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Panel Creates ‘Single Language’ for Grading Delayed Effects

Panel Creates ‘Single Language’ for Grading Delayed Effects

ST. PETERSBURG, Florida—New cancer regimens are sometimes a double-edged
sword, offering better survival but also delayed toxicity affecting quality of
life. At the Late Effects of Normal Tissues (LENT) IV workshop, an
international, multidisciplinary panel tackled the Herculean task of defining,
grading, and reporting chronic toxicity. The workshop included representatives
from more than 10 countries, including two European organizations.

"It’s not a clear-cut issue like survival—we’re trying to
quantitate about 500 different toxicity endpoints in a uniform way," said
conference moderator Andy Trotti, MD, associate professor and director of
clinical research in radiation oncology, H. Lee Moffitt Cancer Center at the
University of South Florida, Tampa. "The delayed effects of cancer
treatment are usually far less visible than acute effects, less appreciated
even by experienced professionals, and often much harder to measure."

Delayed effects of chemotherapy, radiation therapy, and surgery include
chronic fatigue, musculoskeletal atrophy and fibrosis, pain syndromes, limited
mobility and exercise intolerance, dry mouth and dental disease, chronic edema,
impaired cognitive and sexual functions, chronic intestinal dysfunction, and
increased risk of heart disease and stroke.

Reporting and analyzing complications like these has, in the past, often
suffered from a hit-or-miss approach: culling random observations hastily
scrawled in charts or relying on complaints from patients, who are often
reluctant to trouble harried providers.

Over the years, different cooperative oncology groups have developed their
own toxicity scales. These groups include the Radiation Therapy Oncology Group
(RTOG) and at least four others. However, lack of uniformity among the
different scales hinders comparability and interpretation of results.

"Through the hard work of the participants of this workshop, one day in
the near future, all of these organizations should be able to speak in a single
toxicity language, utilizing a common platform, a common library of
definitions, terminology, and severity scaling guided by standardized data
collection and reporting techniques," Dr. Trotti said.

His team is comprised of 90 investigators, including surgeons, radiation
oncologists, medical oncologists, nurses, research associates, biologists,
statisticians, and other specialists; 12 National Cancer Institute (NCI)
representatives; and 25 industry sponsors.

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