Concomitant Adjuvant Chemotherapy Research Articles

NUT Carcinoma in Children and Adolescents: The Expert European Standard Clinical Practice Harmonized Recommendations.

Nuclear protein of the testis ( NUT ) carcinoma (NC) is a rare and highly aggressive tumor mainly occurring in adolescents and young adults, defined by the presence of a somatic NUTM1 rearrangement. The aim is to establish internationally harmonized consensus recommendations for the diagnosis and treatment of adolescents and young adults with NC in the framework of the European Reference Network for Paediatric Oncology. The European Cooperative Study Group for Pediatric Rare Tumors developed recommendations according to the Consensus Conference Standard Operating procedure methodology and reviewed by external "experts." No evidence of level I to II exists. Recommendations were developed based on published prospective (level III), but more frequently retrospective series (level IV), case reports (level V), and personal expertise (level V). In addition, "strength" of recommendations were categorized by grading (grade A to E). Histology is mandatory for the diagnosis of NC, including immunolabeling with anti-NUT antibodies and molecular biology ( NUTM1 rearrangement) (level V; grade A). Treatment of NC usually combines aggressive approaches in multimodal regimens. Chemotherapy should be considered as first-line treatment (neoadjuvant vincristine-adriamycin-ifosfamide/cisplatin-adriamycin-ifsofamide or vincristine-doxorubicin-cyclophosphamide/ifosfamide-etoposide) for unresectable or metastatic tumor (ie, 3 courses), rapidly followed by local treatment (level IV; grade B). Referral to a specialized surgical oncology center is highly recommended (level V; grade A). In localized NC, a complete microscopic surgical resection should be attempted whenever and as soon as possible, followed by primary irradiation (60 to 70Gy) and involved lymph nodes area (level IV; grade B). For head and neck tumors, a systematic neck dissection might be considered, even if N0 (level V; grade C). Adjuvant postirradiation chemotherapy is recommended, for a total of 9 to 12 courses (level IV; grade B). For first-line resected tumors, concomitant adjuvant chemotherapy to radiotherapy may be discussed (level IV; grade B). Targeted therapies and immunotherapeutic regimens should be delivered in the setting of prospective trials (level V; grade B). This project leads to a consensus strategy based on international experience with this very rare disease.

Adjuvant intra-arterial chemotherapy for patients with resected colorectal liver metastases: a systematic review and meta-analysis.

The practice of adjuvant hepatic arterial infusion chemotherapy (HAIC) for colorectal liver metastasis (CRLM) varies widely. This meta-analysis investigates the effectiveness of adjuvant HAIC and the influence of variations in HAIC treatment in patients with resected CRLM. PRISMA guidelines were followed for this study. The search was limited to comparative studies (HAIC vs non-HAIC) for overall survival. Subgroup meta-analyses using random-effects were performed for type of intra-arterial drug, method of catheter insertion, use of concomitant adjuvant systemic chemotherapy, and study design. Eighteen eligible studies were identified. After excluding overlapping cohorts, fifteen studies were included in the quantitative analysis, corresponding to 3584 patients. HAIC was associated with an improved overall survival (pooled hazard ratio (HR) 0.77; 95%CI 0.64-0.93). Survival benefit of HAIC was most pronounced in studies using floxuridine (HR 0.76; 95%CI: 0.62-0.94), surgical catheter insertion with subcutaneous pump (HR 0.71; 95%CI: 0.61-0.84), and concomitant adjuvant systemic chemotherapy (HR 0.75; 95%CI: 0.59-0.96). The pooled HR of RCTs was 0.91 (95%CI 0.72-1.14), of which only 3 used floxuridine. Adjuvant HAIC is a promising treatment for patients with resectable CRLM, in particular HAIC with floxuridine using a surgically placed catheter and a subcutaneous pump, and concomitant systemic chemotherapy.

Abstract LB064: Long-term application of TTFields in anaplastic astrocytoma - a case study

Abstract Background: Anaplastic astrocytomas WHO III° (AA) represent diffusely infiltrating, high grade gliomas (HGG). Despite advancements in the molecular characterization of HGG treatment options are limited and are often in analogy to grade IV glioblastoma treatment. Tumor Treating Fields therapy (TTF) is an established modality for newly diagnosed and recurrent glioblastoma (GBM) shown to significantly improve progression-free and overall survival. While TTF is under investigation in grade III gliomas in several clinical trials, we present an exemplary case of an AA undergoing mid-term TTF therapy and adjuvant chemotherapy to explore treatment adherence, feasibility and safety. Methods: We present case details of a patient from our specialized neurosurgical oncology center, with an anaplastic astrocytoma (WHO grade III) who began TTF treatment at first diagnosis while being in the adjuvant chemotherapy phase at the time of TTF commencement. We describe treatment details and the course of disease under continuous and ongoing TTF therapy. Results: In December 2016 a 43year-old male patient was diagnosed with an anaplastic astrocytomaIDH 1/2 mutant, MGMT promoter-hypermethylation without 1p/19q codeletion. After biopsy and consequent partial tumor resection, he received concomitant radiochemotherapy and adjuvant chemotherapy with temozolomide. TTF was started six months after initial diagnosis. He has now completed 1328 days of treatment with an average daily usage of 90% and has survived 48 months from first diagnosis (cutoff January, 8th, 2021). Since beginning TTF, he has undergone temozolomide treatment for 6 cycles. He continues TTF without further adjuvant therapy. The patient is symptomatically stable and his quality of life is maintained. Significant adverse events or longer treatment interruptions have not occurred. Conclusion: The treatment with TTFields was well tolerated and seems to be feasible in this patient with an anaplastic astrocytoma. Considering the long treatment duration and favorable average daily usage, this treatment might be suitable for a long-term treatment in high grade gliomas. Ongoing clinical trials will provide more information on safety and efficacy for the use of TTFields in patients with grade III gliomas. Citation Format: Darko Markovic. Long-term application of TTFields in anaplastic astrocytoma - a case study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB064.

UNUSUAL CASE OF MALE BREAST CANCER: A CLINICAL REPORT

A 56-year-old man started oncologic treatment in 2010 for right side breast cancer, having been submitted to radical mastectomy plus axillary emptying and concomitant adjuvant chemotherapy. Infusion of zoledronic acid was used to minimize the risk of bone metastases. In 2017, pulmonary and cerebral metastases were identified with concomitant persistent wound in the posterior edentulous residual border of the mandible. Expansion of a bone necrosis area in the jaw body was observed (right side; diagnostic hypothesis: bisphosphonate-induced osteonecrosis). Then, pharmacologic treatment was applied. Submandibular abscess (right side) with tongue projection and difficulty maintaining airway permeability were observed in 2019. Abscess drainage and complete removal of the necrotic bone fragment were performed. Histopathologic analysis of bone material and associated soft tissue indicated mouth squamous cell carcinoma. Oncologic treatment for pulmonary and cerebral metastases has not been modified by this new carcinoma, and the patient is being monitored.

Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma: A Multicenter Study

We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P=.001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P=.032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P=.038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P=.786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P=.436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P=.458) in pT3b UTUC. Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

Pre- and post-surgery treatments in rectal cancer: a long-term single-centre experience.

Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. The study included 196 patients [median age: 58 years (range: 20-86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined. The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p = 0.013 and p = 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45-46 Gy, both p = 0.002), and concomitant ctx use (p = 0.004 and p = 0.001) and type (5-fluorouracil-leucovorin-folinic acid vs. tegafur-folinic acid, p = 0.034 and p = 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better 5-year os rates for postoperative T0-T3 disease (p = 0.003) and disease at all lymph node stages (p = 0.001). Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil-based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival.

PO50AN AUDIT OF THE USE OF POST-OPERATIVE IMAGING FOLLOWING GLIOMA RESECTION

INTRODUCTION: Gliomas are by far the most common type of primary brain tumour in adults. High grade gliomas are often managed surgically, with maximal debulking, followed by concomitant chemo-radiotherapy and adjuvant chemotherapy. There is increasing evidence that maximal surgical debulking confers a survival advantage. After surgical debulking, early post-operative MRI scanning is an accurate means by which to assess the extent of residual tumour and may highlight the need to perform second-look surgery prior to oncology treatment. Local protocol implemented at Salford Royal Foundation Trust proposes that all patients should be scanned within 24 to 72 hours subsequent to intended gross macroscopic removal of glioma. METHOD: We performed a retrospective audit of 100 consecutive patients undergoing glioma debulking surgery in 2012/3. The attempted degree of glioma resection, time interval from surgery to scan, and MRI scan reports were assessed. The number of patients returning to theatre for further debulking surgery following attempted total resection was recorded. RESULTS: 47% of patients had an MRI scan within 72 hours following attempted total resection. Of these, 9% returned to theatre for subsequent debulking prior to chemo-radiotherapy. CONCLUSION: A significant proportion of patients having early post-operative imaging are returning to theatre for second surgeries to complete maximal tumour resection. Reasons for second surgery are discussed. Patients not having early post-operative imaging may be missing an opportunity for maximal surgical debulking prior to oncological treatment. A significant rate of return to theatre for second surgery may indicate the need for an intra-operative MRI scanner.

Comparison of vaginal brachytherapy versus whole pelvic radiation therapy versus either with concomitant adjuvant chemotherapy for post-operative therapy of FIGO stage I uterine papillary serous carcinoma

Comparison of vaginal brachytherapy versus whole pelvic radiation therapy versus either with concomitant adjuvant chemotherapy for post-operative therapy of FIGO stage I uterine papillary serous carcinoma

Post-operative radiotherapy in patients with early stage cervical cancer

ObjectiveThe aim of this study is to investigate the impact of treatment policy changes in cervical cancer patients treated with adjuvant (chemo) radiotherapy. MethodsBetween 1970 and 2007, 292 patients received adjuvant radiotherapy after a radical hysterectomy with pelvic lymphadenectomy for early stage cervical carcinoma. All patients received pelvic radiotherapy (40Gy–46Gy in 1.8Gy–2Gy/fraction). Vaginal vault brachytherapy boost (10–14Gy) was increasingly used for patients with high-risk factors, and since 1993 systematically applied in patients with at least 2 of the 3 risk factors: adenocarcinoma, nodal involvement and parametrial invasion. Cisplatin-based chemotherapy was introduced in this group of patients from 2000. ResultsThe 5-year cumulative risk of local recurrence (CRLR) was 13% (95%CI 9%–17%), resulting in an overall 5-year survival (OS) of 78% (95%CI 83%–73%). Since 1970, the OR for the 5-year locoregional recurrence risk (LRR) decreased from 2.5 to 1.15 (linear-OR=−0.02/year). The OR for the 5-year mortality risk reduced from 2.2 in 1970 to 1.0 in 2007 (linear-OR=−0.03/year). The largest risk reductions were observed before 1990 with a minor rise after 2002. The risk of severe late toxicity reduced from 1.8% to 1.5% (linear-OR=−0.03/year). The addition of concomitant adjuvant chemotherapy since 2000 may have benefited a subgroup of patients with squamous cell carcinoma, but not the patients with adenocarcinoma, and after introduction of chemotherapy the risk of severe late toxicity tripled from 2% to 7%. ConclusionSince 1970, tumour recurrence risk and mortality have decreased, as radiation dose increased. The potential benefit of concomitant adjuvant chemotherapy could not be demonstrated in this nonrandomized study.

Could Metabolic Therapy Become a Viable Alternative to the Standard of Care for Managing Glioblastoma?

Little progress has been made in the long-term management of glioblastoma multiforme (GBM) for more than 40 years. The current standard of care (SOC) for GBM involves radiotherapy with concomitant adjuvant temozolomide chemotherapy. Perioperative corticosteroids are also administered to the majority of GBM patients. The current standard treatment strategy for GBM increases availability of glucose (from steroids) and glutamine (from radio-necrosis) in the tumor microenvironment. Emerging evidence indicates that GBM, like most cancers, is a metabolic disease displaying a robust Warburg effect. It is well documented that glucose and glutamine are major metabolic fuels that drive tumor progression. Recent evidence suggests that neoplastic cells with macrophage/microglia properties can contribute to the most invasive cell subpopulation within GBM. Glucose and glutamine are major fuels for myeloid cells as well as for the more rapidly proliferating cancer cells. Metabolic therapy exploits the biological differences between tumor cells and normal cells for the non-toxic targeting of the tumor cells. Studies in preclinical models show that calorie restricted ketogenic diets (KD-R), anti-glycolytic drugs, and hyperbaric oxygen therapy can reduce availability of glucose and glutamine in the tumor microenvironment while enhancing oxidative stress in tumor cells. The predominant ketone body (b-hydroxybutyrate) reduces oxidative stress in normal brain cells. The potential success of metabolic therapy was also seen in human glioma case studies suggesting that this therapeutic strategy could become a viable alternative to the SOC.

Could Metabolic Therapy Become a Viable Alternative to the Standard of Care for Managing Glioblastoma?

Little progress has been made in the long-term management of glioblastoma multiforme (GBM) for more than 40 years. The current standard of care (SOC) for GBM involves radiotherapy with concomitant adjuvant temozolomide chemotherapy. Perioperative corticosteroids are also administered to the majority of GBM patients. The current standard treatment strategy for GBM increases availability of glucose (from steroids) and glutamine (from radio-necrosis) in the tumor microenvironment. Emerging evidence indicates that GBM, like most cancers, is a metabolic disease displaying a robust Warburg effect. It is well documented that glucose and glutamine are major metabolic fuels that drive tumor progression. Recent evidence suggests that neoplastic cells with macrophage/microglia properties can contribute to the most invasive cell subpopulation within GBM. Glucose and glutamine are major fuels for myeloid cells as well as for the more rapidly proliferating cancer cells. Metabolic therapy exploits the biological differences between tumor cells and normal cells for the non-toxic targeting of the tumor cells. Studies in preclinical models show that calorie restricted ketogenic diets (KD-R), anti-glycolytic drugs, and hyperbaric oxygen therapy can reduce availability of glucose and glutamine in the tumor microenvironment while enhancing oxidative stress in tumor cells. The predominant ketone body (β-hydroxybutyrate) reduces oxidative stress in normal brain cells. The potential success of metabolic therapy was also seen in human glioma case studies suggesting that this therapeutic strategy could become a viable alternative to the SOC.

Prognostic value of SPINK1 expression in bladder cancer after radical cystectomy.

274 Background: Serine peptidase inhibitor Kazal type 1 (SPINK1) overexpression has been associated with poor outcomes. In one small study, loss of SPINK1 expression in urothelial carcinoma of the bladder (UCB) was associated with advanced tumor stage. We assessed the expression of SPINK1 in normal urothelium and UCB and analysed the association of SPINK1 with pathological features and clinical outcomes of patients treated with radical cystectomy (RC). Methods: The study used TMAs containing samples from 438 consecutive UCB patients treated with RC. 62 cases of normal urothelium were included as controls. A monoclonal antibody was used for immunohistochemical SPINK1 staining. SPINK1 expression of UCB was evaluated by two pathologists, blind to clinical outcome. Samples demonstrating less than 50% staining extent and 0 to 1 intensity (scale 0 to 3), were considered to have loss of expression. Results: SPINK1 expression was noted in umbrella cells of normal urothelium in 32/62 controls (52%). UCB of 254 patients (57.9%) exhibited loss of SPINK1 expression. Loss of SPINK1 expression was significantly associated with advanced pathological stage (p=0.002) and presence of lymph node (LN) metastasis (p=0.04). Within a median follow-up of 130 month (IQR 98.4), loss of SPINK1 expression was associated with an increased risk of disease recurrence (5-year RFS: 52±3 vs. 61±4 months; p=0.02) and cancer-specific mortality (5-year CSS: 59±3 vs. 68±3 months; p=0.03). In multivariable Cox regression analyses that adjusted for the effects of age, gender, tumor stage and grade, concomitant CIS, LN status and adjuvant chemotherapy, SPINK1 was not associated with disease recurrence (p=0.09) or cancer-specific death (p=0.12). Conclusions: While umbrella cells in normal urothelium commonly expresses SPINK1, more than half of UCB specimen exhibit loss of SPINK1 expression. Loss of SPINK1 expression is strongly correlated with local disease stage and LN metastasis. SPINK1 revealed no independent prognostic value for outcome prognostication, but it is a very promising marker for tumor staging which could be used for tailored follow-up protocols and possibly as a target for therapy as it has similarities with epidermal growth factor.

Cosmetic outcome of breast conservative treatment for early stage breast cancer

To evaluate the cosmetic outcome of breast conservative therapy and to examine the degree of agreement between the patients' and oncologists' ratings. We also analyze the influence of several factors on cosmesis. We retrospectively evaluated 145 patients with primary breast cancer treated by local excision and radiotherapy between January 2000 and May 2001. Cosmetic outcome was evaluated by doctors and patients and was scored as excellent, good, fair or poor. 73% of patients rated cosmesis as excellent or good while the percentage was 71% when rated by radiation oncologists. The degree of cosmesis concordance evaluated by oncologists and patients was low (kappa = 0.3). In our study the variables which significantly influence on the cosmetic outcome were concomitant adjuvant chemotherapy (p = 0.04) and radiation therapy boost, either by electron beam or brachytherapy (p = 0.013). The cosmetic outcome of breast conserving therapy was good. There was a similar rating by the patient and radiation oncologist, but the level of concordance between patients and doctors was low. Factors that significantly influence the cosmesis appear to be concomitant adjuvant chemotherapy and radiation therapy boost.

Phase II study assessing the effectiveness of Biafine cream as a prophylactic agent for radiation-induced acute skin toxicity to the breast in women undergoing radiotherapy with concomitant CMF chemotherapy

Purpose: To assess the efficacy of Biafine cream in preventing Grade 2 acute radiation dermatitis, according to the National Cancer Institute of Canada skin radiation toxicity criteria in patients undergoing concomitant adjuvant chemotherapy and radiotherapy to the breast. Methods and Materials: Sixty patients participated in this study. Patients were treated with a lumpectomy followed by concomitant chemotherapy and radiotherapy to the breast. Biafine cream was applied daily, starting on the first day and ending 2 weeks post-radiotherapy. Patients underwent weekly skin assessments throughout radiotherapy and at 2 and 4 weeks after treatment. Outcome measures were assessed using a Skin Assessment Questionnaire that was scored according to the National Cancer Institute of Canada skin radiation toxicity criteria and a self-administered questionnaire that evaluated skin symptoms. Results: The maximum skin toxicity observed during the course of treatment was as follows: less than Grade 2 toxicity, 15% (9 patients); Grade 2, 83% (50 patients); Grade 3, 2% (1 patient); Grade 4, 0% (0 patients). The majority of the radiation dermatitis was observed after 3 weeks of radiotherapy. Conclusion: The majority of patients who underwent concomitant chemo- and radiotherapy for breast cancer developed Grade 2 radiation dermatitis with the use of Biafine cream. However, no treatment delays or interruptions were observed because of skin toxicity.

Does concomitant chemoradiotherapy influence cosmetic outcome in conservative treatment of breast cancer?

To evaluate retrospectively factors influencing the cosmetic outcome after conservative treatment for breast cancer. From 1988 until 1992, 164 patients were treated with conservative surgery (quadrantectomy) and radiotherapy with 60Co (50 Gy on the whole breast) plus 10 Gy on the surgical bed (300 kV photons) for T1-T2 breast cancers; 46 patients (28%) received concomitant adjuvant chemotherapy (CMF schedule). Cosmesis evaluation was carried out after 24 to 108 months (median, 38 months). A logistic regression analysis was performed to identify independent variables influencing the aesthetic outcome. P values of 0.05 or less were considered significant. Univariate analysis showed that T2 versus T1 (P = 0.0102), lower quadrants site (P = 0.0002) and concomitant adjuvant chemotherapy (P = 0.0009) produced a worse aesthetic outcome. Multivariate analysis confirmed the same factors: tumor size (P = 0.0020), tumor site (P = 0.0150) and concomitant chemotherapy (P = 0.0024). The significant negative influence on the cosmetic outcome of concomitant adjuvant chemotherapy implies questions about the timing of radiotherapy and chemotherapy in breast cancer conservative treatment.

73 Post-operative radiotherapy and concomitant adjuvant chemotherapy for breast carcinoma

Between May 1992 and December 1993, 72 patients operated for breast carcinoma underwent radiotherapy (RT) and concomitant adjuvant chemotherapy (CT). There were 2 T0, 23 T1, 47 T2 and 1 T4b. Lymph node status was 59 N0, 10 N1 and 4 unknown. Surgical treatment was lumpectomy (59) or mastectomy (13) and axillary dissection for all. Radiation therapy delivered 50 Gy in 5 weeks to the breast or chest wall. A 10 Gy boost was added to the tumor site after lympectomy. The internal mammary chain was irradiated in 64 patients, the subclavicular area in 53 and the axilla in I patient. The CT regimen was a combination of Mitoxantrone (12mg/m²), 5-FU (500 mg/m²) and Cyclophosphamide (500 mg/m²), 6 cycles were delivered with 21 days interval. Compliance to RT evaluated on dose and treatment length was good for 88%. On the 65 patients analysed for CT: 98% received all 6 cycles at the prescribed dose, but 69% strictly respected intercycle intervals. Mild digestive and cutaneous toxicity (grade 1 and 2) was observed in 50%. Major toxicity was neutropenia (grade 2 or 3) in 18 patients and 1 severe infection. The 3 year actuarial survival rate was 87%. No local relapse was observed Metastases occurred in 6 patients. These preliminary results show that this concomitant association is safe although compliance to chemotherapy should be improved.

74 Concomitant adjuvant chemotherapy (FNC regimen) and radiotherapy in operable stage II breast cancer (O.B.C.)

The purpose of multimodality treatment including simultaneous radiochemotherapy is to reduce the total length of the adjuvant treatment after surgery. Aims of study were to evaluate the compliance, global toxicity and local cutaneous side effect. The treatment scheme is F.N.C (F: Flourouracil 500mg/m², N: Mitoxantrone 12mg/m², C: Cyclophosphamide: 500mg/m²) every 21 days. Six cycles for N+, 4 cycles for N− with poor prognosis (RH- or SBR III). Radiotherpy is indicated by the consensus of the "Societe Francaise de Radiotherapie Oncologique" S.F.R.O. (50 Gy/25 fractions/5 weeks, 15 Gy overdose when T>10 mm). We report a feasibility study in 154 pts with O.B.C. included from May 90 to October 95 Median age: 49, 5 y (29–72), postmenopausal: 46.8%; premenopausal: 52.6%; Performance Status O: 96.7%, 1: 2%, unknown: 1.3%, Radical surgery: 29.9% conservative: 69.5%, N−: 29.9%; N+: 70.1%. Ductal carcinoma: 85.7%, lobular: 5.8%, SBR I: 2.6%, SBR II: 26.6%, SBR III: 65.6%. Total number of courses was 773 (60.4% of pts received 6 courses). Full dose of N was administered to 84.4% of pts, F to 90.3%, C to 88.3%. Interval between 2 cycles was 21 days in 30.9% pts, 28 days in 45.4% pts, upper than 28 days in 23.7% pts. Median total radiotherapy dose was 50 Gy. Main toxicities observed (per pts) were: gastrointestinal grade 3–4: 4.6%, dysphagia: 27.9%, leucopenia grade 3–4: 12.3%, anemia grade 2: 2%, thrombocytopenia grade 2: 1 pt. A reversible cardiotoxicity occurred in 15 pts including extrasystole: 1 pts, low blood pressure: 2 pts, pericarditis 3 pts. Local toxicity was mild (grade≤1: 62.3%, grade 2: 16.9% and grade 3: 4.5%). No major pulmonary toxicity was observed. Quality of life (E.C.O.G scale) was performed to evaluate the repercussion of this treatment grade 0: 44.2%, grade 1: 34.4%, grade 2: 7.8% and grade 3 in 1 pt. Well acceptability of treatment in 51.9% of pts. Mitoxantrone containing chemotherapy and postoperative radiotherapy can thus be combined in an adjuvant treatment program with good compliance and acceptable toxicity. Ongoing or further study of a large patients groups comparing various strategies of chemotherapy and radiation sequencing will be needed to confirm our data.

Concomitant adjuvant chemotherapy with FNC regimen and radiotherapy for stage II breast carcinoma: A feasibility study

Concomitant adjuvant chemotherapy with FNC regimen and radiotherapy for stage II breast carcinoma: A feasibility study

Concomitant adjuvant chemotherapy and radiotherapy for high risk breast cancer patients

Thirty four patients treated with mastectomy and axillary node dissection for potentially curable breast cancer received a seven month combined adjuvant chemotherapy and radiation therapy program. These patients were considered to be at high risk for recurrence because they had either three or more positive axillary lymph nodes or their primary tumor was greater than 5 cm in diameter. The chemotherapy given at 3-week intervals consisted of cyclophosphamide, 600 mg/m2, Adriamycin 40 mg/m2, and methotrexate 40 mg/m2 during cycles 1 through 3 and 7 through 9. Radiation therapy was administered during cycles 4 through 6 with concomitant administration of 5-fluorouracil 600 mg/m2, vincristine 1.4 mg/m2, and prednisone 40 mg/m2 for 7 days. Median follow up time from initiation of study is 60 months (range 36-93). Seventeen of 34 patients (50%) remain free of recurrent breast cancer. Distant metastases and local-regional recurrence have occurred in 16 (47%) and 4 (12%) patients, respectively. Significant myelosuppression and infections requiring hospitalization were seen in 4 patients, with 1 treatment-related death. Adriamycin-containing chemotherapy and post-operative radiotherapy can thus be combined in an adjuvant treatment program with acceptable toxicity.

Irradiation and Breast Cancer

CA: A Cancer Journal for CliniciansVolume 39, Issue 2 p. 123-124 LetterFree Access Irradiation and breast cancer: To the editor Roy E. Abendroth MD, Roy E. Abendroth MD Los Angeles, CaliforniaSearch for more papers by this author Roy E. Abendroth MD, Roy E. Abendroth MD Los Angeles, CaliforniaSearch for more papers by this author First published: March/April 1989 https://doi.org/10.3322/canjclin.39.2.123AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Holmberg L, Zarén E, Adami H-O, et al: The patient's appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease. Ann Surg 207: 189– 194, 1988. 2 Borger JH, Keijser AH: Conservative breast cancer treatment: Analysis of cosmetic results and the role of concomitant adjuvant chemotherapy. Int J Radiat Oncol Biol Phys 13: 1173– 1177, 1987. 3 Delouche G, Bachelot F, Premont M, Kurtz JM: Conservation treatment of early breast cancer: Long term results and complications. Int J Radiat Oncol Biol Phys 13: 29– 34, 1987. 4 Baclesse F: Roentgentherapy alone in the cancer of the breast. Acta Un Int Cancr 15: 1023– 1026, 1959. 5 Veronesi U, Banfi A, Del Vecchio M, et al: Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: Long-term results. Eur J Cancer Clin Oncol 22: 1085– 1089, 1986. 6 Veronesi U, Zucali R, Luini A: Local control and survival in early breast cancer: The Milan trial. Int J Radiat Oncol Biol Phys 12: 717– 720, 1986. 7 Fisher B, Bauer M, Margolese R, et al: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312: 665– 673, 1985. 8 Fisher B, Redmond C, Fisher ER, et al: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312: 674– 681, 1985. 9 Zucali R, Luini A, Del Vecchio M, et al: Contralateral breast cancer after limited surgery plus radiotherapy of early mammary tumors. Eur J Surg Oncol 13: 413– 417, 1987. Volume39, Issue2March/April 1989Pages 123-124 ReferencesRelatedInformation