Publications by authors named "Soon Yu Yang"
Research productivity of RANZCR radiation oncology trainees from 2014 to 2023.
J Med Imaging Radiat Oncol
October 2024
Introduction: The aim of this study was to describe the research productivity among RANZCR Radiation Oncology (RO) trainees.
Methods: Publicly available data on RO fellows, who were awarded the RANZCR fellowship between July 2014 and June 2023, was extracted from the RANZCR Annual Reports. Fellows who had qualified overseas and did not undertake full RANZCR training were excluded.
Importance: Observed treatment effects on overall survival (OS) differed substantially in the first 2 randomized clinical trials of lutetium Lu 177 vipivotide tetraxetan (Lu-177) prostate-specific membrane antigen (PSMA) in metastatic castration-resistant prostate cancer.
Objective: To investigate factors associated with the observed difference in treatment effects on OS, including differences in the risk of crossover from randomized treatment after disease progression.
Design, Setting, And Participants: This comparative effectiveness study used individual participant data from 2 randomized clinical trials, TheraP (A Randomised Phase 2 Trial of 177Lu-PSMA617 Theranostic Versus Cabazitaxel in Progressive Metastatic Castration Resistant Prostate Cancer [ANZUP Protocol 1603]) (n = 200), recruited from February 2018 to September 2019 in Australia, and published data from VISION (An International, Prospective, Open Label, Multicenter, Randomized Phase 3 Study of 177Lu-PSMA-617 in the Treatment of Patients With Progressive PSMA-Positive Metastatic Castration-Resistant Prostate Cancer) (n = 831), recruited from June 2018 to October 2019 in North America and Europe.
Article Synopsis
- - This research examines why positive treatment effects seen in the first interim analysis of clinical trials may decline in later analyses, focusing on issues like overestimation bias, non-proportional hazards, and varied recruitment.
- - The study analyzed 71 oncology randomized clinical trials, showing that hazard ratios often overestimate treatment effects, especially when fewer events have occurred by the interim analysis.
- - The findings highlight the need to apply adjusted hazard ratios to reduce overestimation bias and stress the importance of considering various factors when reporting on positive interim analysis results.
Article Synopsis
- The study examined whether comprehensive geriatric assessment (CGA)-guided care enhances health-related quality of life (HRQL) in older cancer patients compared to standard care.
- Meta-analyses showed a potential moderate improvement in HRQL scores at 3 months, though results were not definitive and depended on the size and type of trials.
- Overall, findings suggested that larger RCTs and those requiring CGA before cancer treatment were more likely to show better HRQL outcomes.
Article Synopsis
- Patients with advanced non-small-cell lung cancer (NSCLC) and brain metastases are often treated with osimertinib, but the effectiveness of adding stereotactic radiosurgery (SRS) is uncertain.
- This study proposes a meta-analysis of existing trials to determine if SRS combined with osimertinib improves control of brain metastases compared to osimertinib alone.
- The research will evaluate various outcomes, including intracranial progression-free survival and overall survival, and will be shared with the medical community and patients through publications and presentations.*
Article Synopsis
- - The study investigates how effectively PET/MRI can predict treatment response in localized rectal cancer patients undergoing preoperative chemoradiotherapy (CRT), focusing on sensitivity and specificity of imaging parameters.
- - Out of 31 recruited patients with rectal adenocarcinoma, 20 completed the study; results showed that 20% of patients were good responders to treatment, while 80% had a poor response based on histopathological assessments.
- - Key imaging metrics like percent maximum thickness reduction and percent apparent diffusion coefficient (ADC) change demonstrated promising predictive values, suggesting their potential use in identifying good responders, highlighting the need for larger studies to validate these findings.
Article Synopsis
- - Survivors of head and neck cancers (HNC) in Singapore have a higher risk of stroke, and a study aimed to understand this risk among different subpopulations of HNC survivors from January 2005 to December 2020.
- - The study used data from national cancer and stroke registries, focusing on demographic and treatment factors to analyze stroke outcomes over a median follow-up period of about 42.5 months.
- - Out of nearly 10,000 HNC survivors studied, 3.4% suffered a stroke, showing a significant stroke risk increase with an SIRR of 2.46, indicating they were over twice as likely to have a stroke compared to the general population.
Article Synopsis
- A literature review identified clinical trials and real-world studies on stage IV NSCLC patients who progressed after platinum-based chemotherapy, using EMBASE and MEDLINE databases from 2017 to 2021.
- The review included 15 publications, showing varied sample sizes and indicating that eight of the nine clinical trials had an overall response rate of ≥15%, while median progression-free survival (PFS) ranged from 1.9 to 6.8 months.
- The findings highlighted the limited treatment response and significant adverse effects for these patients, emphasizing the need for better and more tolerable treatment options.
Article Synopsis
- The review analyzes the effectiveness of reirradiation (reRT), systemic therapy, and their combination on overall survival (OS), progression-free survival (PFS), adverse effects (AEs), and quality of life (QoL) in patients with recurrent high-grade glioma (rHGG).
- A total of 31 studies involving 2084 participants were assessed, showing that combination therapy generally improves PFS and OS compared to systemic therapy or reRT alone, though evidence certainty was low.
- The introduction of bevacizumab in combination therapy significantly improves PFS and OS while reducing the risk of radionecrosis, making it a potentially safer option for rHGG patients.
Article Synopsis
- Life-prolonging therapies for metastatic non-small cell lung cancer (NSCLC) have made managing brain metastases (BMs) more complex, leading to discussions among Australian oncologists about effective management strategies.
- Patient management should consider whether BMs are symptomatic or asymptomatic and take into account various factors like the number and location of metastases, tumor types, and overall treatment goals.
- An individualized treatment approach is crucial due to the lack of comprehensive clinical trial data on the best way to sequence multiple modern therapies in the rapidly evolving treatment landscape.
Article Synopsis
- The study investigated factors that predict primary resistance to immune checkpoint inhibitors (ICIs) in patients with advanced non-small-cell lung cancer (NSCLC), defining resistance as disease progression within 6 months of treatment.
- Out of 108 patients, over half (54.6%) exhibited primary resistance, with notable demographics including a majority being male, smokers, and predominantly Chinese with adenocarcinoma.
- Key predictive factors for resistance included being female, having a neutrophil-to-lymphocyte ratio (NLR) of 3 or higher at 6 weeks, and receiving immunotherapy as a later treatment line (≥2 lines).
Article Synopsis
- - The study aimed to compare the dosimetric outcomes of advanced radiation techniques (IMRT vs. VMAT) through a systematic review and meta-analysis, consolidating previous non-randomized research findings where results were inconsistent.
- - A total of 17 studies involving 383 patients were analyzed, revealing that dual arc VMAT significantly reduced doses to specific organs, treatment times, and the number of monitor units required, while IMRT showed better target coverage in certain scenarios.
- - Subgroup analyses determined that the Eclipse treatment planning system performed better in terms of integral dose and delivery time, while IMRT outperformed VMAT in target coverage when using the Pinnacle and Monaco systems.
Background: Durvalumab consolidation is associated with improved survival following concurrent chemoradiotherapy (CCRT) in patients with stage III non-small cell lung cancer (NSCLC). Given the heterogeneity of stage III NSCLC patients, in this study we evaluated the efficacy and safety of durvalumab in the real-world setting.
Method: Unresectable stage III NSCLC patients were retrospectively studied: one cohort received CCRT, another had CCRT-durvalumab.
Article Synopsis
- The study investigates the effectiveness of adjuvant radiotherapy (RT) after gross total resection (GTR) for patients with atypical meningioma (AM), as its benefits are not clearly established.
- After analyzing data from 12 studies involving 1,078 patients, the findings indicate that adjuvant RT can increase progression-free survival (PFS) by an average of 3.9 months and overall survival (OS) by 1.1 months.
- While further randomized controlled trials are needed for confirmation, the results suggest that adjuvant RT should be recommended for improved patient outcomes following GTR for AM.
Article Synopsis
- The study aimed to compare the effectiveness and safety of stereotactic body radiation therapy (SBRT) with conventional external beam radiation therapy (cEBRT) for patients suffering from painful bone metastases.
- Researchers reviewed randomized controlled trials to assess outcomes like pain response, overall survival, and side effects, employing rigorous quality assessment methods.
- The results indicated that SBRT significantly improved complete pain response rates and reduced local progression at 3 months, although it also led to more pain flare-ups compared to cEBRT.
Importance: Patients with cancer have an increased risk of severe disease and mortality from COVID-19, as the disease and antineoplastic therapy cause reduced vaccine immunogenicity. Booster doses have been proposed to enhance protection, and efficacy data are emerging from several studies.
Objective: To evaluate the proportion of COVID-19 primary vaccination non-responders with cancer who seroconvert after a booster dose.
Article Synopsis
- * After reviewing 23 studies with over 1,100 patients, the survival rates were significantly higher for CRT-S (65% at 1 year) compared to CRT (30% at 1 year), while treatment-related complications were relatively low for both groups.
- * The researchers concluded that while chemoradiotherapy is a viable option for T4 esophageal cancer, the combination with surgery may be beneficial for some patients, but more high-quality randomized controlled trials are needed to confirm these results.
Background: The benefits of adding upfront post-operative radiation, either whole-brain (WBRT) or cavity, after resection of brain metastases have been debated, particularly due to the long-term sequalae post radiation. We sought to compare the efficacy and safety between post-operative radiation versus resection alone.
Methods: We searched various biomedical databases from 1983 to 2018, for eligible randomized controlled trials (RCT).
Article Synopsis
- The study aimed to compare how effective COVID-19 vaccines are for people with compromised immune systems versus those with healthy immune systems.
- Researchers conducted a systematic review and meta-analysis using data from various reputable sources for studies published between December 2020 and November 2021.
- The results indicated that patients with hematological cancers, inflammatory disorders, and solid cancers had significantly lower seroconversion rates after vaccination, with organ transplant recipients showing an extremely low likelihood of developing antibodies.
Article Synopsis
- The study aims to evaluate and compare the efficacy and side effects of weekly versus tri-weekly administration of paclitaxel, alongside carboplatin, as the first-line treatment for newly diagnosed epithelial ovarian cancer.
- The researchers systematically reviewed numerous databases for randomized controlled trials, measuring outcomes like progression-free survival, overall survival, and adverse effects, applying standardized methodology for data collection and analysis.
Background: Oxaliplatin-induced peripheral neuropathy (OIPN) has significant clinical impact on the quality of life for cancer patients and is a dose limiting toxicity. Trials studying preventive measures have been inconclusive. A systematic review and meta-analysis were conducted to evaluate the existing pharmacological and non-pharmacological interventions to prevent chronic OIPN.
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- - Next-generation sequencing (NGS) can identify mutations for targeted therapy, and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a procedure that may provide samples for this analysis, though its efficacy was previously unclear.
- - A review of 21 studies with 1,175 patients showed that EBUS-TBNA has an 86.5% yield rate for obtaining adequate samples for NGS, with an average DNA weight of 868.7 ng extracted from these samples.
- - The success of EBUS-TBNA correlates positively with the number of passes made during the procedure, indicating that more passes may lead to better outcomes for NGS sample adequacy.
Article Synopsis
- The study investigated the impact of COVID-19 on cancer patients, finding they are more vulnerable due to their weakened immune systems.
- A systematic review analyzed data from various studies, concluding that cancer patients had a higher risk of severe outcomes and mortality compared to non-cancer COVID-19 patients.
- The results indicated that specific factors like lung cancer or stage IV didn’t significantly increase this risk, but age and gender were associated with severe outcomes; however, publication bias was noted as a limitation.
Background: Paclitaxel-induced peripheral neuropathy (PIPN) is a disabling side effect of paclitaxel with few effective preventive strategies. We aim to determine the efficacy of pharmacological and non-pharmacological neuroprotective interventions in preventing PIPN incidence.
Methods: Biomedical literature databases were searched from years 2000 to 2021 for trials comparing neuroprotective interventions and control.
Article Synopsis
- - The FDA has approved nivolumab, an immune checkpoint inhibitor, for treating advanced gastric or esophageal adenocarcinoma as a first-line therapy, without considering PD-L1 expression levels, although its effectiveness in low PD-L1 patients is uncertain.
- - This study reconstructs unreported data from major clinical trials (CheckMate-649, KEYNOTE-062, KEYNOTE-590) to evaluate the survival outcomes of patients based on their PD-L1 scores using a new analysis method called KMSubtraction.
- - Findings showed no significant survival advantage for the combination of immune checkpoint inhibitors and chemotherapy compared to chemotherapy alone in certain PD-L1 subgroups, with one subgroup actually indicating worse outcomes for patients receiving pembrolizumab.*