Preoperative Concomitant Chemoradiotherapy Research Articles

Sphincter Saving Surgery in Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiotherapy

AbstractAim: To evaluate the feasibility of sphincter saving surgery in locally advanced low rectal cancer after neoadjuvant concomitant chemoradiotherapy (CCRT) by assessing the effect of CCRT on downstaging of primary tumor, hence sphincter preservation rate and outcome.Patients and Methods: Patients presenting to the National Cancer Institute-Cairo University from May 2014 to October 2014; with locally advanced low (3-6m from the anal verge) rectal cancer received long-course CCRT and the response was evaluated, then they were subjected to APR or sphincter saving surgery.Results: The study started by 60 patients; 33/60 (55%) underwent APR, 25/60 (41.7%) underwent sphincter saving surgery and 2/60 patients (3.3%) lost follow-up.The clinical response was assessed by the status of the distance from the anal verge: It increasedin 23/60 patients (38.33%), stationary in 17/60 patients (28.33%) and decrea-sedin 20/60 patients. The radiological response showed: downstaging occurred in 27/60 (45%). Pathological response revealed: Down-staging in 28/58 patients (48.3%).Negative distal margin was obtained in all patients had sphincter saving surgery with one case only had positive radial margin.Conclusion: Sphincter saving surgery is an oncologically safe alternative to the standard APR in low rectal cancer, with the added benefit of avoiding a permenant stoma. The use of preoperative concomitant chemoradiotherapy (CCRT) enhances the rate of sphincter saving surgery by downsizing and down-staging of the tumors.

Radiation field size and dose determine oncologic outcome in esophageal cancer

BackgroundLocoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy. Approximately half of the patients fail locoregionally. We analyzed the impact of enlarged radiation field size and higher radiation dose incorporated to chemoradiotherapy on oncologic outcome.MethodsSeventy-four consecutive patients with histologically proven nonmetastatic squamous or adenocarcinoma of the esophagus were included in this retrospective analysis. All patients were locally advanced cT3–T4 and/or cN0-1. Treatment consisted of either definitive concomitant chemoradiotherapy (Def-CRT) (n = 49, 66 %) or preoperative concomitant chemoradiotherapy (Pre-CRT) followed by surgical resection (n = 25, 34 %). Patients were treated with longer radiation fields. Clinical target volume (CTV) was obtained by giving 8–10 cm margins to the craniocaudal borders of gross tumor volume (GTV) instead of 4–5 cm globally accepted margins, and some patients in Def-CRT group received radiation doses higher than 50 Gy.ResultsIsolated locoregional recurrences were observed in 9 out of 49 patients (18 %) in the Def-CRT group and in 1 out of 25 patients (3.8 %) in the Pre-CRT group (p = 0.15). The 5-year survival rate was 59 % in the Def-CRT group and 50 % in the Pre-CRT group (p = 0.72). Radiation dose was important in the Def-CRT group. Patients treated with >50 Gy (11 out of 49 patients) had better survival with respect to patients treated with 50 Gy (38 out of 49 patients). Five-year survivals were 91 and 50 %, respectively (p = 0.013).ConclusionsRadiation treatment planning by enlarged radiation fields in esophageal cancer decreases locoregional recurrences considerably with respect to the results reported in the literature by standard radiation fields (18 vs >50 %). Radiation dose is as important as radiation field size; patients in the Def-CRT group treated with ≥50 Gy had better survival in comparison to patients treated with 50 Gy.

P-0207 Colorectal Cancer in The Elderly Moroccan Patients

ABSTRACT Introduction The management of colorectal cancer in the elderly patients is becoming a major problem of public health. The principles of treatment of colorectal cancer in patients aged 70 years old and over are the same as those of younger ones, but therapeutic indications should be adjusted according to physiological age, general condition, and the existence of co morbidities. Methods In this retrospective study, we reviewed 62 cases of colorectal cancer in patient aged 70 years old and over admitted in the medical oncology unit of HASSAN II university hospital between January 2009 and January 2012. The aim of this study is to determinate epidemiologic, clinical and therapeutic aspects of this disease in the elderly Moroccan population. Results 62 cases of colorectal cancer were diagnosed in patients aged 70 years old and over representing 27, 5% of all colorectal cancers. 70% of our patients are aged between 70 and 74 years old (n= 43), 20% between 75 and 79 years old, and 10% 80 years old and over. 20% of cases had antecedent of cardiovascular disease, and 8 % had a history of cancer family. The average time of diagnosis was 7.3 months, the clinical symptoms were mainly rectal bleeding (53%), abdominal pain (43%). 37 % of the patients were metastatic at the diagnosis (n=23), sites of metastasis were liver in 10 cases (43%), lung in 7cases (30%), peritoneum in 6 cases (26%), lymph nodes in 5 cases (21%). 20% of patients (n=13) presented a stage III disease, stage II was noted in 35% (n=22), and stage I in 6% (n=4). Left resection of the colon was performed in 24 % of cases, right hemi-colectomy was done in 22%, surgery of rectum was performed in 20%, and metastatic liver resection was done in 5% of all metastatic patients. Preoperative concomitant chemo radiotherapy was performed in 13% for lower and middle rectum. Adjuvant chemotherapy based on Capecitabine alone was administrated in 12 cases, and XELOX in 4 cases, with 25% of diarrhea (n=4), 18 % of hand and foot syndrome (n=3), 18% of non-febrile neutropenia (n=3), and 12% of peripheral neuropathy (n=2). 11% of our patients received metastatic chemotherapy based on XELERI+BEVACIZUMAB (n=7) with 2 cases of diarrhea grade 2, 11% patients received chemotherapy based on XELOX with one death secondary to thrombocytopenia grade 4 after first cycle, and 3% chemotherapy with CAPECITABINE alone. We opted for no treatment in 11% of patients (n=7): Cardiac failure in four cases, 2 cases because of deterioration of performance status, and terminal renal failure in one case. Conclusion All patients with colorectal cancer aged 70 years old and over should receive the most appropriate treatment thought to be effective and safe, according to their biological age and co morbidities. Geriatric assessment is essential in the care for elderly patients with colorectal cancer.

P-0300 Preoperative Concomitant Chemoradiotherapy with Capecitabine in Locally Advanced Rectal Carcinoma: Results at 3 Years

ABSTRACT Introduction Rectal cancer is a real problem of public health in the world. It represents about 40% of colorectal cancer and its treatment has greatly improved these last ten years with the surgery of the mesorectum and the neo-adjuvant and adjuvant treatments. Sphincter preservation in low rectal cancers is usually difficult and their prognostics are worse due to anatomic and non-biologic factors and tumor is just near genital organs, trend to reach them and make so surgery difficult. The appearance of new surgical techniques, better knowledge of natural history of the disease and the impact of neo-adjuvant treatments of rectal cancer are needful to make a consensual approach of rectal cancer treatment which is in continuous evolution and providing a better quality of life of patients. Methods A prospective study has been achieved with the collaboration of the Medical Oncology Department of Oran University Hospital to evaluate concomitant chemo-radiotherapy with capecitabine in neo-adjuvant setting of locally advanced non metastatic rectal cancer (low and middle rectal cancer): Primary endpoint was Response Rate (RO) and secondary endpoints were: Sphincter preservation, Quality of life, time to recurrence and global survival. Results 46 patients were enrolled between 15 May 2007 and 30 June 2010 with locally advanced rectal cancer without metastasis (T3 – T4 /N+) and treated with Capecitabine (825mg/m2) and radiotherapy (45 Gy: 2Gy/day)in neo-adjuvant setting. Surgery was performed 4 to 8 weeks later in responding patients: 65% of patients were stage IIIB and 35% stage IIIC. Median age was 58 years. Time to diagnosis was 5.7 months. Time to treatment was 1.3 months. Three cycles of Capecitabine were given with concomitant radiotherapy (45 Gy: 2Gy/Day). Objective Response was observed in 63% of patients, Complete Pathological Response was achieved in 33% of cases and Sphincter preservation was possible in 20% of patients. Main adverse effects (NCI-CTC): Neutropenia G3: 2% and Diarrhea G3: 2%. The probability of survival after thirty six months follow-up is 42%. The median duration of the survival without relapse is 37.4+0.5 months. Conclusion Concomitant Chemo-radiotherapy with Capecitabine is an effective regimen with an acceptable safety profile for locally advanced rectal cancer leading to a high probability of tumor down staging and sphincter preservation.

Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

Several studies have been performed to evaluate the usefulness of neoadjuvant treatment using oxaliplatin and fluoropyrimidines for locally advanced rectal cancer. However, preoperative biomarkers of outcome are lacking. We studied the polymorphisms in thymidylate synthase, epidermal growth factor receptor, glutathione S-transferase pi 1 (GSTP1), and several DNA repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 128 rectal cancer patients treated with preoperative chemoradiotherapy. Blood samples were obtained from 128 patients with Stage II-III rectal cancer. DNA was extracted from the peripheral blood nucleated cells, and the genotypes were analyzed by polymerase chain reaction amplification and automated sequencing techniques or using a 48.48 dynamic array on the BioMark system. The germline polymorphisms studied were thymidylate synthase, (VNTR/5'UTR, 2R G>C single nucleotide polymorphism [SNP], 3R G>C SNP), epidermal growth factor receptor (Arg497Lys), GSTP1 (Ile105val), excision repair cross-complementing 1 (Asn118Asn, 8092C>A, 19716G>C), X-ray repair cross-complementing group 1 (XRCC1) (Arg194Trp, Arg280His, Arg399Gln), and xeroderma pigmentosum group D (Lys751Gln). The pathologic response, pathologic regression, progression-free survival, and overall survival were evaluated according to each genotype. The ∗3/∗3 thymidylate synthase genotype was associated with a greater response rate (pathologic complete remission and microfoci residual tumor, 59% in ∗3/∗3 vs. 35% in ∗2/∗2 and ∗2/∗3; p=.013). For the thymidylate synthase genotype, the median progression-free survival was 103 months for the ∗3/∗3 patients and 84 months for the ∗2/∗2 and ∗2/∗3 patients (p=.039). For XRCC1 Arg399Gln SNP, the median progression-free survival was 101 months for the G/G, 78 months for the G/A, and 31 months for the A/A patients (p=.048). The thymidylate synthase genotype and XRCC1 Arg399Gln polymorphism might help to identify Stage II-III rectal cancer patients with a better outcome after preoperative concomitant chemoradiotherapy.

Preoperative Concomittant Chemotherapy/EBRT With HDR Brachytherapy Boost for Rectal Adenocarcinoma: The Initial Moffitt Cancer Center Experience

Purpose: Preoperative concomitant chemoradiotherapy is the standard of care for ≥T3 or node positive disease rectal cancer. Additionally, high-dose-rate (HDR) endorectal brachytherapy can effectively downstage rectal cancers, resulting in both increased local control and sphincter preservation for lower one-third tumors. We report our initial experience using HDR endorectal brachytherapy as a boost after EBRT for rectal cancer.

Effect of preoperative concomitant chemoradiotherapy in chemotherapy-refractory breast cancer on feasibility of curative surgery and pathologic tumor response.

644 Background: To assess therapeutic response and treatment-related morbidity in patients treated with concomitant chemoradiotherapy for inoperable breast cancer (BC) who had progressed under anthracyclines (A) and/or taxanes (T)-containing primary chemotherapy (CT). Methods: A total of 14 patients (1.8%) with chemotherapy-refractory locally advanced BC (CT-RLABC) from 750 women who received primary CT for between 2000-2009, at Institut Gustave Roussy, Villejuif, France were studied. Patients had T2 (n = 1), T3 (n = 4), T4c (n = 1) and T4d (n = 8) at disease presentation and received either A followed by T (n = 10), or A (n = 3) or T (n = 1) regimens prior to tumor progression. At the time of CT-RLABC, an association of IV vinorelbine 30 mg/m2 day 1 and 8 and either 5-day continuous 5FU (1,000 mg/m2/day) or 14-days capecitabine (2,000 mg/m2/day), 3-weekly regimen, 4 cycles, was given concurrently with radiotherapy (50 Gy) to the breast and regional lymph nodes for 5 weeks followed by a boost of 20 Gy to tumor (n = 10) to all patients. If feasible, radical mastectomy followed radiotherapy. Safety, accessibility to curative surgery and pathologic tumor response were assessed. Results: In 10/14 (71%) patients, grade 2-3 skin acute toxicities were observed during locoregional chemoradiotherapy. Even though all BC were initially inoperable, combined chemoradiotherapy permitted 71% of pts to undergo curative surgery (n = 10) 4-8 weeks after RT completion. Among the 4 remaining pts, 2 had refused surgery despite clinical complete or partial response and 2 developed metastatic progression during loco-regional treatment. Of the 10 patients who had undergone surgery, complete pathologic response was observed in 5 patients (50%). None of them had major peri- or postoperative complications. Conclusions: FUN-based chemoradiotherapy enabled to perform surgery in 71% of A/T-refractory inoperable BC with a pathologic complete response in 50% of operated pts. Combined chemoradiotherapy should be further assessed at a larger scale to take part in BC treatment when refractory to primary CT. No significant financial relationships to disclose.

Preoperative concomitant chemoradiotherapy with capecitabine in locally advanced rectal carcinoma

e15134 Background: Preoperative concomitant chemoradiotherapy has shown to improve local control and sphincter preservation with decreased acute toxicity compared with postoperative treatment in locally advanced rectal carcinoma. The primary endpoint of this phase II trial was pathologic tumor response. Secondary endpoint was sphincter preservation and toxicity. Methods: Inclusion criteria: rectal adenocarcinoma <12 cms from anal verge, clinical stage T3–4, adequate renal, hematological and liver function. Planned sample for this trial was 40 patients. Treatment schedule: Pelvic radiotherapy (45 Gy : 2 Gy /day ) and chemotherapy: Capecitabine 850 mg/m2 b.i.d p.o: day 1 to 14 (2weeks of treatment followed by 1 week rest period (cycle repeated every 3 weeks). Surgery with TME was performed after the end of the second cycle of chemotherapy. Adjuvant chemotherapy with 5FULV2 was administered after surgery Results: 15 patients have been recruited between January and October 2007: 12 males/3 females. Median age 40 years (range 22–70). Clinical stage (determined by CT or RMI): T3: 70% and T4: 30%. Tumor location (from anal verge): < 6 cm in 8pts, >6 cm in 7pts. Surgery (performed in 14 patients) consisted of low anterior resection in 7pts and abdominal-perineal resection in 8pts. Tumor down staging was observed in 9pts (60%), including 5pts with complete pathological response (33.3%). Main adverse effects (NCI-CTC): diarrhea G3–4: 15.2%, nausea/vomiting G3–4: 13%, Anemia G3- 4: 8.5%, neutropenia G3–4: 12.5%. Conclusions: Preliminary results show that preoperative concomitant chemoradiotherapy with Capecitabine is an effective regimen with an acceptable safety profile for locally advanced rectal cancer, leading to a high probability of tumor downstaging. No significant financial relationships to disclose.

Preoperative concomitant chemoradiotherapy with oxaliplatin and 5-fluorouracil in locally advanced rectal carcinoma

e15108 Background: Preoperative concomitant chemoradiotherapy has shown to improve local control and sphincter preservation with decreased acute toxicity compared with postoperative treatment in locally advanced rectal carcinoma. The primary endpoint of this phase II trial was pathologic tumor response. Secondary endpoint was sphincter preservation and toxicity Methods: Inclusion criteria: rectal adenocarcinoma <12 cms from anal verge, clinical stage T3–4, adequate renal, hematological and liver function. Planned sample for this trial was 40 patients. Treatment schedule: Pelvic radiotherapy (25 Gy/ 5 fractions: 5 Gy on day 1 to day 5) and chemotherapy: Oxaliplatin 85 mg/m2 on 2 hours, day 1 and 15, folinic acid 20 mg/m2 and 5 fluoro-uracil bolus 500 mg/m2 on day 1, 8 and 15 (cycle repeated every 4 weeks). Surgery with TME was performed after the end of the second cycle of chemotherapy. Adjuvant chemotherapy with 5FULV2 was administered after surgery Results: 15 patients have been recruited between January and October 2006: 10 males/5 females. Median age: 45 years (range 26–62). Clinical stage (determined by CT or RMI): T3: 66.6% and T4: 33.3%. Tumor location (from anal verge): < 6 cm in 10pts, >6 cm in 5pts. Surgery (performed in 14 patients) consisted of low anterior resection in 5pts and abdominal-perineal resection in 10p. Tumor down-staging was observed in 10pts (66.6%), including 5pts with complete pathological response (33.3%). Main adverse effects (NCI-CTC): diarrhea G3–4: 14.2%, sensitive peripheral neurotoxicity G1: 26.6%, nausea/vomiting G3–4: 11%, Anemia G3–4: 7.1%, neutropenia G3–4: 14.2% Conclusions: Preliminary results show that preoperative concomitant chemoradiotherapy with oxaliplatin and 5FU-folinic acid is an effective regimen with an acceptable safety profile for locally advanced rectal cancer, leading to a high probability of tumor downstaging. This interim analysis has to be confirmed by the final analysis. No significant financial relationships to disclose.

Preoperative concomitant chemo-radiotherapy (CT-RT) in superior sulcus tumors (SST): A mono-institutional experience

7578 Background: SST is an uncommon neoplasia, whose optimal treatment remains controversial. Recently preoperative chemo- radiotherapy is arousing interest. Methods: Treatment consisted of a platinum-based CT: carboplatin AUC 5 on days 1 and 22, with mitomycin-C 8 mg/m2, d.1 & 22, and vinblastine 4mg/m2 dd.1, 8, 22 & 29 (MVC), from 1994 to 1999 or combined with vinorelbine 25mg/m2 dd.1, 8, 22 & 29 (NC), from 2000 to 2007. RT was administered 5 dd/week, 30Gy in 10 fractions from dd. 22 to 35 (from 1994 to 1996), or 44Gy in 22 fractions, dd.22 to 52 (from 1997 to 2007). Surgery was planned after 2–3 weeks from the conclusion of RT. Results: Since 1994, 38 pts were treated with induction CT-RT. M/F ratio was: 33/5, median age 61 years/ range (43–77yrs), median PS was 80 (range 50–90). Histology subtypes were as follows: squamous 14 (37%), adeno 16 (42%), NSC 8 (21%); stage: 20 had IIb (53%), 8 IIIa (21%), and 10 IIIb (26%); 5 pts had a weight loss>5% (13%), 4 pts had a weight loss<5% (11%), 29 had no weight loss (76%); 31 pts had shoulder pain (82%), 4 pts had the Horner syndrome (11%). Induction CT: 16 pts had MVC (43%) and 21 CN (57%); Induction RT: 7 patients treated with MVC had 30 Gy/10F, 9 had 44 Gy/22F; all of the patients treated with CN had 44 Gy/22 F, but 2 of them did not complete RT because of early death or toxicity. Hematologic toxicity was mild: out of 94 cycles we observed 6 gr.4 and 3 gr.3 neutropenia; 11 gr.3 leukopenia; 1 gr4 leukopenia; 1 gr.4 and 2 gr.3 thrombocytopenia; 2 gr.3 and 3 gr.2 anemia. Nonhematologic toxicity consisted of constipation in 11 pts, esophagitis in 4 pts. One complete, 18 partial, 7 stable disease and 1 progressive disease were observed; 11 were not evaluable. Surgery: 30 upper lobectomies and 4 segmentectomies, with chest wall resections, were performed (89% resection rate); 4 pts were not operated: 2 for unresectability 1 for early death and 1 for progression during CT-RT. At resection 5 pathologic complete remissions were seen. 24 pts had improvement of shoulder/arm pain. Median progression-free survival was 106 weeks and median survival was 196 weeks. Conclusions: In SST, concurrent carboplatin-based CT plus RT was active and feasible without major toxicities. This resulted in a high resectability rate and favorable progression-free and overall survival rates. No significant financial relationships to disclose.

Preoperative concurrent chemoradiotherapy versus pre- and postoperative radiotherapy for advanced hypopharyngeal carcinoma: A single-center study

Objective The purpose of this study was to improve the survival and phonatory rates in patients with advanced hypopharyngeal carcinoma. Methods Seventy-two consecutive patients with advanced hypopharyngeal carcinoma were treated with pre- and postoperative radiotherapy (RTS), or preoperative concomitant chemoradiotherapy (CCRTS). Surgical procedures, including total laryngectomy plus partial pharyngectomy (TLPP) to preserve the posterior pharyngeal wall offering a functional neoglottis for esophageal or tracheoesophageal shunt phonation postoperatively, were conducted for patients who did not achieve CR. Results A significantly higher survival rate at 5 years (93.3%) was observed for N0-2b stage patients in the CCRTS group ( n = 16) than the RTS group ( n = 34; 41.5%) ( p < .005). The distant metastasis-free rate was 92.9% (CCRTS group) versus 55.4% (RTS group) ( p < .05) in these patients. In the CCRTS group, the 5-year survival rate with laryngeal or esophageal and/or tracheoesophageal shunt phonation was 22.2%. Conclusion It is suggested that the CCRTS protocol and TLPP procedure may improve the survival rates without deterioration of phonatory rates in patients with N0-2b advanced hypopharyngeal carcinoma.

Preoperative concomitant chemoradiotherapy in locally advanced cervical cancer: Safety, outcome, and prognostic measures

Objectives To evaluate the morbidity, and the therapeutic value of surgery after chemoradiation in a large series of locally advanced cervical cancers (LACC). The prognostic role of different clinico-pathological factors has been also evaluated. Methods Between October 1997 and October 2006, 161 LACC patients were treated at both the Gynecologic Oncology Units of the Catholic University of Rome and Campobasso. Radiotherapy was administered to the whole pelvic region in combination with cisplatin and 5-fluorouracil. Radical surgery was performed 5–6 weeks after the end of the treatment. Results A clinical complete/partial response was observed in 153 patients and radical surgery was performed in 152 cases. The overall rate of surgical complications was 33% with 15 (10%) patients experiencing severe toxicities. At pathological examination 111 of 152 patients (73%) showed absent/microscopic residual disease. With a median follow-up of 28 months, the 5-year disease free-survival (DFS) was 83% and the 5-year overall survival (OS) 90%. Advanced FIGO (Federation Internationale de Gynecolgie et d'Obstetrique) stage, pathological response and lymph node involvement were found significantly associated with clinical outcome. Conclusions We confirmed in a larger series the safety and efficacy of this multimodal approach in the treatment of LACC. The pathological assessment of response can allow not only a tailored surgery in selected patients, but also the identification of patients with higher risk of recurrence to be submitted to adjuvant therapies.

Predicting and monitoring tumor response to epidermal growth factor receptor inhibitor gefitinib in patients with locally advanced esophageal adenocarcinoma

14112 Background: This study aimed to validate an ex vivo chemosensitivity assay to measure the pharmacodynamic effect of gefitinib on esophageal adenocarcinoma (EAC) prior to treatment with pre-operative concomitant chemoradiotherapy (CRT). Methods: A 14 day run-in period with 250 mg/day of gefitinib preceded CRT. Endoscopic biopsies (D 0 and 14) in 4 patients with T2–3N0/1M0/1a EAC were analyzed by ex vivo chemosensitivity assay. Day 0 tissue was exposed to gefitinib ex vivo, then tumor was exposed to gefitinib for 14 days in vivo (ie in the patient). Phosphorylation of the EGFR, raf/MEK/ERK and PI3/AKT pathways was measured by Western blot. Profiles were compared for correlation between ex vivo and in vivo exposure, and patterns were correlated with response to CRT. The effects were also characterized by immunohistochemistry (IHC). EGFR, K-Ras, and PI3K mutations, serum concentrations of gefitinib and PTEN status were measured as potential confounders. Results: One patient with stage T3N1 died of unexplained hemorrhage during surgery. Three had clinical and path stages of: T3N1/T0N0, T3N0/T3N0, T3N1/T2N1. Gefitinib levels were constant, confirming exposure of target tissue to the drug. Ex vivo exposure yielded four distinct pathway patterns. The exact same patterns were seen after in vivo exposure. No mutations were identified in exons 18–21 of the EGFR, exons 2/3 of K-ras or exons 9/22 of PI3K. PTEN levels were similar in all tumors. PCNA expression correlated with raf/MEK/ERK pathway inhibition, but not with inhibition of EGFR activity. IHC correlated with Western blot for expression of EGFR, and phospho- and total ERK levels. No correlation was observed between gefitinib effect and pathologic response to CRT. Conclusions: This study used a novel ex vivo chemosensitivity assay to demonstrate the activity of gefitinib to inhibit target in tumor tissue obtained from patients with EAC. The exact correlation of pre- and post-treatment profiles suggests potential use in the pre-treatment setting to predict in vivo effects of targeted therapies. This approach may facilitate the further refinement of patient selection to maximize potential benefit while sparing patients unlikely to respond to a given agent. No significant financial relationships to disclose.

Combined-modality therapy for esophageal and gastroesophageal junction cancers

The optimal management of locoregional esophageal cancer is controversial. Preoperative concomitant chemoradiotherapy (two courses of cisplatin and 5-fluorouracil plus 50 Gy of radiation) may provide benefit in survival and local control compared with surgery alone and is a reasonable alternative to surgery alone in stages IIB, III, and possibly stage IVa disease. This benefit is less clear in stages I and IIA, for which surgery alone is thus a reasonable option. Preoperative chemotherapy without radiation also provides a survival benefit compared with surgery alone, but data are insufficient to conclude it is superior to preoperative chemoradiotherapy. Control of distant disease remains a problem with preoperative chemotherapy and preoperative chemoradiotherapy.

Preoperative concomitant chemo-radiotherapy (CT-RT) in non small cell lung cancer patients with superior sulcus tumor (SST): A single institution experience

Preoperative concomitant chemo-radiotherapy (CT-RT) in non small cell lung cancer patients with superior sulcus tumor (SST): A single institution experience

Preoperative concomitant chemo-radiotherapy (CT-RT) in non small cell lung cancer patients with superior sulcus tumor (SST): A single institution experience

7372 Background: SST is an uncommon tumor, usually resected after induction RT. In the recent years some experiences with preoperative chemo-radiotherapy were published. Methods: CT was platinum-based: Carboplatin AUC 5 on days 1 and 22, combined to Mitomycin-C 8 mg/m2, d.1 & 22, and Vinblastine 4mg/m2 dd.1, 8, 22 & 29 (MVC, from 1994 to 1999) or combined to Navelbine 25mg/m2 dd.1, 8, 22 & 29 (NC, from 2000 to 2003). RT was administered 5 dd/week, 30Gy in 10 fractions from dd. 22 to 35 (in the period 1994–96), or 44Gy in 22 fractions, dd.22 to 52 (in the period 1997–2003). Surgery was planned after 2–3 weeks from the end of RT. Results: since 1994 26 pts were treated with induction CT-RT, 1 with induction RT M/F ratio was: 23M/4F, median age 61 years/ range (43–77yrs), median PS was 80 (range 50–80), Histology subtypes were: squamous 11 (41%), adeno 10 (37%), not specified (NSCLC) 6 (21%); stage: 17 had stage IIIa according to TNM-1986 and stage IIb according to TNM-1997, 3 stage IIIa N+, and 7 stage IIIb; 4 pts had a weight loss>5%, 4 pts had a weight loss<5%. 18 pts had shoulder pain irradiated to the arm, 3 pts had the Horner Syndrome. Induction CT: 13 pts had MVC and 13 NC; 8 pts were treated with the 30Gy/10fx RT schedule, 7 had MVC as concurrent CT, 1 had not CT; 19 pts were treated with the 44Gy/22fx RT schedule, 7 had MVC and 12 NC as concurrent CT. Hematologic toxicity of induction CT-RT was mild: out of 52 cycles we observed 3 gr.4 and 2 gr.3 neutropenia; 7 gr.3 leukopenia; 1 gr.4 and 1 gr.3 thrombocytopenia; 2 gr.3 and 3 gr.2 anemia. Non-Hematologic toxicity was: constipation in 9 pts, oesophagitis in 5 pts, N/V in 4 pts; 14 partial and 3 minimal responses were observed.. Surgery: 22 upper lobectomies (15 right, 7 left) and 2 segmentectomies, with chest wall resections, were performed (89% resection rate); 3 pts were not operated: 2 for unresectability 1 for early death during induction CT-RT. Two pathologic complete remissions were seen. 17 pts had improvement of shoulder/arm pain. Median survival was 167 weeks. Conclusions: in SST, concurrent CT-RT was active and feasible without major toxicities, and resulted in a high resectability rate. No significant financial relationships to disclose.