Completion Of Adjuvant Chemotherapy Research Articles

Factors associated with failure to complete adjuvant chemotherapy in pancreatic cancer

BackgroundThe importance of completing adjuvant chemotherapy in pancreatic cancer is becoming recognized. However, the clinicopathological factors associated with failure to complete adjuvant chemotherapy remain unclear. MethodsA total of 135 patients were analyzed to identify the factors associated with failure to complete adjuvant chemotherapy. ResultsNinety patients completed planned adjuvant chemotherapy, whereas 45 patients failed to complete adjuvant chemotherapy. Lower preoperative prognostic nutritional index, intraoperative blood transfusion, and organ and/or space surgical site infection, and advanced tumor stage were associated with failure to complete adjuvant chemotherapy. Neoadjuvant chemoradiotherapy was associated with significantly lower prognostic nutritional index, less incidence of organ and/or space surgical site infection, and earlier tumor stage, suggesting the conflicting effects of neoadjuvant chemoradiotherapy on completing adjuvant chemotherapy. ConclusionsSeveral clinicopathological factors including patient conditions and perioperative events were associated with failure to complete adjuvant chemotherapy.

Prognosticating metastatic osteosarcoma treated with uniform chemotherapy protocol without high dose methotrexate and delayed metastasectomy: a single center experience of 102 patients.

Data on prognostic factors in patients with metastatic osteosarcoma treated with uniform chemotherapy protocol are lacking. The objective of this study was to analyze demographic data, treatment outcome and prognostic factors for patients with metastatic osteosarcoma at our center treated with a uniform chemotherapy protocol without high dose methotrexate. This is a single-institutional data review of patients treated between June 2003 and December 2012 with neoadjuvant chemotherapy, local site surgery followed by adjuvant chemotherapy and metastasectomy at completion of adjuvant chemotherapy. 102 patients of metastatic osteosarcoma were treated with a median age of 18years (range 8-48years), male to female ratio of 3.3:1 and median symptom duration of 4months. EFS and OS at 5years were 12.7±0.1 and 28.1±0.1%, respectively. On multivariate analysis, elevated serum alkaline phosphatase (p<0.001) and number of metastasis >3 (p=0.04) were predictive of lower EFS, whereas elevated serum alkaline phosphatase (p=0.01), number of metastasis >3 (p=0.05), and margin positivity (p<0.001) were predictive of lower OS. This is the largest data on metastatic osteosarcoma treated with a uniform chemotherapy protocol without high dose methotrexate. The data showed prognostic factors similar to what have been observed previously such as elevated serum alkaline phosphatase and >3 metastatic lesions in lung predicting inferior outcome. Notably our survival was comparable to data from other studies despite our practice of delaying metastasectomy to completion of chemotherapy rather than performing the same along with local site surgery.

Surgical management of large-cell neuroendocrinelung carcinoma: an analysis of 25 cases.

Large-cell neuroendocrine carcinoma (LCNEC) of the lung is a relatively uncommon and aggressive subset of pulmonary neuroendocrine tumors, which include typical and atypical carcinoid, and small-cell lung cancer. LCNEC of the lung accounts for no more than 1% of all lung cancers. LCNECs show features of high-grade neuroendocrine tumors and patients with LCNEC have a very poor prognosis. Twenty-five patients (22 males and 3 females; mean years 60.7; range 48 to 77 years) who underwent pulmonary resection for large-cell neuroendocrine carcinoma between January 2004 and December 2014 were investigated retrospectively. Type of surgery, pathologic TNM stage, adjuvant chemotherapy, time of recurrence, site of recurrence, response to treatment, and long-term results were evaluated. The longest patient follow-up period was 83 months. One-, two-, and three-year survival rates of these patients were, respectively, 80.95%, 76.47%, and 50%. Complete surgical resection is the treatment of choice for early-stage LCNEC and chemotherapy after radical surgical treatment improves survival. Follow-up periods after surgery adjuvant chemotherapy will prevent recurrence and patients may survive for many years if complete surgical resection and adjuvant chemotherapy are possible.

Factors Affecting the Completion of Adjuvant Chemotherapy in Early-Stage Breast Cancer.

Despite the survival benefit associated with adjuvant chemotherapy in early-stage breast cancer, many do not complete treatment. This study identified factors associated with noncompletion of adjuvant chemotherapy among a select population of women with early-stage breast cancer. The study sample was obtained from a multicenter study designed to evaluate patient-assistance program usage among early-stage breast cancer patients requiring adjuvant therapy. In this study, 333 patients with stages I and II breast cancer undergoing surgery from October 2006 to September 2009 completed 6-month follow-up surveys assessing their experiences with care, health status, social support, self-efficacy, and treatment beliefs. In- and outpatient medical records were abstracted to assess treatment completion. Of the 333 patients, 198 initiated adjuvant chemotherapy and formed our study cohort. The study compared patients who did and did not complete adjuvant chemotherapy. The median patient age was 53years (range 28-86years). According to self-identification, 41% of the patients were non-Hispanic white and 21% were black. A total of 13 patients (7%) did not complete adjuvant chemotherapy. In the bivariate analysis, the patients not completing chemotherapy were more likely to be black and unmarried women with low emotional social support and a poor body image after treatment. In the multivariate analysis, black race [odds ratio (OR) 5.62; 95% confidence interval (CI) 1.63-20.36] and poor body image (OR 9.75; 95% CI 2.12-95.95) were independently associated with noncompletion of chemotherapy. Overall chemotherapy noncompletion rates were low among women exposed to patient-assistance programs. However, poor body image and black race were independent predictors of uncompleted chemotherapy. The true impact of race in this group may result from social factors that occur more often among black women, including poor social support.

Intraluminal superior vena cava metastasis from adenosquamous carcinoma of the duodenum: A case report.

In 2013, a 76-year-old male with a cardiac pacemaker was diagnosed with adenosquamous carcinoma of the duodenum. Subsequently, a pancreatoduodenectomy and lymph node dissection were performed, and 12 cycles of adjuvant chemotherapy (modified FOLFOX6 regimen), which consisted of fluorouracil, leucovorin and oxaliplatin, were administered via a central venous catheter. At 5 months after the completion of adjuvant chemotherapy, the patient experienced the sudden onset of severe pain at the back right of the ear, edema of the right side of the face and right jugular vein dilatation. Computed tomography (CT) revealed filling defects in the superior vena cava (SVC) and right brachiocephalic vein, indicating catheter-induced venous thrombosis. Although the catheter was removed and anti-coagulation therapy, aspiration of the thrombosis and ballooning dilatation were performed immediately, the patient's symptoms were not ameliorated. Notably, histological examination following thrombus aspiration revealed metastatic cancer cells, and fluorodeoxyglucose-positron emission tomography/CT identified metabolically active nodules in the SVC at locations consistent with the initial duodenal tumors detected by CT and in the first thoracic vertebrae. The tumor thrombus rapidly increased in size and resulted in worsening dyspnea. Subsequently, radiotherapy was performed, followed by chemotherapy, which relieved the systemic symptoms and suppressed the tumor growth. Adenosquamous carcinoma of the duodenum is extremely rare, and to the best of our knowledge, intraluminal SVC metastasis as a result of adenosquamous carcinoma of the duodenum has not been reported previously. The placement of a cardiac pacemaker, central venous catheter and tumor cells possessing high metastatic potential are hypothesized to have contributed to this rare case of metastasis.

Rôle de la radiothérapie postopératoire des cancers bronchiques non à petites cellules : revue de la littérature actualisée sur de nouvelles données

Most non-small-cell lung cancer long-term survivors are patients having had a completely resected tumor. Even in this highly selected group of patients, there is still a high risk of both local and distant failure. In patients with stage II and III, administration of adjuvant platinum-based chemotherapy is now considered the standard of care, based on level 1 evidence. The role of postoperative radiation therapy (PORT) remains controversial, especially in stage III. In the PORT meta-analysis published in 1998, the conclusions were that if PORT was detrimental to completely resected patients with no mediastinal involvement (pN0 and pN1 patients), the role of PORT in the treatment of tumors with N2 involvement was unclear and further research was warranted. Thus at present, after complete resection, adjuvant radiotherapy should not be administered in patients with early lung cancer (pN0 or pN1). Recent retrospective and non-randomized studies as well as subgroup analyses of randomized trials evaluating adjuvant chemotherapy, provide evidence of the possible benefit of PORT in patients with mediastinal nodal involvement. The role of PORT needs to be evaluated also for patients with proven N2 disease who undergo neo-adjuvant chemotherapy followed by surgery. Based on currently available data, PORT should be discussed for fit patients with completely resected non-small-cell lung cancer with N2 nodal involvement, preferably after completion of adjuvant chemotherapy or after surgery if patients have had pre-operative chemotherapy. There is need for new randomized evidence to reassess PORT using modern three-dimensional conformal radiation technique. A new large multi-institutional randomized trial (Lung ART IFCT 0503) evaluating PORT in this patient population is needed and now underway. In patients with R1 or R2 resection, postoperative radiotherapy should be proposed when re-resection cannot be achieved, based on a strong consensus, and despite the absence of randomized trial.

Isolated brain metastasis – A rare site of recurrence in a recurrent epithelial carcinoma ovary

A 40-year-old lady presented with 15 months after completion of adjuvant chemotherapy with headache and impaired memory. MRI brain revealed isolated frontal lobe metastasis. She underwent surgical excision, whole brain RT followed by six cycles of chemotherapy.

Singapore Cancer Network (SCAN) Guidelines for Adjuvant Trastuzumab Use in Early Stage HER2 Positive Breast Cancer

The SCAN breast cancer workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for adjuvant trastuzumab use in early stage HER2 positive breast cancer. The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting. Five international guidelines were evaluated- those developed by the National Comprehensive Cancer Network (2015), the National Institute of Health and Clinical Excellence (2006, 2009), the European Society of Medical Oncology (2013), the Breast Cancer Disease Site Group in conjunction with the Program in Evidence Based Care and Cancer Care Ontario (2011) and the Scottish Intercollegiate Guidelines Network (2013). Recommendations on suitable candidacy for adjuvant trastuzumab, whether adjuvant trastuzumab should be given concurrently with a taxane or sequentially after completion of adjuvant chemotherapy, the optimal frequency of cardiac monitoring during adjuvant trastuzumab and the optimal duration of adjuvant trastuzumab were developed. These adapted guidelines form the SCAN Guidelines 2015 for adjuvant trastuzumab use in early stage HER2 positive breast cancer.

Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma – A population-based cohort study

Background. Multimodality treatment (MMT) improves survival for patients with pancreatic ductal adenocarcinoma (PDAC). The surgery-first (SF) strategy is the most universally accepted approach.Material and methods. Population-based retrospective cohort study of all cases of resectable PDAC from 2006 to 2012. Patients were planned for adjuvant chemotherapy (AC) with the Nordic 5-fluorouracil/leucovorin regimen. Reasons for and rates of failure to complete AC, postoperative major complications (PMC), and overall survival (OS) were analysed.Results. Of 203 patients, 85 (41.9%) completed AC, 41 (20.2%) failed to complete AC, and 77 (37.9%) never initiated AC. Primary reasons for not initiating or completing AC were early disease progression (34.7%), postoperative complications/poor performance status (32.2%), and age > 75 years (24.6%). Median OS in the whole cohort was 17.0 months, and 20.0 months in patients who initiated AC. Median OS in patients who completed AC was higher than in patients who did not (25.0 months vs. 12.0 months, p < 0.001). PMC (n = 41) were associated with decreased initiation rate (p < 0.001) and completion rate (p = 0.007) of AC, and decreased median OS (11.0 months vs. 19.0 months, p = 0.028). Among patients with R1 resection, PMC again were associated with worse median OS (8.0 months vs. 16.0 months, p = 0.028). Multivariate analysis demonstrated that completion of MMT and tumour grade (G1/G2) were related to mortality rate (p < 0.001). Mortality risk for patients who completed AC was reduced also when adjusting for competing risk (SHR 0.426, p < 0.001).Conclusions. MMT completion is strongly associated with reduced mortality risk in patients with resectable PDAC undergoing the SF approach. Early disease progression and PMC/poor performance status preclude MMT completion in more than one third of the patients. These reasons for failure to complete MMT underscore the need for strategies to improve patient selection and reduce surgical morbidity in patients with resectable PDAC.

When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients.

There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer, especially if the patient requires adjuvant chemotherapy. This study aimed to assess whether the timing of stoma closure could influence postoperative morbidity. Patients with rectal cancer undergoing laparoscopic proctectomy with temporary stoma were included and divided into three groups according to the delay of stoma closure after proctectomy: ≤60 days (Group A), 61-90 days (Group B), and >90 days (Group C). From 2008 to 2013, 259 patients (146 men, median age 61 years) were divided into Groups A (n = 65), B (n = 115), and C (n = 79). At the time of stoma closure, seven (11%) patients received adjuvant chemotherapy in Group A versus 42 (37%) in Group B (p = 0.0002) and 24 (30%) in Group C (p = 0.004), and peristomal hernia was noted in four patients (6%) in Group A versus 14 (12%) in Group B and 21 (27%) in Group C (p < 0.0001). Although overall postoperative morbidity was similar between groups, anastomotic leakage (at the stoma closure site) was noted in one patient in Group A versus zero in Group B versus four in Group C (p = 0.03). Median hospital stay was 5 days in Group A versus 6 in Group B versus 6 in Group C (p = 0.004). Our results suggested that timing of temporary stoma closure can influence postoperative morbidity. Best results were obtained if stoma closure was performed before 90 days, even during adjuvant chemotherapy. There is no benefit in delaying stoma closure after completion of adjuvant chemotherapy.

P0131 Factors affecting significant weight loss after concurrent chemoradiotherapy followed by adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

<h3>Background</h3> Chemoradiotherapy is regarded as the definitive treatment of locally advanced nasopharyngeal carcinoma (NPC). Treatment often leads to unintentional weight loss for many reasons such as swallowing dysfunction, mucositis, and cancer cachexia. <h3>Methods</h3> Patients with non-metastatic NPC who underwent chemoradiotherapy between January 2007, and December 2012, were identified through the Ramathibodi Cancer Registry database. Data on patient characteristics, treatment, body weight, and body mass index (BMI) were gathered. Significant weight loss was defined as ⩾10% loss from that before treatment. Factors that affected weight loss after chemoradiotherapy and within 1–3months post-adjuvant chemotherapy were identified. <h3>Findings</h3> 245 patients with NPC were identified. 135 patients were included in this analysis. Median follow-up was 35.6months. Overall, 28% and 39% of patients had significant weight loss after chemoradiotherapy and adjuvant chemotherapy, accordingly. The mean percent weight loss from baseline after chemoradiotherapy and adjuvant chemotherapy was −6.9%±6.0, and −8.5%±8.2, respectively. Baseline BMI ⩾23 was associated with longer overall survival (<i>p</i><0.001). <h3>Interpretation</h3> Approximately a third of patients with NPC had significant weight loss after chemoradiotherapy and further lost weight after completion of adjuvant chemotherapy. Baseline BMI was significantly associated with weight loss after treatments. Early nutritional interventions could improve treatment outcomes.

PWE-195 The enhanced recovery programme does not influence adjuvant chemotherapy rates following major pancreatic and liver resection surgery

Introduction The Enhanced Recovery Programme (ERP) has been shown to improve postoperative complications and reduce hospital stay in patients undergoing major HPB surgical oncological resections. 1 The ERP should allow more patient autonomy in their care and extend beyond the current hospital admission. The benefits of the ERP following hospital discharge are unclear, particularly with regards to adjuvant chemotherapy completion rates. Method A retrospective study was designed looking at the effect of the ERP on adjuvant chemotherapy rates following major pancreatic and liver resections. Patients deemed suitable for curative oncological resection surgery were included in the study. Neo-adjuvant and adjuvant chemotherapy regimens were decided as per the multidisciplinary team decision. Patients in the ERP group who didn’t complete the ERP protocol were analysed in the EPR group on an intention-to-treat basis. Results Between 2005 and 2013, 222 patients (100 liver resections and 122 pancreatic resections; median age 66 years, 1.4:1 male:female ratio) were identified and included in the study, with 142 patients (64.0%) following the ERP protocol. Two-thirds of patients in the ERP group successfully completed the ERP protocol. The ERP did not influence the time to chemotherapy (p = 0.14 pancreas group; p = 0.23 liver group) or successful completion of at least 6 cycles of chemotherapy (0.42 pancreas group; p = 0.06 liver group). Conclusion The ERP has been shown to benefit patients in the immediate postoperative period, with a shorter hospital stay. The results of this study suggest that the benefit of the ERP following hospital discharge is limited and, in particular, does not affect the uptake or successful completion of adjuvant chemotherapy. The effect of the ERP on long-term outcome and cancer-specific survival is, however, still unclear. The ERP following major resection should be further developed to include a stronger community and primary care component to help facilitate care after discharge. Disclosure of interest None Declared. Reference . Jones C, Kelliher L, Dickinson M, et al . Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013July;100(8):1015–1024.

Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer.

Much attention has been paid to preoperative treatment as a new strategy especially for borderline resectable pancreatic cancer (BRPC). The purpose of this study was to define the optimal indication of neoadjuvant chemoradiotherapy (NACRT) for pancreatic cancer. We analyzed consecutive 184 patients who had undergone pancreatic resection in Nara Medical University Hospital. Resectability status was classified by NCCN guidelines. Full-dose gemcitabine with concurrent radiation was used as NACRT. We evaluated 85 patients treated with NACRT in comparison with 99 patients without NACRT as control. The regimen of NACRT was well tolerated and feasible. The perioperative outcomes were almost comparable. The postoperative complications were significantly less frequent in NACRT group than non-NACRT group. The pathological effects on both resectable and borderline tumors were favorable in NACRT group compared to non-NACRT group. The overall survival of resectable pancreatic cancer was significantly better than that of BRPC regardless of whether the patients were treated with or without NACRT. The prognosis of the patients with NACRT in resectable tumors was significantly better than without, while there was no significant difference in BRPC. Furthermore, multivariate analysis of various factors in the patients with NACRT identified resectability status and completion of adjuvant chemotherapy as independent prognostic factors. NACRT did not improve the prognosis of the patients with BRPC, although it induced substantial pathological antitumor effect. In contrast, the prognosis of resectable pancreatic cancer treated with NACRT was favorable. Therefore, resectable pancreatic cancer may be good indication for multimodal treatment including NACRT.

Abstract OT1-2-02: Trastuzumab in HER2-negative early breast cancer as adjuvant treatment for circulating tumor cells (CTCs) (Treat CTC)

Abstract Background: The presence of Circulating Tumor Cells (CTCs) in metastatic breast cancer (BC) is associated with worse clinical outcome. Recent data showed an association between CTC(s) detection and reduced disease-free and overall survival in early disease. Patients with persisting CTC(s) after (neo)adjuvant chemotherapy might benefit from additional systemic treatment. Trastuzumab is a part of the standard of care for patients with HER2-positive BC. Recent data have reinforced the hypothesis that the therapeutic effect of trastuzumab depends on immune-related mechanisms. It has been demonstrated that trastuzumab eliminated CTC(s), irrespective of the HER2 status of the primary tumor and of CTC(s) and this was associated with improved relapse-free survival (Bozionellou et al, Clin Cancer Res 2004, Georgoulias et al Ann Oncol 2012). The Treat CTC trial is designed to explore the effect of trastuzumab in patients with HER2-negative early BC and persisting CTC(s) after (neo)adjuvant chemotherapy and surgery. Trial Design: Treat CTC trial is a multicentre (6 countries, 92 centers) European randomized phase II trial, sponsored by the EORTC and run under the BIG umbrella. It will assess the efficacy of trastuzumab in eliminating persisting CTC(s) after the completion of (neo)adjuvant chemotherapy and surgery in patients with HER2-negative early BC. Eligible patients will be randomized in a 1:1 ratio to either 6 cycles of trastuzumab or observation. Eligibility criteria: - Adequately excised HER2-negative early BC - Evidence of CTC(s) detection using the CellSearch technology after completion of (neo)adjuvant chemotherapy - Completion of adjuvant chemotherapy for node-positive disease or neoadjuvant chemotherapy with residual invasive disease in breast or lymph nodes (no complete pathological response) Specific aims: The primary objective is to evaluate whether trastuzumab decreases the detection rate of CTCs in patients with HER2-negative primary BC by comparing the trastuzumab treated arm to the observation arm. Furthermore, clinical outcomes as measured by Recurrence Free Interval (RFI), Invasive Disease Free Survival (IDFS), Disease Free Survival (DFS) and Overall Survival (OS) between the trastuzumab and observation arms will be compared. Present accrual and target accrual: It is estimated that 2175 women will be registered to include 174 patients eligible for randomization in a 1:1 ratio. Accrual is expected to be completed in 2 years. Treat CTC started patient screening in May 2013 in Belgium, in March 2014 in Germany and in June 2014 in France. An update of the proportion of patients screened versus patients randomized will be presented during SABCS. Methods: The primary test will be a one-sided test to compare the trastuzumab arm to the observation arm for the CTC(s) detection rate at week 18 (superiority test). The comparison for the primary endpoint will be performed on the intention-to-treat population using a one-sided test with overall α of 0.1. The odds ratio and its confidence interval will be estimated using a logistic regression model. The comparison of RFI, IDFS, DFS and OS will be done using a two-sided test in a proportional hazards model for cause specific hazard, adjusted for the stratification factors. Citation Format: Michail Ignatiadis, Carlo Messina, Saskia Litiere, Dimitris Mavroudis, Christian Dittrich, Anthony Kong, Wolfgang Janni, Christos Sotiriou, Martine Piccart, Jean-Yves Pierga, Brigitte Rack. Trastuzumab in HER2-negative early breast cancer as adjuvant treatment for circulating tumor cells (CTCs) (Treat CTC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT1-2-02.

Self-directed physical activity intervention in older adults undergoing adjuvant chemotherapy for colorectal cancer: Design of a randomized controlled trial

BackgroundColorectal cancer (CRC) diagnosis and treatment can have substantial detrimental impacts on health related quality of life (HRQOL) and physical function. This is especially true for older CRC patients and is of paramount concern in chemotherapy treatment decision making; yet, few studies to date have focused on understanding and managing fatigue in older CRC patients. We present the design of a study to evaluate the feasibility and impact of a home-based, self-directed physical activity intervention on fatigue in older CRC patients receiving adjuvant chemotherapy treatment. Secondary aims pertain to intervention impact on HRQOL, physical function, and self-efficacy for managing fatigue. Methods/designMulti-site, randomized controlled trial of physical activity intervention compared to usual care in a sample of older adults undergoing adjuvant chemotherapy for CRC. Forty CRC patients will be recruited and study questionnaires/assessments will be performed at baseline, 3months, and after completion of adjuvant chemotherapy. The primary outcome is a comparison of the change in fatigue from baseline to 3months between Intervention and Control arms. We will also compare changes in engagement in physical activity, HRQOL, physical function, and self-efficacy. Exploratory analyses will compare Intervention and Control arms with regard to changes in muscle mass and a biomarker aging that is known to increase during chemotherapy (p16INK4a). DiscussionIf positive, findings from this pilot study would suggest the potential for improving the care of older persons with CRC undergoing adjuvant chemotherapy through a home-based physical activity intervention to manage fatigue, HRQOL, and physical function.Trial Registration: NCT02191969

Efficacy of intensity-modulated radiotherapy with concurrent carboplatin in nasopharyngeal carcinoma.

Background.The aim of the prospective phase II study was to evaluate the efficacy and toxicities of concurrent carboplatin with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC).Patients and methods.Between October 2005 and November 2011, 73 stage II–IVB NPC patients received IMRT 70 Gy concurrently with three cycles of carboplatin (AUC 5) every three weeks, followed by three cycles of adjuvant carboplatin (AUC 5) and 5-FU (1,000 mg/m2/day for four days) every four weeks. All patients were evaluated for tumour response using response evaluation criteria in solid tumour (RECIST) criteria, survival analysis using Kaplan-Meier methods, and toxicities according to common terminology criteria for adverse events (CTCAE) version 4.0.Results.At three months after chemoradiation, 82.2% and 17.8% of patients achieved complete and partial response, respectively. With a median follow-up of 48.1 months (1.3–97.8 months), 9.6% and 17.8% had local recurrence and distant metastasis, respectively. The median survival was not reached. A three-year overall survival was 83.6% and a progression-free survival was 65.3%. Regarding treatment compliance, 97.2%, 68.5% and 69.8% completed radiation treatment, concurrent carboplatin and adjuvant chemotherapy, respectively. Grade 3–4 acute toxicities were oral mucositis (16.4%), dysphagia (16.4%), xerostomia (15.1%) and haematotoxicity (6.8%).Conclusions.Carboplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. This should be considered as an alternative treatment for NPC patients.

Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Data Base.

To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n = 2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014). For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.

Phase I study of s-1 plus fractional cisplatin as adjuvant chemotherapy for advanced gastric cancer in an outpatient setting (KOGC-03).

157 Background: The aim of this phase I study is to confirm the dose of cisplatin as adjuvant combination chemotherapy with S-1 in gastric cancer patients in an outpatient setting. Methods: The first course was initiated with S-1 monotherapy on days 1-28. From the second to sixth course, S-1 was administered on days 1-28 and cisplatin was added on days 1, 15, and 29. Dose level of cisplatin was escalated as follows: 20 mg/m2 (level 1); 25 mg/m2 (level 2); 30 mg/m2 (level 3). Results: Between Sep. 2010 and Feb. 2014, 13 patients were entered into this study. The median age was 65 years. All patients had a performance status of 0. Final stages were: Stage IIIA, 4; Stage IIIB, 8; and Stage IIIC, 1. The first three patients enrolled at level 1 and none of the three patients experienced Dose-limiting toxicity (DLT). However, one patient at level 2 could not complete administration of cisplatin. Therefore, an additional three patients were entered into level 2. Since these patients did not experience any severe adverse events, level 2 was completed. The first patient enrolled at level 3 had experienced leukocytopenia and elevated bilirubin. These toxicities did not resolve to the level of the starting criteria for the next course within 21 days. In the next patient, the third course could not be started within 21 days because of fatigue and anorexia. Based on these results, the Maximum Tolerated Dose and Recommended Dose were confirmed as level 3 and level 2, respectively. The DLT was &gt;21-day delay of starting the next course. Three patients at level 1 completed combination adjuvant chemotherapy between the second and sixth course based on the protocol. During these treatments, no grade &gt;2 hematological or non-hematological toxicities were experienced. At level 2, two out of six patients completed 5 courses of combination chemotherapy without experiencing severe adverse events. Three out of six patients at level 2 had received 4 courses of combination chemotherapy. Conclusions: Although further clinical trials are recommended to evaluate efficacy, this combination S-1 plus cisplatin regimen is expected to become a standard adjuvant treatment for gastric cancer in the outpatient setting. Clinical trial information: 601995.

Mesenchymal chondrosarcoma: Prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study

BackgroundMesenchymal chondrosarcoma (MCS) is a distinct, very rare sarcoma with little evidence supporting treatment recommendations. Patients and methodsSpecialist centres collaborated to report prognostic factors and outcome for 113 patients. ResultsMedian age was 30years (range: 11–80), male/female ratio 1.1. Primary sites were extremities (40%), trunk (47%) and head and neck (13%), 41 arising primarily in soft tissue. Seventeen patients had metastases at diagnosis. Mean follow-up was 14.9years (range: 1–34), median overall survival (OS) 17years (95% confidence interval (CI): 10.3–28.6). Ninety-five of 96 patients with localised disease underwent surgery, 54 additionally received combination chemotherapy. Sixty-five of 95 patients are alive and 45 progression-free (5 local recurrence, 34 distant metastases, 11 combined). Median progression-free survival (PFS) and OS were 7 (95% CI: 3.03–10.96) and 20 (95% CI: 12.63–27.36) years respectively. Chemotherapy administration in patients with localised disease was associated with reduced risk of recurrence (P=0.046; hazard ratio (HR)=0.482 95% CI: 0.213–0.996) and death (P=0.004; HR=0.445 95% CI: 0.256–0.774). Clear resection margins predicted less frequent local recurrence (2% versus 27%; P=0.002). Primary site and origin did not influence survival. The absence of metastases at diagnosis was associated with a significantly better outcome (P<0.0001). Data on radiotherapy indications, dose and fractionation were insufficiently complete, to allow comment of its impact on outcomes. Median OS for patients with metastases at presentation was 3years (95% CI: 0–4.25). ConclusionsPrognosis in MCS varies considerably. Metastatic disease at diagnosis has the strongest impact on survival. Complete resection and adjuvant chemotherapy should be considered as standard of care for localised disease.

Postoperative Serum Albumin Level is a Marker of Incomplete Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma.

Adjuvant chemotherapy (AC) is recommended as a standard treatment after curative resection in patients with pancreatic adenocarcinoma (PA). Although patients who failed to complete AC had significantly worse survival compared with those who completed AC for cancers in various organs, the effects of complete AC on survival in patients with PA have not been investigated. The purpose of this study was to clarify the impact of complete AC on PA patient survival and to identify independent risk factors for incomplete AC. Medical records of 236 consecutive PA patients who planned to undergo surgical resection with curative intent between January 2000 and September 2012 at Kobe University Hospital were retrospectively reviewed. Of these, the complete AC (n = 75) and the incomplete AC (n = 30) groups due to adverse events were compared. Patient survival was significantly better in the complete AC group than in the incomplete AC group (median survival time 48.9 vs. 17.9 months; 5-year survival rate 42.7 vs. 17.1 %; p < 0.0001). Preoperative white blood cell count and postoperative serum albumin level were identified as independent risk factors for incomplete AC. By receiver operating characteristic curve analysis, the cutoff value of postoperative serum albumin level was 3.1 mg/dL. PA patients who completed AC had significantly better survival than those who failed to complete AC. Postoperative serum albumin level is a marker for failure to complete AC. Further prospective studies are needed to determine whether perioperative nutritional intervention could increase AC completion rate and improve prognosis in PA patients.