Courses Of Adjuvant Chemotherapy Research Articles

Gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor: a case of a rare malignancy

BackgroundA gastric adenosquamous carcinoma (ASC) that produces granulocyte-colony stimulating factor (G-CSF) is an uncommon malignancy with a poor prognosis. Due to the rarity of this lesion, a standard treatment for the disease has not been established.Case presentationWe describe a case of a 66-year-old male with a G-CSF-producing gastric ASC who presented with severe anemia and leukocytosis. A radical resection was performed, followed by a course of adjuvant chemotherapy. Histopathologic examination revealed that the tumor consisted of areas of both squamous cell carcinoma and adenocarcinoma. Immunohistochemical staining with an anti-G-CSF antibody was also positive. He was started on adjuvant capecitabine and oxaliplatin (CapeOX) 6 weeks after surgery. The patient stopped treatment after 3 months due to his own preference. Eight months following surgery, the patient was found to have diffuse lymph node, liver, and peritoneal metastases.ConclusionsG-CSF-producing gastric ASC is a rare and aggressive tumor. Because patients are usually diagnosed at an advanced stage, multidisciplinary evaluation and innovative treatments are needed. The rarity of this disease, with its aggressive features, poses a significant challenge in its treatment. In this brief case report, we summarize the management and outcomes of G-CSF-producing gastric ASC.

Surveillance after resection of pancreatic ductal adenocarcinoma with curative intent - a multicenter survey in Germany and review of the literature.

Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers with high risk of relapse even after curative-intended resection. There are no evidence-based recommendations for surveillance in actual guidelines. Given this situation and as a basis for prospective studies, we wanted to determine the current practice of surveillance after pancreatic cancer resection in German institutions. Methods A web-based questionnaire was sent in 2015 to 300 German institutions (hospitals, outpatient clinics, and private practices) experienced in the care of patients with PDAC. The questionnaire comprised 23 items including the respective institution, the level of care, the annual case load of pancreatic cancer surgery, the surveillance algorithms used, and the most frequently used means for surveillance as well as their evaluation by the users with respect to the effectiveness of these means. Additionally, we perform a review of the literature. Results The final analysis comprised 161 questionnaires (response rate 53.7 %). Mainly high-volume centers (82.5 % with > 300 hospital beds) participated. In 46.6 % of centers, more than 80 % of patients received adjuvant chemotherapy after surgery. Between 60 - 80 % of these patients completed the recommended 6 months of adjuvant treatment, and 47 % of the patients received the whole treatment (surgery, adjuvant therapy) and surveillance in the same center. Upon completion of adjuvant treatment, 96 % of centers survey their patients, and 82 % of these centers already employ diagnostic means during the course of adjuvant chemotherapy. The most commonly used diagnostic means were taking patient history, conducting physical examination, performing laboratory tests including CA19 - 9, and imaging. Of those employed, CA19 - 9 and imaging followed by patient history were considered the most efficient to detect disease relapse by the centers. Half of the institutions perform surveillance for 5 years after surgery. Conclusion This is the first systematic analysis of self-reported surveillance strategies used in Germany after resection of PDAC with curative intent. Surveillance after resection of PDAC with curative intent is common in Germany. Alterations of CA19 - 9 levels as well as imaging and taking patient history are considered the most efficient means to detect relapse of disease by the physicians participating in our survey.

Osteogenic Sarcoma: Systemic Chemotherapy Options for Localized Disease.

Treatment for osteosarcoma, the most common malignant tumor of bone in children and adolescents, has not changed in decades. Treatment is multimodal, employing neoadjuvant chemotherapy followed by aggressive and complete surgical resection to achieve negative margins and a prolonged course of adjuvant chemotherapy. The primary tumor is usually successfully managed via surgery, but micrometastases are likely present in most patients at diagnosis. Death is the result of tumor recurrence in the lungs or more rarely in other bones despite aggressive treatment regimens and is likely attributable to innate resistance to chemotherapy. Better therapies are desperately needed. The three most active agents-high-dose methotrexate, doxorubicin, and cisplatin-commonly referred to as "MAP," form the backbone of therapy. After 2cycles of MAP, surgical resection is performed of all sites of disease if possible. Histologic response following neoadjuvant chemotherapy is prognostic in non-metastatic osteosarcoma, but augmentation of adjuvant therapy for poor responders with additional agents (ifosfamide, etoposide) has not improved outcome. Inclusion of immunotherapy into treatment regimens is promising. Specifically, liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (L-MTP-PE), a macrophage and monocyte activator, improved 10-year overall survival for patients with localized disease, with a similar pattern of response in patients with metastatic disease. L-MTP-PE (mifamurtide) is approved and in widespread use in Europe and elsewhere but has not been approved for use by the Federal Drug Administration in the USA. Identifying novel targeted therapies to improve outcomes for patients with osteosarcoma remains an area of active research.

Abstract P1-01-03: Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial

Abstract Background: The presence of circulating tumor cells (CTCs) before chemotherapy is known to be associated with reduced disease free survival (DFS) and overall survival (OS) in early breast cancer (EBC). In addition, recent findings suggest that CTCs persisting after adjuvant chemotherapy indicate poor prognosis. In an explorative analysis of the SUCCESS A trial, we evaluated the prognostic relevance of changes in CTC counts during the course of adjuvant chemotherapy across molecular subtypes to assess whether the prognostic role of persisting CTCs varies according to tumor biology. Methods: The SUCCESS A trial is a phase III study, where patients with high-risk EBC (stage pN1-3 or pT2-4 or grade 3 or age ≤ 35 or hormone-receptor negative) were randomized to adjuvant chemotherapy with 3 cycles of epirubicin-fluorouracil-cyclophosphamide followed by either 3 cycles of docetaxel or 3 cycles of gemcitabine-docetaxel. CTC enumeration was performed before and after chemotherapy using the FDA-approved CellSearch® System (Janssen Diagnostics, LLC), and CTC positivity was defined as ≥ 1 CTC in 23 ml blood. Molecular subtypes were defined as luminal A like (hormone-receptor positive, grading 1 or 2), luminal B like (hormone-receptor positive, grading 3), triple-negative or HER2-positive. Patient outcome in terms of DFS and OS was analyzed using univariate log-rank tests and Cox regression models (median follow-up time 65.2 months). Results: Data on both molecular subtypes and CTC status before and after chemotherapy were available for 1485 (39.6%) of 3754 patients randomized. This cohort contained 577 (38.9%) luminal A like, 236 (15.9%) luminal B like, 379 (25.5%) HER2-positive and 293 (19.7%) triple negative tumors. Overall, 917 (61.8%) patients were CTC negative before and after chemotherapy (neg/neg), 260 (17.5%) patients had a negative CTC status before and a positive CTC status after chemotherapy (neg/pos), 229 (15.4%) patients converted from positive to negative CTC status (pos/neg), and 79 (5.3%) patients were positive for CTCs at both time points (pos/pos). There were significant differences in DFS and OS among these four groups in patients with luminal A like tumors (log rank test, both p < 0.003) and patients with luminal B like tumors (log rank test, both p < 0.001). In both patients with luminal A like or luminal B like tumors, persistently CTC positive patients had the worst outcome (relative to persistently CTC-negative patients) in terms of DFS and OS. In contrast to luminal-like tumors, no significant differences with regard to DFS or OS were found among the four groups (neg/neg, neg/pos, pos/neg, pos/pos) in patients with HER2-positive or triple-negative tumors (log rank test, all p > 0.13). Conclusion: The presence of CTCs both before and after adjuvant chemotherapy was associated with poor survival in luminal A like and luminal B like tumors, but not in HER2-positive or triple-negative tumors. Further research is needed to evaluate the effect of chemotherapy on CTC prevalence in different molecular subtypes of EBC. Citation Format: Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-03.

P2.02-033 The Role of Surgery for Treating Occult N2 Non-Small Cell Lung Cancer

The presence of mediastinal nodal metastasis is one of the most important factors in the treatment of non-small cell lung cancer (NSCLC). The role of surgical intervention for treating N2 disease is controversial, and two randomized trials failed to show an overall survival benefit. Consequently, the purpose here is to elucidate the needs for surgical intervention of resectable N2 NSCLC. Between April 2010 and May 2016, 316 patients with NSCLC underwent pulmonary resection and mediastinal lymph node dissection. Patients with pathologic N2 were 26. Clinical outcomes and risk factors for pathologic N2 disease were retrospectively analyzed for this cohort. Surgical treatment was performed of 26 pathologic N2 disease patients; there were 18 men and 8 women with a mean age of 68.3 years old (range 55-84). Occult pathologic N2 disease was identified in 22 patients (84.6%). The most common type of resection was lobectomy (96.1%). Adjuvant chemotherapy was administered in 21 patients (80.8%). N2 involvement was single-station in 4 (15.4%) and multiple-station in 22 (84.6%). All patients recovered and were discharged home. There was no operative mortality, and no hospital deaths. The 5-year overall and disease-free survival rates were 58.6% and 33.4%, respectively. The 5-year survival rates of single-station and multiple-station N2 were 50% and 73.2%, respectively (p =0.92). Patients with clinical (expected) N2 disease exhibited better survival outcomes compared with those with occult N2 disease (100% vs 59.8%). The group receiving adjuvant chemotherapy had significantly higher the 5-year survival rates. The 5-year survival rate in patients who received 4 or more cycles of adjuvant chemotherapy was 78.1%, as compared with 0% in non-treated patients (p =0.0008). The 5-year overall and disease-free survival rates of N2 disease tend to improve in recent years. The reasons for improved survival are the increasingly successful treatment options for recurrent disease, including chemotherapy, radiotherapy, and/or molecular targeting drugs. It is common knowledge that therapy of N2 disease needs not only surgery but also chemotherapy. The multiple courses of adjuvant chemotherapy may further improve the outcome in N2 disease. However, patients treated with surgery and chemotherapy had significantly better the 5-year survival rates than patients treated with chemotherapy alone. Though surgery might be very important in that way, the role of surgery for treating N2 disease remains an open question. Because we acknowledge that as a single-institution and retrospective analysis, our sample size was limited. We consider that large-scale, multicenter clinical trials are needed.

A case of Wilms tumour recurrance successfully treatment

Patients’ survival with nephroblastoma improved dramatically with a multimodal treatment. Wilms tumour (WT) relapses occur during 18 months of follow up in a tumour bad or/and in lungs in most cases. Herein we present a case of patient with a late nephroblastoma recurrence locally, in irradiated field, and with metastasis in a right liver lobe. Primary treatment included: urgent surgery (nephrectomy), irradiation of a tumour bad, paraaortic lymph nodes, a left abdominal flank (29–33 Gr); and chemotherapy (vincristine, actinomycin D and adriamycin) according the protocol SIOP WT 2001 recommendations for stage III. A boy was 5 years old when WT was diagnosed. The patient developed relapse 18 months later a primary surgery. A tumour’s volume has been decreased dramatically after 3 courses (ICE – ifosfamide, carboplatin, etoposide) of neoadjuvant chemotherapy. A left retroabdominal mass, a left ureteral stump and a right liver lobe (V, VI, VII) were removed during a surgery followed by 2 courses of adjuvant chemotherapy (ICE). The radiotherapy was avoided because of a primary irradiation. After 18 months of follow up the patient is in a second remission.

Outcome of high grade gliomas–An institutional experience

Objective: In this study we evaluated the prognostic factors, dosimetry and survival outcome of high grade gliomas receiving radiotherapy with concurrent temozolomide and with or without adjuvant temozolomide. Materials and Methods: Eighty patients with high grade gliomas were treated with concurrent chemoradiation post operatively. 27 patients received 3D Conformal Radiotherapy, 25 received Intensity Modulated Radiotherapy and 28 were treated with Rapid arc. Temozolomide 75mg/m2/d seven days a week was given concurrently with radiation (60Gy in 30 fractions) followed by 6 cycles of adjuvant Temozolomide with a dose of 150mg/m2/d for 5 days in every 28 days. Primary end point was overall survival and secondary end point was effect of radiation technique on overall survival and dose to organs at risk. Results: All patients completed concurrent chemoradiation but only 52 patients completed 6 months course of adjuvant chemotherapy. Median age was 52.5 years; The prognostic factors important for overall survival are at least 6 cycles of adjuvant temozolomide (p

599TiP - A randomized phase III trial of capecitabine with or without irinotecan driven by UGT1A1 in neoadjuvant chemoradiation of locally advanced rectal cancer (CinClare)

Irinotecan is an effective drug for rectal cancer. Early small sample size trials have assessed the addition of irinotecan to standard CRT with fluoropyrimidines in neoadjuvant phase of locally advanced rectal cancer, in which pCR rates varied from 13.7 to 37%. ARISTOTLE trial, a multicentre UK-based phase III trial, will complete recruitment in autumn 2016. However, all patients in case group were prescribed with weekly irinotecan dose of 60mg/m2 for four times, regardless of the genetype of UGT1A1, which has been regarded in favor of predicting toxicities. In our previous phase I trial, the weekly dose of irinotecan was escalated to 65mg/m2 and 80mg/m2 guided by UGT1A1*28 6/6 and 6/7 genetypes in neoadjuvant chemoradiation. Therefore, this phase III trial was designed to confirm the potential improvement in outcomes seen with the addition of irinotecan to CRT. Trial design: Eligible patients are randomly allocated to either radiotherapy 50 Gy with concurrent capecitabine, followed by a cycle of capecitabine and oxaliplatin two weeks after the end of CRT (Control arm) or radiotherapy 50 Gy with concurrent capecitabine and irinotecan, followed by a cycle of capecitabine and irinotecan (Case arm). Capecitabine is prescribed with 825mg/m2 twice daily from first day of radiotherapy and given 5 days per week during radiotherapy in control group. In the other group, capecitabine dose is 625mg/m2 twice daily and additional weekly irinotecan dose is 80mg/m2 or 65mg/m2 guided by UGT1A1*28 6/6 or 6/7 genetypes (total of five times). Stratification was performed by center, UGT1A1*28 genetype (6/6, 6/7), T stage (cT3, cT4), and distance from anal verge (<= 5cm, >5cm). Surgery is schedule 8 weeks after the end of CRT, then, five cycles of XELOX are recommended during the course of adjuvant chemotherapy. The primary end point is ypCR. The hypothesis is to increase ypCR from 12% in the control group to 25% in the case group. To detect such a difference, with alpha = 0.05 (two-tailed) and belta = 0.15, 360 randomly assigned patients are required. Secondary end points are toxicities, surgical complications, local control, progression-free survival and overall survival. Clinical trial identification: NCT02605265, released on December 24, 2015 Legal entity responsible for the study: Fudan University Shanghai Cancer Center

Anxiety and depression in patients with advanced ovarian cancer: a prospective study

Introduction: Survival of ovarian cancer patients is still unsatisfactory despite the introduction of new diagnostic and therapeutic methods. Women with advanced ovarian cancer with long-term survival are at persistent risk of anxiety and reactive depression due to poor prognosis and risk of burdensome symptoms. The aim of the study was to assess changes in anxiety and depression during multimodality ovarian cancer treatment and to identify correlates of anxiety and depression.Method: The study included 106 consecutive patients with advanced ovarian cancer. Mean age of the study group was 53.9 years (SD = 10.8, range: 23–79). The participants completed Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory four times: prior to and one week after surgery, and before the second and the fourth course of adjuvant chemotherapy. Multivariate analysis was performed to identify the independent determinants of distress at various stages of treatment.Results: The level of anxiety and the prevalence of pathological anxiety (74%) were the highest prior to surgery and gradually decreased thereafter. Irrespective of the treatment stage, the level of anxiety was higher than the corresponding level of depression. History of abortion, presence of intestinal stoma, poor general status, residual disease and time from the initial diagnosis were the main determinants of distress in ovarian cancer patients.Conclusions: Significant changes in the level of anxiety and slight fluctuations in the depression level experienced during ovarian cancer treatment are mostly determined by clinical variables. Identification of individuals with psychological comorbidities is a vital component of patient-oriented multidisciplinary care.

Perioperative chemotherapy with S-1 plus oxaliplatin (SOX) for stage III colorectal cancer patients.

603 Background: Neoadjuvant chemotherapy (NAC) has a potential to increase the curative resection rate and reduce the recurrence rate. The purpose of this study was to evaluate the safety and efficacy of S-1 plus oxaliplatin (SOX) regimen as neoadjuvant (4 courses) and adjuvant (4 courses) for the treatment of patients with Stage III colorectal cancer (anyT and N+). Methods: We have treated patients with Stage III colorectal cancer undergone operation after NAC (SOX 4 courses) and adjuvant chemotherapy (SOX 4 courses) at Fukuoka University Hospital. SOX regimen (S-1 80 mg/ m2 : day1~14 and oxaliplatin 130 mg/m2 : day1) was administrated every 3 weeks. The primary endpoint was response rate and safety. Results: Of the 21 patients enrolled between September 2012 and December 2014. The median age was 62 years (range, 43–87), and 57% were female. Eastern Cooperative Oncology Group performance status scores were 0, 1, and 2 in 50%, 40%, and 10% of the patients, respectively. The patients received median 4(1-4) courses of NAC and median 4(0-4) courses of adjuvant chemotherapy. The cumulative median dose of oxaliplatin was 1204 (210-1841) mg/body. In NAC, 4 patients required treatment interruption because of the toxicity [grade2 gastrointestinal bleeding (n = 1), grade 3 thrombocytopenia (n = 2), and grade4 ileus (n = 1)]. A complete response according to Response Evaluation Criteria in Solid Tumors ver.1.1 was observed in a patient (4.8%) and a partial response was observed in 15 patients (71.4%) and a stable disease was 5 patients (23.8%). The response rate and tumor control rate were 76.1% and 100%. Curative resection was performed in all patients. No perioperative complications more than grade3 as Clavien Dindo classification was observed in all patients. The observed adverse events of Grade 3 or higher were thrombocytopenia (n = 4), neutropenia (n = 3), diarrhea (n = 1), and ileus (n = 1). Conclusions: Perioperative chemotherapy with SOX is safe and effective. Further studies are warranted to confirm the safety and efficacy of this method. A single-arm phase II trial of perioperative chemotherapy (SOX) and operation for stage III colorectal cancer patients (FUTURE1104 SOS3).

Primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine: A case report and review of the literature.

Myxoid liposarcoma frequently occurs in the deep soft tissue of the extremities, particularly in the thigh. The present study describes an extremely rare case of primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine occurring in a 22-year-old woman. Although preoperative magnetic resonance imaging findings were thought to be compatible with schwannoma, the pathological diagnosis of the resected tumor was myxoid liposarcoma. The patient underwent three courses of adjuvant chemotherapy with doxorubicin and ifosfamide, and exhibited no symptoms or signs of local recurrence or metastasis for 18 months post surgery. The present case suggests that, when radiologically diagnosing spinal epidural tumors, clinicians should consider the possibility of myxoid liposarcoma.

A randomized controlled trial comparing four versus six courses of adjuvant platinum-based chemotherapy in locally advanced cervical cancer patients previously treated with neo-adjuvant chemotherapy plus radical surgery

ObjectivesThe aim of this study was to compare 4 versus 6 courses of adjuvant chemotherapy after neo-adjuvant chemotherapy plus radical surgery in terms of overall survival (OS), disease-free survival (DFS), recurrence rate and toxicity profile. MethodsWe randomly assigned 200 patients with IB2-IIB cervical cancer to receive 4 (Group A) or 6 (Group B) courses of cisplatin 100mg/mq and paclitaxel 175mg/mq every 21days. ResultsAt 4-years follow-up, the comparison of recurrence rate (p=1; RR=1.005; 95% CI=0.87 to 1.161), OS (p=0.906) and DFS (p=0.825) did not show statistically significant differences between the two groups.Data analysis showed statistically significant differences between the two groups in term of episodes of leukopenia (p=0.0072; RR=1.513; 95% CI=1.127–2.03), anemia (p=0.048; RR=1.188; CI=1.012–1.395) and febrile neutropenia (p=0.042; RR=1.119; 95% CI=1.014–1.235), in favor of Group A. As regards non-hematological toxicities, there were no statistically significant differences in terms of gastrointestinal symptoms (p=0.49; RR=1.046; CI=0.948–1.153. On the contrary, there was a statistically significant difference regarding neurological symptoms (p=0.014; RR=1.208; CI=1.046–1.395), that were less frequent in Group A (13%) than in Group B (28%). ConclusionsAdjuvant treatment with 4 or 6 courses of platinum-based chemotherapy showed similar results in terms of OS and DSF, with a favorable toxicity profile in favor of the first regimen.

Abstract P1-11-09: Early discontinuation of adjuvant chemotherapy in women with early stage breast cancer: The BQUAL study

Abstract BACKGROUND Adjuvant chemotherapy for early stage breast cancer decreases recurrence and increases survival. However, early discontinuation of chemotherapy occurs frequently and has a negative influence on patient outcomes. METHODS The Breast Cancer Quality of Care Study (BQUAL) is a prospective cohort study designed to investigate factors associated with early discontinuation of adjuvant chemotherapy among women diagnosed with non-metastatic breast cancer at three sites in the U.S between 2006 and 2010 (Columbia University Medical Center, Kaiser-Permanente of Northern California, Henry Ford Health System). Chemotherapy regimens were classified based on NCCN guidelines. Regimens were further categorized as standard and non-standard/experimental. Early discontinuation for standard treatments was defined as missing 20% of the recommended number of treatments for the prescribed regimen. We used multivariate analysis to examine the association between early discontinuation and sociodemographic factors, tumor characteristics, and baseline psychosocial factors. RESULTS Of 1157 women recruited, 478 patients initiated chemotherapy; 35 women received non-standard/experimental chemotherapy and an additional 17 did not complete all interviews and were excluded from the analysis. Of the remaining 426 patients, 59 (13.9%) did not complete the full course of prescribed chemotherapy. In multivariate analysis, compared to those who completed their full prescribed course of adjuvant chemotherapy, those who discontinued were more often &amp;gt;50 years of age (p=0.04). Early discontinuation of chemotherapy was less likely among Asian women (OR 0.12, 95% CI 0.01-0.96), those who held positive beliefs related to the efficacy of chemotherapy (OR 0.43, 95% CI 0.22-0.81), and those who were more optimistic (OR 0.93, 95% CI 0.86-0.99). Women prescribed chemotherapy regimens that had more cycles (&amp;gt;5 cycles) or contained paclitaxel/docetaxel were significantly more likely (OR 7.54, 95% CI 2.68-21.20 and OR 5.02, 95% CI 1.59-15.83, respectively) to discontinue chemotherapy treatment early than regimens with 6 or less cycles. CONCLUSIONS Women prescribed longer regimens were significantly more likely not to complete the full course. Positive beliefs about the efficacy of treatment were associated with continuation of treatment. Educational interventions focused on the importance of completing therapy may increase chemotherapy adherence. Citation Format: Alfred I Neugut, Grace C Hillyer, Lawrence W Kushi, Lois Lamerato, Jinjoo Shim, Dana H Bovberg, David Nathanson, Christine B Ambrisone, Jeanne S Mandelblatt, Carol Magai, Wei Yann Tsai, Judith S Jacobson, Dawn L Hershman. Early discontinuation of adjuvant chemotherapy in women with early stage breast cancer: The BQUAL study [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 P1-11-09.

Successful delivery after abdominal radical trachelectomy followed by adjuvant chemotherapy for advanced invasive uterine cervical cancer: a case report and literature review

Uterine cervical cancer is increasingly prevalent among young Japanese women who are eager to preserve their fertility, and abdominal radical trachelectomy (ART) is often performed in patients with early-stage invasive lesions. Herein we present details of a 27-year-old woman with stage IB1 cervical cancer. Although the patient received ART, histopathological findings revealed a parametrial invasion. Hence, 3 courses of adjuvant chemotherapy with paclitaxel and carboplatin (TC) were administered, and the patient conceived spontaneously 44months later. Rupture of the membrane occurred at 32weeks and 4days, and a 1822g female baby was delivered by emergency cesarean section. The patient is alive without disease and her child is growing favorably. This case demonstrates the balance between preservation of fertility and curative adjuvant chemotherapy after ART.

Prognostic Factors in Patients with Malignant Pleural Mesothelioma

The aim of the present study was to examine the factors of prognosis in patients with malignant pleural mesothelioma (MPM) after combined and multimodality treatment, including the prognostic significance of preoperative intrapleural perfusion hyperthermo-chemotherapy (IPHC). Material and Methods: The study included 20 patients (11 men and 9 women) aged from 30 to 70 years (mean age 51.9±8.5 years) who underwent surgical treatment for MPM. The diagnosis of MPM was verified by immunohistochemical data. The patients were divided into two groups. Group 1 included 9 patients who underwent combined treatment that included the extrapleural pneumonectomy (EPP) and 4 courses of adjuvant chemotherapy. Group 2 included 11 patients who received multimodality treatment (IPHC, EPP, and 4 courses of adjuvant chemotherapy). All patients were followed prospectively at threemonthly intervals for the first year and six-monthly thereafter until the last time of contact or death. Statistical analysis was performed by using Kaplan-Meier method and the log-rank test. Cox-regression model was used for multivariate analysis. Results: Patient’s age over 60 years and the sarcomatoid type of the tumor can be regarded as prognostic factors for poor survival in patients with MPM who underwent EPP. Application of IPHC as a part of a multimodality treatment enhances the survivability of MPM patients.

Thoracoscopic radical esophagectomy and laparoscopic transhiatal lymph node dissection for superficial esophageal cancer associated with lymph node metastases in the dorsal area of the thoracic aorta.

Esophageal cancer invading the muscularis mucosa sometimes involves regional lymph node metastases. However, lymph node metastases are rare in the dorsal area of the thoracic aorta. We describe a patient with an intramucosal esophageal cancer invading the muscularis mucosa, accompanied by lymph node metastases in the dorsal area of the thoracic aorta. These lesions were successfully resected by hand-assisted laparoscopic surgery using a transhiatal approach. A 60-year-old man was diagnosed with superficial esophageal cancer during a routine health examination. Endoscopic examination and ultrasonography revealed a superficial cancer, of diameter 6.0 cm, invading the submucosal layer and intramural metastases caudal to the primary tumor. Enhanced computed tomography and F-deoxyglucose positron emission tomography demonstrated the two metastatic lymph nodes, one in the dorsal area of the thoracic aorta and the other near the left gastric artery. Thoracoscopic radical esophagectomy with three-field lymph node dissection was performed. The metastatic lymph node in the dorsal area of the thoracic aorta was successfully removed by hand-assisted laparoscopic surgery using a transhiatal approach. Histopathological examination showed primary cancer invading the muscularis mucosa and intramural metastases in the lamina propria mucosa and submucosal layer. The pathological diagnosis according to the Japanese classification of esophageal cancer was MtLt, 47 mm, 0-IIa + IIb, pT1a-MM, ie(+), INF-b, ly3, v0, pN4(4a), pIM1, M0, and pstage IVa. The patient underwent two courses of adjuvant chemotherapy, consisting of CDDP and 5-fluorouracil. At present, 1 year and 8 months after surgery, the patient remains alive without tumor recurrence. Although the lymph node in the dorsal area of the thoracic aorta is not recognized as regional nodes of thoracic esophageal cancer, solitary mediastinal metastases from a mucosal cancer may indicate the existence of direct lymphatic flow from the thoracic esophagus to the retroaortic region. Transhiatal approach by hand-assisted laparoscopic surgery is useful to dissect the metastatic lymph node in the dorsal area of the thoracic aorta.

Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre

BackgroundRetinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk...

Early vs. Late Chemoradiation Therapy and the Postoperative Interval to Adjuvant Therapy Do Not Correspond to Local Recurrence in Resected Pancreatic Cancer.

ObjectiveStandard postoperative therapy for pancreatic cancer consists of both chemotherapy alone and chemoradiation. We sought to investigate whether the sequence of chemotherapy and chemoradiation and overall time to initiation of adjuvant therapy would impact local vs. distant recurrence.MethodsAfter Institutional Review Board approval, resected pancreas cancer patient charts were evaluated for medical background, surgical, pathological, chemoradiation (CRT), and follow-up. Local recurrence (LR) was defined as failures occurring in the postoperative bed and regional lymph nodes. Early vs. late CRT was defined by whether CRT was given early (within 1–2 cycles of adjuvant chemotherapy) or late in the course of adjuvant chemotherapy (after the 3rd cycle of chemotherapy). The postoperative interval variance was compared to LR factors such as progression-free survival (PFS) and overall survival (OS).ResultsOf the 34 eligible patients, 47% (n=16) underwent early CRT and 41% (n=14) underwent late CRT. 12% (n=14) did not undergo any induction chemotherapy. At median follow-up of 22 months, 53% (n=18) had metastases, 24% (n=8) had LR, and 24% (n=8) were disease free. Kaplan-Meier curves revealed that early vs. late CRT did not appear to significantly impact OS (p=0.63), PFS (p=0.085) or LR (p=0.19). Postoperative interval did not affect PFS (p=0.42) or OS (p=0.93).ConclusionsEarly vs. late CRT and the time to initiation of adjuvant therapy were not significantly associated with LR in patients with resected pancreatic cancer. Future prospective studies are required to determine if sequencing of chemotherapy, CRT, or the postoperative interval impact survival and patterns of recurrence.

Cytomegalovirus-associated ulceration of gastric conduit after chemoradiotherapy following esophagectomy for cancer.

A 64-year-old man underwent radical esophagectomy for cancer and simultaneous reconstruction using the gastric conduit through the posterior mediastinum. Two courses of adjuvant chemotherapy were performed. Twenty-eight months postoperatively, recurrence of the cancer was detected in the mediastinal lymph nodes, and he underwent concurrent chemoradiotherapy and boost chemotherapy. Endoscopy was then performed to investigate the cause of epigastralgia, and multiple ulcerations were found in the lesser curvature of the gastric conduit. Although a proton-pump inhibitor was orally administered, the ulceration was intractable. Re-examination of the original biopsy specimens and serological testing revealed positivity for cytomegalovirus. The ulcers began to heal after administration of foscarnet sodium. After the treatment, no signs of exacerbation associated with reinstitution of chemotherapy were observed.

792 Radical cystectomy with or without shortened course of adjuvant chemotherapy in high risk muscle-invasive bladder cancer: Results of a single centre prospective randomized trial

792 Radical cystectomy with or without shortened course of adjuvant chemotherapy in high risk muscle-invasive bladder cancer: Results of a single centre prospective randomized trial