: AnesthesiologyType: Case ReportBackground: Over-reliance on opioids in the perioperative period has contributed to the opioid epidemic and new non-opioid strategies for multi-modal analgesia are being analyzed and implemented with anesthesiologists playing a vital role. Data regarding the pattern of opioid use intra-operatively is scarce. This study evaluates the trend of intraoperative opioid analgesic use at our institution from 2014 to 2018 among patients undergoing laparoscopic cholecystectomy.Methods: We analyzed a retrospective cohort of 2,554 patients without opioid dependence, liver, or renal failure who were administered opioids intraoperatively. Doses of each opioid were converted into morphine milligram equivalents (MMEs). Data were analyzed via univariate and multivariate linear regression models including surgery date, age, BMI, length of surgery, gender, race, and procedure.Results: Fentanyl was the most commonly prescribed opioid medication intraoperatively, and it was typically prescribed alone. There was a continuous decrease in intraoperative MMEs from 2014 to 2018. Sub-analyses among patients who were prescribed fentanyl alone or fentanyl and hydromorphone together indicated that the use of fentanyl and hydromorphone decreased concurrently during the study period.Conclusions: Our study shows a trend of decreasing opioid administration 							linked to the opioid epidemic and efforts to control opioid administration. However, this study reports isolated trends in opioid administration during the intraoperative period and does not quantify other analgesic modality utilization. Further studies comparing intra-operative opioid and non-opioid analgesic use, and related patients’ pain 								of alternative methods. https://doi.org/10.32873/unmc.dc.gmerj.2.1.014Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves  Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma Brendan Coutu1, Avyakta Kallam2, Matthew Lunning2, Gregory Bociek2, Phillip Bierman2, Julie Vose2, James Armitage2, Charles Enke11 University of Nebraska Medical Center, Department of Radiation Oncology  2University of Nebraska Medical Center, Department of OncologyMentor: Charles EnkeProgram: Radiation OncologyType: Original ResearchBackground: To evaluate the role of accelerated fractionated salvage radiation therapy (SRT) in patients with diffuse large B-cell lymphoma (DLBCL) refractory to salvage chemotherapy in preparation for high dose chemotherapy (HDT) and autologous stem cell transplant (ASCT). Relapsed/primary refractory patients who are also salvage chemotherapy refractory are usually not considered eligible for HDT and ASCT. Conventional and accelerated fractionated salvage radiation therapy was used with the goal of making salvage chemotherapy refractory patients eligible for HDT and ASCT. Patients receiving two different radiation therapy fractionation schedules were compared.Methods: We reviewed the medical records of 54 consecutive patients at one institution with DLBCL who were refractory to salvage chemotherapy and underwent salvage radiation therapy (SRT) from 2000-2019. 							fractionated SRT (most commonly 3600 cGy in 20 twice daily 180 cGy fractions) and 19 patients underwent conventional fractionated SRT (most commonly 3600 cGy in 20 daily 180 cGy fractions). Patients were excluded if they had a complete response to salvage chemotherapy or the SRT fraction size <150 cGy.Results: We evaluated 35 males (65%) and 19 females (35%) with a median age of 59 (range: 24-81) at the time of SRT. Thirty patients (56%) had primary chemotherapy refractory DLBCL having never achieved a remission and were also refractory to salvage chemotherapy, while 24 patients (44%) were refractory to salvage chemotherapy following relapse. All patients were found to have progressive disease in response to salvage chemotherapy. Thirty-seven patients (69%) underwent high dose chemotherapy and proceeded to HDT and ASCT within 180 days of radiation therapy. Accelerated fractionation compared to conventional 	improvement in complete response (CR) rate (80% vs 26%, p<0.001), 1-year disease free survival (54% vs 26%, p<0.001), and 1-year overall survival (61% vs 39%, p=0.018). The rate of patients undergoing ASCT was 			undergoing accelerated fractionation (73% vs 60%, p=0.14).Conclusion: In patients with DLBCL who are refractory to salvage chemotherapy, the use of salvage radiation therapy was associated with a high rate of conversion to ASCT eligibility in a group of patients that are frequently ineligible for ASCT. Additionally, the use of accelerated fractionation compared to conventional fractionation SRT was 		rate, PFS, and OS. https://doi.org/10.32873/unmc.dc.gmerj.2.1.015

Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma

https://digitalcommons.unmc.edu/cgi/viewcontent.cgi?article=1108&amp;context=gmerj

Accelerated Fractionated Compared to Conventional Fractionated Salvage Radiation Therapy Improves Outcomes in Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma

Abstract

Similar works

Full text

Available Versions

University of Nebraska Medical Center Research: DigitalCommons@UNMC