|
1
|
Nguyen NP, Chirila ME, Page BR, Vinh-Hung V, Gorobets O, Mohammadianpanah M, Giap H, Arenas M, Bonet M, Lara PC, Kim L, Dutheil F, Lehrman D, Montes LZ, Tlili G, Dahbi Z, Loganadane G, Blanco SC, Bose S, Natoli E, Li E, Mallum A, Morganti AG. Immunotherapy and stereotactic body radiotherapy for older patients with non-metastatic renal cancer unfit for surgery or decline nephrectomy: practical proposal by the International Geriatric Radiotherapy Group. Front Oncol 2024; 14:1391464. [PMID: 38854736 PMCID: PMC11162108 DOI: 10.3389/fonc.2024.1391464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
The standard of care for non-metastatic renal cancer is surgical resection followed by adjuvant therapy for those at high risk for recurrences. However, for older patients, surgery may not be an option due to the high risk of complications which may result in death. In the past renal cancer was considered to be radio-resistant, and required a higher dose of radiation leading to excessive complications secondary to damage of the normal organs surrounding the cancer. Advances in radiotherapy technique such as stereotactic body radiotherapy (SBRT) has led to the delivery of a tumoricidal dose of radiation with minimal damage to the normal tissue. Excellent local control and survival have been reported for selective patients with small tumors following SBRT. However, for patients with poor prognostic factors such as large tumor size and aggressive histology, there was a higher rate of loco-regional recurrences and distant metastases. Those tumors frequently carry program death ligand 1 (PD-L1) which makes them an ideal target for immunotherapy with check point inhibitors (CPI). Given the synergy between radiotherapy and immunotherapy, we propose an algorithm combining CPI and SBRT for older patients with non-metastatic renal cancer who are not candidates for surgical resection or decline nephrectomy.
Collapse
Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Monica-Emilia Chirila
- Department of Clinical Development, MVision AI, Helsinki, Finland
- Department of Radiation Oncology, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, United States
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier Public du Contentin, Cherbourg-en-Contentin, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, Tarragona, Spain
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Pedro Carlos Lara
- Department of Radiation Oncology, Fernando Pessoria Canarias Las Palmas University, Las Palmas, Spain
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY, United States
| | - Fabien Dutheil
- Department of Radiation Oncology, Clinique Sainte Clotilde, Saint-Denis, Reunion Island, France
| | - David Lehrman
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | | | - Ghassen Tlili
- Department of Urology, Sahloul University Hospital, Sousse, Tunisia
| | - Zineb Dahbi
- Department of Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Sergio Calleja Blanco
- Department of Oral Maxillofacial Surgery, Howard University, Washington, DC, United States
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Elena Natoli
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studorium, Bologna University, Bologna, Italy
| | - Eric Li
- Department of Pathology, Howard University, Washington, DC, United States
| | - Abba Mallum
- Department of Radiation Oncology, University of KwaZulu Natal, Durban, South Africa
| | - Alessio G. Morganti
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studorium, Bologna University, Bologna, Italy
| |
Collapse
|
|
2
|
Kamalzadeh L, Tayyebi G, Shariati B, Shati M, Saeedi V, Malakouti SK. Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis. BMC Geriatr 2024; 24:428. [PMID: 38745116 PMCID: PMC11095008 DOI: 10.1186/s12877-024-04963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers. METHODS A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots. RESULTS Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA's performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation. CONCLUSION This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.
Collapse
Affiliation(s)
- Leila Kamalzadeh
- Geriatric Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gooya Tayyebi
- Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behnam Shariati
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- School of Public Health, Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Saeedi
- Pediatric Endocrinology and Metabolism Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
|
3
|
Ionova TI, Frolova EV, Ovakimyan KV, Mkhitaryan EA, Tkacheva ON, Logunov DL, Oskova AY, Vasileva EA, Zhitkova YV, Gasparyan AA, Lunev KV, Luneva EA, Porfirieva NM, Nikitina TP. [The use of the Mini-Cog, MMSE, and GPCOG tests in domestic clinical practice for the evaluation of cognitive disorders in elderly and senile patients: the results of a survey of experts' opinions]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:55-64. [PMID: 37490666 DOI: 10.17116/jnevro202312307155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To explore the experts' opinion on the feasibility of using Mini-Kog, MMSE and GPCOG tests for screening assessment of cognitive impairment in elderly and senile patients at the primary stage of medical care, as well as to compare different characteristics of these tests according to experts' opinion. MATERIAL AND METHODS The survey of specialists was carried out on the basis of 6 Medical Centers. Prior to the survey, specialists tested cognitive functions in elderly and senile patients during routine visits undergoing routine admission using Mini-Kog, MMSE and GPCOG tests, as well as interviewed their relatives using the corresponding section of the GPCOG. During the survey, specialists filled out a special physician checklist containing items for indicating socio-demographic information and questions regarding the use of tests for assessing cognitive functions in elderly and senile patients in daily clinical practice. RESULTS The survey involved 40 specialists from different cities of Russia (mean age±SD - 38.6±14.3 years, 82.5% - women). Elderly and senile patients accounted for the predominant proportion (76-100%) of all followed-up patients. All physicians considered it important to conduct a cognitive assessment in elderly patients and they have to use various cognitive tests in their practice. According to most experts, among the Mini-Kog, MMSE and GPCOG tests, all three tools are informative, convenient and suitable for screening cognitive impairment in geriatric patients. The MMSE test is more informative and convenient. Mini-Kog, compared to the other two tools, is the simplest and most time-efficient tool that is also better perceived by patients. An advantage of the GPCOG is the possibility of participation of informants in the assessment of cognitive functions in older patients. CONCLUSION The findings could be used in further research focused on improving the approaches for early detection of cognitive impairment in geriatric patients by primary care physicians.
Collapse
Affiliation(s)
- T I Ionova
- Multinational Center for Quality of Life Research, St. Petersburg, Russia
- Saint Petersburg State University Hospital, St. Petersburg, Russia
| | - E V Frolova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - K V Ovakimyan
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - E A Mkhitaryan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O N Tkacheva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D L Logunov
- City Polyclinic No. 78, St. Petersburg, Russia
| | - A Yu Oskova
- Dolgoprudny Central City Hospital, Dolgoprudny, Russia
| | - E A Vasileva
- Dolgoprudny Central City Hospital, Dolgoprudny, Russia
| | - Yu V Zhitkova
- Interregional Clinical-Diagnostic Center, Kazan, Russia
| | - A A Gasparyan
- Interregional Clinical-Diagnostic Center, Kazan, Russia
| | - K V Lunev
- Altai State Medical University, Barnaul, Russia
| | | | - N M Porfirieva
- Multinational Center for Quality of Life Research, St. Petersburg, Russia
| | - T P Nikitina
- Multinational Center for Quality of Life Research, St. Petersburg, Russia
- Saint Petersburg State University Hospital, St. Petersburg, Russia
| |
Collapse
|
|
4
|
Zhang T, Ren Y, Shen P, Jiang S, Yang Y, Wang Y, Li Z, Yang Y. Prevalence and Associated Risk Factors of Cognitive Frailty: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 13:755926. [PMID: 35153714 PMCID: PMC8832102 DOI: 10.3389/fnagi.2021.755926] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/27/2021] [Indexed: 01/02/2023] Open
Abstract
Objective Currently, the prevalence of CF (Cognitive Frailty) is not very clear, and the relationship between CF and its associated risk factors has not been accurately evaluated. Therefore, it is necessary to conduct a systematic review and meta-analysis further to understand CF's prevalence and associated factors. Methods Embase, PubMed, Web of Science, Ovid, and Cochrane were systematically searched for articles exploring the prevalence of CF, the deadline of searching date was up to March 2021. For the prevalence of CF, the events of CF and the total number of patients in every included study were extracted to estimate the prevalence of CF. For associated factors of CF, Odds Ratios (ORs) with (corresponding) 95% confidence intervals (CIs) were used for estimations. Results Firstly, the estimated prevalence of CF I (Cognitive Frailty in the model I) was 16%, 95% CI (0.13–0.19), and the estimated prevalence of CF II (Cognitive Frailty in model II) was 6%, 95% CI (0.05–0.07). Secondly, both lower engagement in activities and age were calculated to be independent risk factors of CF, and the OR (95% CI) was 3.31 (2.28–4.81) and 1.10 (1.04–1.16), respectively. Finally, depression was also a prominent risk factor of CF, with the overall OR (95% CI) as 1.57 (1.32–1.87). Conclusion CF was a high prevalence in community older. The various assessment scales and the different cutoff values of diagnostic criteria would affect the prevalence of CF. Lower engagement in activities, age, and depression was the risky factor of CF. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42019121369.
Collapse
Affiliation(s)
- Tao Zhang
- School of Medicine, Zunyi Medical University, Zunyi, China
- Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Yan Ren
- Department of Geriatrics, Fifth People's Hospital of Chengdu, Chengdu, China
| | - Ping Shen
- College of Life and Science, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shixie Jiang
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Yanrong Yang
- Department of Neurology, Fifth People's Hospital of Chengdu, Chengdu, China
| | - Yan Wang
- Department of Neurology, Fifth People's Hospital of Chengdu, Chengdu, China
| | - Zheng Li
- Department of Neurology, Fifth People's Hospital of Chengdu, Chengdu, China
| | - Ying Yang
- Department of Neurology, Fifth People's Hospital of Chengdu, Chengdu, China
- School of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
- *Correspondence: Ying Yang
| |
Collapse
|
|
5
|
Rose AF, Gilbertson AF, Cottrell C, Tampi RR. Cognitive screening for adult psychiatric outpatients: Comparison of the Cognivue ® to the Montreal Cognitive Assessment. World J Psychiatry 2021; 11:265-270. [PMID: 34327120 PMCID: PMC8311515 DOI: 10.5498/wjp.v11.i7.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/10/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
In this editorial we comment on the article by Cahn-Hidalgo D published in a recent issue of the World Journal of Psychiatry 2020; 10(1); 1-11. We focus on the importance of utilizing psychometrically valid cognitive screening tools when assessing for cognitive decline in older adults in a psychiatric outpatient setting. We compared the use of Cognivue® to use of the montreal cognitive assessment (MoCA) as a cognitive screening tool. A total of 58 patients aged 55 and over participated in this comparison study. Patients completed cognitive screening on Cognivue®, a new Food and Drug Administration-cleared computer screening device, and the MoCA. The results of patient performance using these two instruments were analyzed. Sixteen (28%) patients screened negative for cognitive impairment on both assessments. Forty-two (72%) patients screened positive on one or both of the assessments. There was 43% agreement between Cognivue® and the MoCA in identifying patients with cognitive impairment, and individual subtests were weakly correlated. The MoCA was determined to be the preferred instrument due to its high sensitivity and specificity (100% and 87%, respectively) when screening for cognitive impairment. We propose that the use of Cognivue® cognitive screening tool be closely reviewed until more research proves that the test meets the standards for reliability and validity. It is important for clinicians to remember that screeners should not be used to diagnosis patients with neurocognitive disorders; instead, they should be used to determine whether further evaluation is warranted. Additionally, misdiagnosing of neurocognitive disorders can pose unnecessary psychological and emotional harm to patients and their families and also lead to incorrect treatment and undue healthcare costs.
Collapse
Affiliation(s)
- Amanda F Rose
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Alan F Gilbertson
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Constance Cottrell
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH 44106, United States
| | - Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, United States
| |
Collapse
|