Adjuvant Chemotherapy Group Research Articles

Concordance assessment of Watson for Oncology in breast cancer chemotherapy: first China experience

Background: IBM Watson for Oncology (WFO) is an artificial intelligence cognitive computing system that provides confidence-ranked, evidence-based treatment recommendations for cancer. We examine the level of agreement for breast cancer chemotherapy between WFO recommended and clinical use in a large population of breast cancer cases. Methods: A total of 1,301 breast cancer patients were reviewed in The First Affiliated Hospital with Nanjing Medical University, China from June 2013 to December 2017. Patients’ data were entered manually into WFO by the trained senior oncology fellows. Chemotherapy recommendations were provided in 3 categories, “Recommended”, “For Consideration”, and “Not Recommended”. Concordance was achieved when oncologists’ treatment suggestions were in the “Recommended” or “For Consideration” categories. Results: The chemotherapy regimen concordance was 69.4% among all breast cancer cases, 65.0% among the cases in adjuvant chemotherapy (AC) group and 96.7% among the cases in neoadjuvant chemotherapy (NAC) group. The concordance varied greatly in subset analysis with respect to TNM stage and molecular subtype. AC recommendations were concordant in 92.3% of stage III breast cancer and 50.8% of stage I. However, the concordance varied by molecular subtype, which was higher for triple negative breast cancer (89.3%) than others. The chemotherapy regimen concordance declined significantly with increasing age, except for the age group 41–50 years. Conclusions: Chemotherapy regimens provided by WFO did not exhibit a high degree of agreement with those suggested by oncologists in clinical practice in the hospital in China. The current effort is underway to enhance WFO’s capabilities as a cognitive decision support tool by incorporating regional guidelines, enabling oncologists and patients to benefit from WFO worldwide.

Adjuvant chemotherapy improves oncological outcomes of resectable intrahepatic cholangiocarcinoma: A meta-analysis.

Objective:To define the role of adjuvant chemotherapy in the management of resectable intrahepatic cholangiocarcinoma (ICC) by performing a meta-analysis.Summary background data:Oncological benefit of adjuvant chemotherapy in resectable ICC remains controversial, high-level evidence in such context is lacking.Method:A comprehensive search using Pubmed, EMbase, and Web of Science was performed from inception to October 2018. Studies compared the survival of patients receiving adjuvant chemotherapy versus surgery alone were included. Data were analyzed using random effect model. Quality of each study and presence of publication bias were assessed by Newcastle–Ottawa score (NOS) and funnel plot with Egger test respectively.Results:The present meta-analysis included 15 studies (all were retrospective series) and 5060 patients. Adjuvant chemotherapy was administered either intravenously or intra-arterially in the form of trans-arterial chemo-embolization (TACE). The average NOS for the included studies was 6.5. Pooled analysis of the included studies demonstrated significant advantage in the adjuvant chemotherapy group (HR 0.66, 0.55–079, P <.001, I-square [I2] = 20.8%). After 2 studies were removed for heterogeneity, advantage of adjuvant chemotherapy remained (HR 0.72, 0.62–0.84, P <.001, I2 = 0%). Funnel plot suggested no significant publication bias (Egger test, 2-tailed P = .203). Subgroup analyses suggested that intravenous route of chemotherapy injection (P <.001) and use of gemcitabine base regimen (P = .004) are associated with improved overall survival. Adjuvant chemotherapy did not improve disease-free survival in subgroup analysis (P = .94).Conclusion:Adjuvant chemotherapy is associated with improved overall survival and should be considered in patients with ICC following curative resection and in particular to patients with advance disease.

Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

BackgroundThe optimal care for pT3N0 rectal cancer remains controversial. And whether tumor location can be used to guide the administration of adjuvant radiotherapy for pT3N0 rectal cancer is not fully confirmed. The current study was designed to identify the benefit of adjuvant radiotherapy for pT3N0 rectal cancer.MethodsWe performed a retrospective study of 265 pT3N0 rectal cancer patients who were treated by surgery and adjuvant therapy from Mar. 2005 to Sept. 2015. All patients were divided into two groups according to receiving adjuvant radiotherapy or not. Overall survival (OS), disease-free survival (DFS) were compare between patients who did and did not receive adjuvant radiotherapy. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).ResultsFor patients with lower tumor, DFS in adjuvant chemo-radiotherapy group was higher than that in adjuvant chemotherapy group. Besides, the rates of local recurrence and distant metastasis were found lower in patients who did receive adjuvant radiotherapy than those who did not. For patients with upper tumor, the 5-year OS and DFS were similar between groups of adjuvant chemotherapy and adjuvant chemo-radiotherapy. Multivariable analysis indicated both the CEA and tumor location were independent predictors of LRFS. And adjuvant radiotherapy predicted the DFS, LRFS and DMFS in lower rectal cancer patients.ConclusionTumor location can serve as an indication for the administration of adjuvant radiotherapy in pT3N0 rectal cancer patients.

The benefit of adjuvant chemotherapy in the subtypes of ampullary adenocarcinoma: international propensity score matched study

Introduction: Ampullary adenocarcinoma (AAC) is a rare malignancy with extensive morphological heterogeneity. Randomized controlled trials regarding adjuvant chemotherapy in AAC are lacking. The aim of this study was to investigate the potential benefit of adjuvant chemotherapy in the suvtypes of AAC, using propensity score matching. Method: An international multicenter cohort study was conducted, including all patients who underwent pancreatoduodenectomy for AAC (January 2006 – December 2017). Propensity scores were used to match patients who received adjuvant chemotherapy to those who did not receive adjuvant chemotherapy, in the complete cohort and in two subgroups (pancreaticobiliary/mixed and intestinal subtype). Survival was assessed using the Kaplan-Meier method and Cox regressions. Result: Overall, 1163 patients underwent pancreatoduodenectomy for AAC. Of those, 179 patients were excluded for various reasons. Median survival of the resulting 976 patients was 67 (95% CI 56-78) months. A total of 520 patients received adjuvant chemotherapy and 456 patients did not. The most commonly given regimen was Gemcitabine monotherapy. In the matched cohort (194 vs 194 patients), median survival was not reached in the adjuvant chemotherapy group vs 60 months in the no adjuvant chemotherapy group, P=0.05. A survival benefit from adjuvant chemotherapy was seen in the pancreaticobiliary/mixed subtype; not reached median survival in patients receiving chemotherapy vs 32 months in those who did not, P=0.02. The intestinal subtype did not show a survival benefit from adjuvant chemotherapy (not reached vs not reached), P=0.72. Conclusion: Patients with the pancreaticobiliary/mixed subtype AAC showed a survival benefit from a Gemcitabine containing regimen. Intestinal subtype AAC showed no such survival benefit. It is unknown if and from what kind of adjuvant chemotherapy regimen, the latter group of patients benefit.

Role of Adjuvant Chemotherapy in Advanced Stage Upper Urinary Tract Urothelial Carcinoma after Radical Nephroureterectomy: Competing Risk Analysis after Propensity Score-Matching.

Objective: To determine whether adjuvant chemotherapy (ACH) influences cancer-specific mortality, bladder cancer-specific mortality, and other-cause mortality in patients with locally advanced upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU) through the use of competing risk analysis.Methods: Among 785 patients with UTUC who underwent RNU from 1994 through 2015, we analyzed 338 individuals with locally advanced UTUC (pathologic T3-T4 and/or positive lymph nodes) without distant metastases. Patients were classified into two groups according to receipt of ACH. We performed a 1:1 propensity score-matching analysis between the ACH and no ACH group. The study endpoints were UTUC- and other cause-specific survivals. The association of potential risk factors with outcome was tested with the Fine and Gray regression model.Results: During a median follow-up duration of 31.5 months, rates of UTUC- and other cause-mortalities were 32.9% (n = 79) and 8.7% (n = 21), respectively. Of note, there were no significant differences in overall survival between the observation and ACH groups according to the competing risks of death (UTUC and other causes of death). Multivariate analysis showed that only older age at surgery (≥ 65 years; hazard ratio [HR] = 1.73), multifocality (HR = 1.74), and tumor size (HR = 1.92) remained as poor predictors of UTUC-specific survival. Additionally, positive surgical margin was only identified as independent predictor of other causes of death (HR = 4.23).Conclusion: In summary, postoperative chemotherapy failed to improve UTUC- and other cause-specific survival rates, based on competing risk analysis after propensity score-matching.

Post-esophagectomy Adjuvant Chemotherapy Benefits Esophageal Cancer Patients.

Postoperative chemotherapy is an absolutely imperative treatment for advanced esophageal cancer patients, while preoperative chemotherapy is the standard therapy for clinical stage II/III esophageal squamous cell carcinoma (ESCC) in Japan. The aim of this study was to report the effect of postoperative chemotherapy on survival after esophagectomy due to thoracic esophageal squamous cell carcinoma. One hundred thirteen consecutive patients with esophageal carcinoma who underwent esophagectomy were included. Several regiments were performed at various times. Adjuvant chemotherapy brought a significantly superior overall survival (p=0.002), although there was no significant difference in cancer-specific survival (p=0.054) for clinical stage II or stage III esophageal cancer patients. Depth of invasion (p=0.003), number of lymph node metastases (p=0.048), and venous invasion (p<0.001) were risk factors for recurrence in the adjuvant-chemotherapy group with positive lymph nodes. Additionally, a not well-differentiated type, lymphatic and venous invasions were risk factors for recurrence in the surgery-alone group without positive lymph nodes. Postoperative adjuvant chemotherapy contributes to the prognosis of clinical stage II or III esophageal cancer patients.

Utility of adjuvant chemotherapy in patients receiving surgery and adjuvant radiotherapy for primary treatment of esthesioneuroblastoma

Past research established that surgery plus adjuvant radiotherapy (S + AR) improves overall survival (OS) in esthesioneuroblastoma (ENB). However, it is unknown if the addition of adjuvant chemotherapy (AC) further improves survival. The primary objective of this study was to compare survival among patients treated with S + AR alone to patients who underwent S + AR + AC. Retrospective review of patient records. Thirty-eight patients met inclusion criteria for either S + AR or S + AR + AC treatment groups. The S + AR + AC group contained more patients with Kadish stage D disease, dural invasion, and positive histologic margins postsurgery. All S + AR + AC patients received platinum-based regimens, combined with etoposide in 67%. OS and recurrence-free survival did not differ between the two groups, even when restricting the analysis to patients with Kadish stages B and C disease. Patients who received platinum-based AC did not exhibit improved survival compared to S + AR alone. Further investigation, preferably prospective, into the optimal use of systemic therapy in ENB is warranted.

Adjuvant Systemic Therapy in Patients With Early-Stage NSCLC Treated With Stereotactic Body Radiation Therapy

IntroductionStereotactic body radiation therapy (SBRT) is commonly used to treat nonsurgical patients with early-stage NSCLC. There are no prospective data on the role of adjuvant chemotherapy in this setting. MethodsPatients (≥18 years) diagnosed with clinical stages I-II NSCLC from 2004 to 2013 were identified using the National Cancer Database (n = 11,836). The Kaplan-Meier method was used to estimate overall survival (OS) distributions and the log-rank test was used to compare distributions by treatment strategy. Clinical stages I and II were subdivided according to the TNM staging and log-rank tests was used to compare survival distributions by treatment strategy within each subgroup. ResultsIn patients with T2bN0, median OS in the SBRT alone and SBRT plus adjuvant chemotherapy groups were 16.5 months versus 24.2 months, respectively (95% confidence interval [CI]: 14.1–20.1 months and 18.8–33.3 months, respectively; p < .001); whereas for T3N0, median OS times were 13 months and 20.1 months, respectively (95% CI: 11.7–14.5 mohths and 17.7–21.9 months, respectively; p < .001). For tumors 4 cm or larger and node-negative disease, median OS was 15.9 months in the SBRT-alone group, and 19 months in the SBRT-plus-chemotherapy group (95% CI: 15.1–16.8 months and 17.9–20.8 months, respectively; p < .001). For patients with tumors less than 4 cm and node-negative disease, the median OS was 28.5 months in the SBRT-alone group and 24.3 months in the SBRT-plus-chemotherapy group (95% CI: 27.4–29.4 months and 22.8–26.1 months, respectively; p < .001). ConclusionsSBRT followed by adjuvant chemotherapy was associated with improved OS in comparison with SBRT alone in patients with T greater than or equal to 4 cm, similar to that seen after surgery.

Efficacy of adjuvant chemotherapy after resection of pulmonary metastasis from colorectal cancer: a propensity score–matched analysis

BackgroundPulmonary metastases from colorectal cancer are resected due to the favourable 5-year overall survival rates of 30–60% reported in many studies. However, the efficacy of subsequent adjuvant chemotherapy remains unclear. Patient and methodsWe retrospectively collected clinical data of 1237 patients who underwent surgical resection of pulmonary metastasis from colorectal cancer at 46 Japanese institutions between 2004 and 2008. Patients with non-curative resection, pre-operative chemotherapy, extra-thoracic metastasis, complications after surgery, and inadequate data were excluded. Then, a 1:1 propensity score nearest-neighbour matching between patients with and without adjuvant chemotherapy was performed, considering relevant co-variables, and survival of patients between groups was compared. ResultsData of 524 patients (surgery alone, 269 patients; surgery with adjuvant chemotherapy, 255 patients) were used for matching. From each group, 192 patients with similar background characteristics between groups were selected. Adjuvant chemotherapies included fluoropyrimidine alone (71%), an oxaliplatin-containing regimen (23%), or an irinotecan-containing regimen (6%). In the surgery alone and adjuvant chemotherapy groups, 5-year overall survival rates were 68% and 69%, and 5-year disease-free survival rates were 40% and 34%, respectively. There were no significant differences between the two groups in terms of overall survival (hazard ratio [HR]: 1.00, 95% confidence interval [CI]: 0.69–1.45, P = 1.00) and disease-free survival (HR: 1.07, 95% CI: 0.82–1.39, P = 0.62). ConclusionsAdjuvant chemotherapy after curative resection of lung-limited metastasis from colorectal cancer did not show a survival benefit in the propensity score–matched analysis and should not be recommended without further clinical trials.

Prognostic analysis of neoadjuvant chemotherapy for locally advanced gastric cancer with propensity score matching method

To compare the effects of neoadjuvant chemotherapy and adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer using propensity score matching method. Clinical data of patients with locally advanced gastric cancer undergoing open D2 radical gastrectomy between January 2012 and December 2014 at the Affiliated Tumor Hospital of Zhengzhou University were analyzed retrospectively. Sixty-five patients receiving neoadjuvant chemotherapy (NAC) were allocated into the NAC group and 1243 patients receiving postoperative adjuvant chemotherapy (AC) were allocated into the AC group. (1) age ranged from 18 to 75 years old, and biopsy specimen was confirmed as adenocarcinoma; (2) all the operative procedures were open D2 radical gastrectomy;(3)image examinations showed no distant metastasis or other unresectable factors. no open D2 radical gastrectomy, undergoing laparoscopic surgery, neoadjuvant chemotherapy course <2 cycles, without adjuvant chemotherapy, history of other malignancies, severe complications, incomplete data. SOX (tegafur-gimeracil-oteracil plus oxaliplatin) or XELOX (capecitabine plus oxaliplatin) was used as neoadjuvant and postoperative adjuvant chemotherapy regimen. One-to-two propensity score matching was performed to balance the covariance between two groups. Survival was analyzed using the Kaplan-Meier method. Differences between the curves were tested using log-rank test. After balancing the covariates including gender, age, tumor location, degree of differentiation, clinical stage, chemotherapy regimen, chemotherapy course and surgical approach, 195 patients were enrolled, including 65 patients of the NAC group and 130 patients of the AC group. The number of harvested lymph nodes in NAC and AC group was 22.3±4.6 and 22.6±5.1 respectively, without statistically significant difference(t=1.125, P=0.263). Pathological response assessment for NAC group showed TRG0 in 6 cases, TRG1 in 8 cases, TRG2 in 17 cases, TRG3 in 34 cases; sensitive (TRG 0 to 2) in 31 cases (47.7%), non-sensitive in 34 cases (52.3%). The 3-year progression-free survival rate of NAC and AC group was 73.6%(95%CI: 62.8-84.3) and 69.9%(95%CI:62.1-77.7) respectively, which was not significantly different(P=0.361). The 3-year overall survival rate of NAC and AC group was 80.0%(95%CI:70.2-89.8) and 74.6%(95%CI:67.2-82.0) respectively, which was not significantly different as well(P=0.387). Subgroup analysis revealed that the 3-year progression-free survival rate and 3-year overall survival rate of sensitive patients in NAC group were 83.3%(95%CI:70.0-96.6) and 87.1%(95%CI:75.3-98.9) respectively, which were significantly higher than 62.4%(95%CI:46.1-78.7, P=0.037) and 70.2%(95%CI:54.7-85.7, P=0.033) of non-sensitive patients in NAC group, and those in AC group(P=0.044 and P=0.040). Effects of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer are similar. Patients who are sensitive to neoadjuvant chemotherapy have better prognosis. It may be beneficial to improve prognosis that some appropriate patients with locally advanced gastric cancer are screened for neoadjuvant chemotherapy.

Metastases and death rates after primary enucleation of unilateral retinoblastoma in the USA 2007–2017

Background/aimsEnucleation for retinoblastoma is performed less often in the past decade due to increasingly widespread alternative therapies, but enucleation remains an important option. There is a paucity of reports on...

Supervivencia y complicaciones en pacientes con cáncer gástrico y de la unión gastroesofágica tratados con quimioterapia perioperatoria más cirugía comparada con cirugía más terapia adyuvante: estudio multicéntrico, Bogotá D.C., 2010-2017

Introduction: Oncological management in addition to surgery in patients with gastric cancer remains a matter of debate. We conducted a retrospective longitudinal study to compare the prognosis and complications between perioperative chemotherapy and adjuvant chemotherapy to identify the best treatment scheme. Materials and methods: A longitudinal, retrospective historical cohort study was carried out that included all patients who received one of the two treatment schemes. The main objectives were to evaluate overall survival and perioperative complications (fistula, bleeding, death and toxicity) in each group. Results: 168 patients met the inclusion criteria. Compared with the adjuvant chemotherapy group, the perioperative chemotherapy group had greater survival at 2 and 5 years (80.1% vs. 61.2%, 69.8% vs. 43.6% p=0.003). There was no statistically significant difference in the rate of perioperative complications between the two groups (4.11% vs. 10.64%, p = 0.151). There was an increase in the transfusion requirement in the perioperative chemotherapy group. Discussion: Perioperative chemotherapy increases the long-term survival of patients with locally advanced gastric cancer, without a significant increase in the rate of perioperative complications. There is an increase in the transfusion requirement of the perioperative chemotherapy group without this worsening the prognosis of the patients. Key words: stomach neoplasms; chemotherapy, adjuvant; mortality; survival; postoperative complications.

Prospective Clinical Study of Capecitabine plus Oxaliplatin Concurrent Chemoradiotherapy after Radical Resection of Rectal Cancer

To investigate the efficacy and safety of concurrent chemoradiotherapy with capecitabine or oxaliplatin in locally advanced (T3-4 / N + M0) rectal cancer. A total of 56 patients with rectal cancer after radical operation were randomly divided into group A: capecitabine + oxaliplatin concurrent chemoradiotherapy group (Cap-Oxa-CRT trial, 30 cases), group B: capecitabine concurrent chemoradiotherapy group (Cap-CRT trial as Control group, 26 cases), both groups were given pelvic radiotherapy DT50.4Gy/28f/6 weeks. The two groups received adjuvant chemotherapy after concurrent CRT. (1) The 3-year overall survival rate, 3-year local recurrence rate and 3-year distant metastasis rate were not significantly different between the two groups (P> 0.05). (2) The incidence of grade 1-2 acute toxicity in group A during concurrent CRT was significantly higher than that in group B, the difference was statistically significant (P <0.05). Grade 3 toxicities were not statistically significant between the two groups (P> 0.05). No grade 4 toxicity was found in both groups. The incidences of interrupted or suspend concurrent chemotherapy in both groups were 19.23% and 46.67%, respectively, P <0.05. The incidences of interruption or suspension of radiotherapy were 11.54% and 30% respectively (P> 0.05). The completion rate of adjuvant chemotherapy in group B was higher than that in group A, but the difference was not statistically significant (P> 0.05). In postoperative adjuvant chemotherapy, the incidence of bone marrow suppression in group A was higher than that in group B (P <0.05), and the incidence of non-hematologic adverse reactions was similar between the two groups. Capecitabine combined oxaliplatin concurrent CRT, and oxaliplatin concurrent CRT have a good effect for treatment of patients with locally advanced rectal cancer after radical resection of rectal cancer. However, group A failed to further improve the curative effect, and its grade 1-2 toxicity increased significantly.

Stereotactic Body Radiation Therapy plus Induction Chemotherapy versus Stereotactic Body Radiation Therapy plus Adjuvant Chemotherapy for Early Stage but Medically Inoperable Pancreatic Cancer: A Propensity Score Matched Analysis

Although surgical resection has been confirmed as the only strategy for cure, especially for resectable pancreatic cancer, only 15-20% of the patients were amenable to this curative-intent treatment at the initial diagnose. However, there was no consensus or clinical trials about optimal multimodality treatment for patients with resectable but medically inoperable pancreatic cancer. Hence, radiotherapy and chemotherapy may be the alternatives if patients are not candidates for surgery. Stereotactic body radiation therapy (SBRT) has become a promising option due to its precise treatment delivery. Therefore, we sought to evaluate the efficacy and safety of SBRT plus chemotherapy and the treatment sequences and identify clinical factors associated with survival in a large cohort of patients with early stage but medically inoperable pancreatic cancer. All patients included in this study were biopsy-proven radiographically resectable pancreatic cancer. Only when they were intolerant of or declined operations, subsequent radiotherapy or chemotherapy was taken into considerations. All patients were required to complete a planned chemotherapy with 6 cycles. The chemotherapy regimen was gemcitabine plus S-1. The interval between induction or adjuvant chemotherapy and SBRT was 2 to 3 weeks. Patients who had completed induction chemotherapy would receive PET-CT to preclude metastasis. Those with metastasis were excluded from the study and received other treatment based on the multidisciplinary approach. CA19-9 response was defined as the level of CA19-9 decrease by 50% from baseline levels of ≥74 U/ml. Hence, three groups were formed for univariate analysis: CA19-9 levels ≥74 U/ml with response vs. CA19-9 levels ≥74 U/ml with no response (including CA19-9 levels within the normal range before SBRT while increased after SBRT) vs. CA19-9 levels <74 U/ml (before SBRT and during follow-up). Factors were investigated for their association with overall survival (OS) and progression free survival (PFS) using univariate log-rank comparisons and then COX regression model. Propensity score matched analyses were performed to further assess the efficacy of different treatment sequences. Forty-eight patients received induction chemotherapy and fifty-two with adjuvant chemotherapy from 2012 to 2016. Only radiation doses were higher in adjuvant chemotherapy group. After multivariate analysis, patients with adjuvant chemotherapy (P<0.001), CA19-9 response (P<0.001) and BED10≥60Gy (P=0.024) had a longer OS, while the former two correlated with PFS. After propensity score matched analysis, patients with adjuvant chemotherapy had OS (23.1 months vs. 15.6, P<0.001) and PFS benefits (18.0 months vs. 11.6 months, P<0.001) than those with induction chemotherapy. SBRT plus chemotherapy, especially adjuvant chemotherapy, may be an alternative for patients with early stage pancreatic cancer but not eligible for surgical resection.

P3.16-36 Adjuvant Chemotherapy May Improve the Outcome of Patients with Non-Small-Cell Lung Cancer with Metastasis of Intrapulmonary Lymph Nodes.

Survival benefit of adjuvant chemotherapy (AC) of patients with intrapulmonary lymph node (IPLN) metastasis (level 12–14) needs investigation. We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes. First, 155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated. Patients received systematic dissection of N2 and N1 nodes. For patients with IPLN metastasis, survival outcomes were compared between those receiving AC and those not receiving AC. In this group, 112 cases (72.3%) had IPLN metastasis and 55 cases (35.5%) had N1 involvement limited to level 13–14 without further disease spread to higher levels. Patients with IPLN involvement had a better prognosis than that of patients with hilar–interlobar involvement. For the intrapulmonary N1 group (level 12–14-positive, level 10–11-negative or unknown, n = 112), no survival benefit was found between the AC group and non-AC group (5-year overall survival (54.6±1.6 vs. 50.4±2.4 months, p = 0.177, Figure 1A). However, 76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports (level 12–14-positive, level 10–11 both negative), oncologic outcome in this group was better for patients receiving AC than those not receiving AC (5-year OS: 57.3±1.5 vs. 47.1±3.2 months, p = 0.002, Figure 1B). Similarly, survival benefit of AC didn’t exist in patients with lymph node metastasis to level 13–14 (level 13–14-positive, 10-12-negative or unknown, n=55, Figure 1C), but was found in 38 patients with complete examination of N1 nodes (58.3±1.7 vs. 51.0±4.2 months, p = 0.048, Figure 1D). Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.

Clinical correlates of severe thrombocytopenia from temozolomide in glioblastoma patients.

This study was conducted retrospectively to evaluate rates of thrombocytopenia and their clinical impact during chemo-radiotherapy for glioblastomas and to elucidate associated clinical factors. A total of 64 patients who received temozolomide chemotherapy at our institution was included; 35 patients received full-dose chemo-radiotherapy as per the STUPP protocol (Group A), and 9 patients received abbreviated radiotherapy with concurrent chemotherapy (Group B). Twenty patients received temozolomide alone with an intended 12 cycles of therapy for first relapse at least 6 months after completion of adjuvant chemotherapy (Group C). In Group A, 27 of 35 (77%) patients completed the chemo-radiotherapy phase; 14% had grade 3-4 thrombocytopenia leading to discontinuation. Of 27 patients, 16 (59%) completed adjuvant chemotherapy. There were no grade 3-4 thrombocytopenias, but 4% discontinued due to grade 2 thrombocytopenias. In Group B, four of nine (45%) patients completed the chemo-radiotherapy phase; 11% had grade 3-4 thrombocytopenias and discontinued treatment. Three of four (75%) patients completed adjuvant chemotherapy. Of these, 75% had grade 3-4 thrombocytopenias, but none discontinued. Finally, in Group C, 8 of 20 (40%) patients completed, with 10% discontinuing due to thrombocytopenias and the rest due to disease progression. In exploratory analyses, being female increased the risk of myelosuppresion, and there was a trend noticed in patients having a higher body surface area. Our toxicity data were within range of the literature. We identified the group of patients that have increased thrombocytopenia risk. Larger pooled retrospective series and prospective studies are required.

Retrospective analysis of concurrent docetaxel and epirubicin neoadjuvant versus adjuvant chemotherapy: Which leads to better outcomes for different subtype breast cancer patients?

Different biological subtype breast cancers respond differently to neoadjuvant chemotherapy, but it is unknown whether neoadjuvant or adjuvant chemotherapy leads to different long-term survival in each specific subtype although equal outcomes have been reported in general population. This study sought to clarify whether the selection of either neoadjuvant or adjuvant chemotherapy was linked to a differential survival benefit based on breast cancer subtypes.A prospectively maintained breast cancer database was queried from 2000 to 2008. All patients with a diagnosis of stage II and III breast cancer who received neoadjuvant or adjuvant chemotherapy were identified, only patients receiving docetaxel and epirubicin (TA) regimen were included. Patients were divided according to the administration of neoadjuvant or adjuvant chemotherapy. The biological subtypes were determined by immunohistochemical tests. The outcomes between neoadjuvant and adjuvant chemotherapy were compared in each different subtype. Kaplan–Meier curves were generated, and the Cox model was used to estimate the association between death risk and chemotherapy timing while adjusting for potentially confounding factors. P values < .05 were considered statistically significant.Of the 406 patients included, 201 (49.5%) received neoadjuvant chemotherapy, and 205 (50.5%) received an adjuvant TA regimen. Patients with the HER2+ and TNBC subtypes showed significantly higher pCR rates than patients with luminal types (P < .05). In general population, the neoadjuvant and adjuvant chemotherapy groups showed little survival variance (HR=1.15, 95% confidence interval (CI) .69–1.91, P=.60). In luminal B-like patients, neoadjuvant chemotherapy led to worse overall survival (OS) than adjuvant therapy (HR=2.92, 95%CI 1.20 to 8.31, P = .02). In patients with the HER2+ subtype, neoadjuvant treatment corresponded to better OS (HR = .10, 95%CI .02–.58, P = .01). In contrast, patients with luminal A-like (HR = 1.14, 95%CI .53–2.43, P = .74) and TNBC disease (HR = 1.00, 95%CI .27–3.73, P = >.99) who underwent neoadjuvant chemotherapy showed equivalent OS when compared to patients undergoing adjuvant therapy.Neoadjuvant versus adjuvant chemotherapy results in a disparate impact on overall survival among patients with variant subtype breast cancer. When neoadjuvant chemotherapy was given, luminal B-like patients showed worse outcome, while patients with HER2+ disease had better OS. Prospective studies are necessary to determine and optimize the timing of chemotherapy for breast cancers with different molecular backgrounds.

Multidisciplinary Treatment of Pediatric Low-Grade Glioma: Experience of Children Cancer Hospital of Egypt; 2007-2012

Abstract Background: Pediatric gliomas comprise a clinically, histologically, and molecularly heterogeneous group of central nervous system tumors. The survival of children with gliomas influenced by histologic subtype, age, and extent of resection. Tumor grade emerged as the most determinant of survival except in the young age groups. The aim of this study was to evaluate the role of multidisciplinary therapeutic approach including surgery and chemotherapy, and their impact on the outcome in pediatric patients with low-grade glioma (LGG). Procedure: Study patients were prospectively enrolled onto the study. All patients were below 18-year-old, diagnosed as LGG between July 2007 and June 2012. Upfront surgical resection was attempted in all tumors other than optic pathway sites. Systemic chemotherapy was given according to CCG-A9952 protocol. Results: Total/near-total resection in 105/227 (46.3%) without adjuvant treatment, while 49/227 patients (21.5%) underwent subtotal tumor resection followed by chemotherapy for big residual (n = 26). Follow-up only was indicated for asymptomatic/small residual (n = 23). The radiological diagnosis was set in 18/227 (7.9%) patients; 13/18 had optic pathway glioma. The 3-year overall survival (OS) was 87.3% versus 65.5% event free survival (EFS) for the whole study patients with a follow-up period of 1–5 years. The OS and EFS for patients who did surgery with no adjuvant treatment (n = 128) were, respectively, 95.2% and 77.3% versus 87.4% and 65.1% for adjuvant chemotherapy group (n = 99); (P = 0.015 and P = 0.016 for OS and EFS, respectively). Conclusion: Pediatric LGGs comprise a wide spectrum of pathological and anatomical entities that carry a high rate of prolonged survival among children and adolescents. Surgical resection is the mainstay of treatment in most of tumors. Combined chemotherapy can be an acceptable alternative when surgery is not safely feasible.

Adjuvant Chemotherapy in Rectal Cancer Patients Treated With Preoperative Chemoradiation and Total Mesorectal Excision: A Multicenter and Retrospective Propensity-Score Matching Study

The role of adjuvant chemotherapy after preoperative chemoradiation therapy (CRT) and curative surgery in rectal cancer has yet to be definitely determined. We performed a retrospective and multicenter study to evaluate whether adjuvant chemotherapy (AC) could reduce recurrence and improve survival in locally advanced rectal cancer. We analyzed data from 8 tertiary institutions for 1442 patients with rectal cancer who underwent preoperative CRT and total mesorectal excision. Patients were classified into 2 groups: the AC group (patients who received chemotherapy after surgery) and the observation group (those who did not receive chemotherapy after surgery). Propensity-score matching was used to assess the exact role of AC. The AC group was then subdivided to investigate the impact of adding oxaliplatin to 5-fluorouracil (5-FU). Group 1 was treated with 5-FU/folinic acid or capecitabine without oxaliplatin, and group 2 received 5-FU/folinic acid or capecitabine with oxaliplatin. The 3-year relapse-free survival rates in the AC and observation groups were 85.9% and 84.3%, respectively (P=.532). The 3-year overall survival rates in the AC and observation groups were 94.9% and 89.9%, respectively (P=.123). The rates of locoregional recurrence (2.2% vs 3.2%, P=.294) and distant metastasis(12.4% vs 12.9%, P=.927) at 3years were not significantly different between the two groups. The 3-year relapse-free survival rates of group 1 and group 2 were 71.5% and 74.8%, respectively (P=.426). The 3-year overall survivalrates of group 1 and group 2 were 89.9% and 96.5%, respectively (P=.102). This multicenter study found insufficient evidence to support the use of 5-FU-based AC after preoperative CRT and curative surgery in rectal cancer.

Comparison of the prognosis of neoadjuvant chemoradiotherapy treatment with surgery alone in esophageal carcinoma: a meta-analysis.

BackgroundResection remains the best treatment for carcinoma of the esophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. Chemo-radiotherapy (CRT) followed by surgery was associated with significantly improved survival benefit, but the effectiveness of neoadjuvant therapy in patients with resectable esophageal carcinoma remains controversial. The aim of this study was to evaluate the effects of neoadjuvant chemoradiotherapy in resectable esophageal carcinoma compared to surgery alone (SA).MethodsA search for publications that compared the efficacy of CRT with SA in resectable esophageal carcinoma was conducted. After a rigorous review of the quality, the data were extracted from eligible trials. The major outcomes measures were odds ratios (ORs). The ORs with their corresponding 95% confidence intervals were the principal measure of effects. For the meta-analysis, Revman 5.3 software was used to analyze the combined pooled ORs using fixed- or random-effects models according to the heterogeneity.ResultsOur findings revealed that, compared with SA, neoadjuvant CRT was associated with improved overall survival (OS) and progression-free survival times, but the 3- and 5-year OS did not show a statistical difference (P≥0.05). The adjuvant chemotherapy group did not show significant improvement on reference rate and metastasis rate compared with the control group.ConclusionCRT does significantly improve progression-free survival and OS in patients with esophageal cancer compared with SA. However, further assessment is still warranted on the role of CRT in future trials with well-selected patients.