Received Radical Treatment Research Articles

Treatment and survival of non-metastatic small cell carcinoma of the bladder from multiple centers in China

Small cell carcinoma of the bladder (SCCB) is a rare, highly malignant neuroendocrine tumor. This study attempted to analyze tumor characteristics, treatments and clinical outcomes in China. We conducted a retrospective analysis of patients diagnosed with non-metastatic SCCB at multi-institutions between January 2007 and January 2022. The Kaplan-Meier method was used to calculate survival. A total of 20 patients were included. 10 had localized disease (T1-2N0), and 10 had locally advanced disease (≥ T3 or N+). 13 received local treatment (partial cystectomy or transurethral resection of the bladder tumor) and 7 received radical treatment (radical cystectomy or radiotherapy). A total of 18 patients (90%) received chemotherapy (CT), either neoadjuvant CT (n = 5) or adjuvant CT (n = 13). The median OS for the receiving local treatment was 65.3 months (95% CI 0 to 138 months) and the corresponding 1-year, 2-year, and 3-year OS was 77%, 54%, and 54%, respectively. The median OS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year OS was 100%, 100%, and 75%, respectively. The median PFS for receiving local treatment was 13.8 months (95% CI 9.3 to 18.3 months) and the corresponding 1-year, 2-year, and 3-year PFS was 46%, 31%, and 31%, respectively. The median PFS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year PFS was 83%, 56%, and 56%, respectively. This study reported the largest cohort of non-metastatic SCCB among Chinese population. Given its metastatic potential, CT remained an essential part of the treatment. The survival outcomes of radical cystectomy and RT in non-metastatic SCCB were encouraging.

Curative Effect of Helicobacter Pylori Radical Treatment on Gastric Cancer Patients with Helicobacter Pylori Infection

To explore the role and value of radical treatment of Helicobacter pylori in patients with gastric cancer complicated with Helicobacter pylori infection. Methods: From January 2022 to January 2023, 152 patients with gastric cancer complicated with Helicobacter pylori infection who were treated in our hospital were included in this study by random number table method. According to whether each patient received radical treatment based on Helicobacter pylori infection while receiving chemotherapy treatment, they were divided into the control group of single chemotherapy treatment and the observation group of combined radical treatment of Helicobacter pylori. The difference of treatment indexes between the two groups was analyzed. Results: The effective rate of treatment in the observation group was 88.16%, the total adverse reaction rate was 39.47%, and the treatment satisfaction rate was 93.42%; The effective rate of treatment in the control group was 78.95%, the total adverse reaction rate was 68.42%, and the treatment satisfaction rate was 82.89%. The difference was statistically significant (P<0.05). Conclusion: For patients with gastric cancer complicated with Helicobacter pylori infection, while receiving chemotherapy for gastric cancer, radical treatment for Helicobacter pylori can significantly improve the effective rate of clinical symptom relief of disease treatment, reduce the incidence of adverse reactions during various treatments, and improve the overall satisfaction of patients and their families with treatment.

Survival outcome of esophagectomy and chemoradiotherapy for resectable esophageal squamous cell carcinoma in patients >75 years of age.

The gold standard for resectable, locally advanced esophageal squamous cell carcinoma (ESCC) is surgery-based treatment; however, it is unclear whether esophagectomy or chemoradiotherapy is suitable for older patients. This retrospective study aimed to identify the treatment outcomes of surgery-based therapy versus definitive chemoradiotherapy (dCRT) as an initial treatment for older patients with resectable, locally advanced ESCC. Data from 434 patients who received radical treatment for resectable, locally advanced ESCC were collected from January 2011 to December 2020. Of the patients >75 years of age, 49 underwent radical esophagectomy and 26 received dCRT. Survival was compared between the surgery and dCRT groups. The mean ages of the surgery and chemoradiotherapy groups were 77.3 and 78.8 years, respectively. Differences in overall survival (OS) between the two groups were not statistically significant (3-year OS: surgery 66.2%, dCRT 55.7%, p = 0.236). Multivariate analysis for OS showed a hazard ratio of 1.229 for dCRT versus surgery (90% confidence interval 0.681-2.217). OS did not differ between the groups in any of the performance statuses. For patients who were able to receive chemotherapy using fluorouracil and cisplatin, OS tended to be better in the surgery group, but the difference was not statistically significant (3-year OS: surgery 68.1%, dCRT 51.8%, p = 0.117). There was no clear difference in survival outcome between surgery-based therapy and dCRT as an initial treatment for esophageal cancer in older patients. Either treatment may be an option for older patients.

PHAROS, a real-world multi-country European study on patients with high-risk localised and locally advanced prostate cancer receiving radical treatment.

PHAROS, a real-world multi-country European study on patients with high-risk localised and locally advanced prostate cancer receiving radical treatment.

Assessing the efficacy of clinical triage in the prostate cancer best practice pathway

Objective: The Prostate Cancer UK timed prostate cancer diagnostic pathway is a new UK pathway to deliver a diagnosis within 28 days for patients with suspected prostate cancer. We aim to review our experience of implementing this pathway, in particular the success of clinical triage. Subjects/patients (or materials) and methods: We reviewed consecutive referrals to the prostate cancer best timed pathway from September 2019 to September 2020. Patients were triaged either straight to test multiparametric magnetic resonance imaging (mpMRI) or straight to outpatient clinic. Inappropriate triage was defined as either: patients referred straight to test mpMRI who were diagnosed with prostate cancer and managed with watchful waiting or androgen deprivation therapy (ADT) or patients who were referred straight to clinic who subsequently had an mpMRI and underwent radical treatment. Results: A total of 154/155 (99.6%) of patients were appropriately triaged in the straight to mpMRI group. A total of 124/132 (94.0%) of patients were appropriately triaged in the straight to clinic group (patients who required review to ascertain if mpMRI was appropriate and then received radical treatment). Conclusion: The implementation of a consultant supervised triage process has been successful in avoiding unnecessary mpMRIs or unnecessary clinic appointments before a patient received a diagnosis or reassuring test. We advise that outcomes are audited regularly to ensure the effective use of resources. Level of evidence: 2C

Cachexia and Sarcopenia in Oligometastatic Non-Small Cell Lung Cancer: Making a Potential Curable Disease Incurable?

Among patients with advanced NSCLC, there is a group of patients with synchronous oligometastatic disease (sOMD), defined as a limited number of metastases detected at the time of diagnosis. As cachexia and sarcopenia are linked to poor survival, incorporating this information could assist clinicians in determining whether a radical treatment should be administered. In a retrospective multicenter study, including all patients with adequately staged (FDG-PET, brain imaging) sOMD according to the EORTC definition, we aimed to assess the relationship between cachexia and/or sarcopenia and survival. Of the 439 patients that were identified between 2015 and 2021, 234 met the criteria for inclusion and were included. The median age of the cohort was 67, 52.6% were male, and the median number of metastasis was 1. Forty-six (19.7%) patients had cachexia, thirty-four (14.5%) had sarcopenia and twenty-one (9.0%) had both. With a median follow-up of 49.7 months, median PFS and OS were 8.6 and 17.3 months, respectively. Moreover, a trend toward longer PFS was found in patients without cachexia and sarcopenia compared to those with cachexia and/or sarcopenia. In multivariate analysis, cachexia and sarcopenia were not associated with an inferior survival, irrespective of receiving radical treatment. High CRP was associated with inferior survival and could be a prognostic factor, helping the decision of clinicians in selecting patients who may benefit from the addition of LRT. However, despite the homogeneous definition of oligometastatic disease and the adequate staging, our subgroups were small. Therefore, further studies are needed to better understand our hypothesis and generating findings.

A Retrospective Study on Predicting Recurrence of Intermediate-Stage Hepatocellular Carcinoma After Radical Therapy.

This study aimed to investigate the potential benefits of radical therapy in patients with stage B disease. A retrospective analysis was conducted on a cohort of 437 patients diagnosed with stage B hepatocellular carcinoma, who underwent either hepatic resection (HR) or radiofrequency ablation (RFA) at the Cancer Institute and Hospital of Tianjin Medical University from May 2011 to May 2022. Multivariate COX regression analysis was performed to identify the independent prognostic factors related to recurrence-free survival (RFS). The performance of the developed nomogram was evaluated using various statistical measures, including the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Multivariate analysis revealed that tumor diameter, number of tumors, number of involved liver segments, alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), lactate dehydrogenase (LDH), and systemic immune inflammation index (SII) were independent prognostic factors influencing patients' RFS, and these factors were incorporated into the nomogram. The C-index of the nomogram in the training cohort was 0.721, and the AUC at 2 and 3 years was 0.772 and 0.790, respectively. These values were appreciably higher than commonly used clinic staging systems and other predictive models. The calibration curve and DCA demonstrated good calibration and net benefit. Survival analysis comparing stage B patients who received radical treatment with stage A patients with multiple lesions did not reveal a significant difference in Kaplan-Meier survival curves (P=0.91). The nomogram provided a precise prediction of the recurrence for stage B hepatocellular carcinoma patients undergoing radical treatment. Furthermore, certain stage B patients may benefit from radical treatment.

HIV and Early Treatment Outcomes Among Women With Cervical Cancer Treated With Concurrent Chemoradiation in Tanzania.

Cervical cancer (CC) is the leading malignancy in Tanzania. Low-income countries are faced with double epidemics of HIV and CC. This study aimed to investigate how HIV and cancer stage at diagnosis affect early treatment outcomes among women with CC treated with concurrent chemoradiation in Tanzania in the highly active antiretroviral therapy era. This was a prospective cohort study of patients newly diagnosed with CC at the Ocean Road Cancer Institute from November 2019 to January 2020. The tumor response was assessed using RECIST 3 months post-treatment. The tumor response was categorized as a complete or partial response according to the ultrasound and pelvic examination findings. The univariate and multivariate logistic regression explained the relationship between several covariates (age, stage, HIV status, equivalent dose in 2 Gy fractions, chemotherapy cycles, and treatment time) and treatment response. A total of 102 patients with CC were included in this study at baseline. After adjusting for other covariates, only completion of treatment within 56 days (odds ratio [OR], 9.23; 95% CI, 1.53 to 55.85; P = .016) and receiving at least three cycles of cisplatin (OR, 5.6; 95% CI, 1.47 to 21.34; P = .012) were significantly associated with complete tumor response. HIV status was not significantly associated with complete tumor response (OR, 1.534; 95% CI, 0.424 to 5.545; P = .5144). Early treatment response was independent of HIV status. With wide coverage of anitretroviral therapy, patients with HIV can receive radical treatment and have the same early outcomes as their HIV-negative counterparts.

Influence of nutritional counseling on treatment results in patients with head and neck cancers

ObjectivesNutritional intervention, including nutritional counseling (NC), plays a significant role in the comprehensive management of patients with head and neck cancer (HNC). The aim of this study was to investigate the effects of NC combined with oral nutritional supplements during radical treatment on weight loss and survival outcomes in patients with HNC. MethodsThe study included 310 patients who received radical treatment for HNC. Among these patients, 119 underwent NC along with oral nutritional supplements (NCONS); 191 were supported with oral nutritional supplements only (ONS). The study aimed to investigate the effects of sex, disease stage, treatment modality, and tumor site on weight loss. Additionally, the Kaplan–Meier method assessed the influence of NC on overall survival and disease-free survival. ResultsThe present study suggested that the NC independently prevented weight loss, regardless of sex and disease stage (female: –1.6%, P = 0.001; male: –2.3 %, P = 0.003; T stage (0–2): –1.7%, P = 0.008; T stage (3–4): –2.7%, P = 0.003; N stage (0–1): 2.5%, P = 0,027; N stage (3–4): 2.9%, P < 0.001). The protective effect was most significant in patients with oral cancer and oropharyngeal cancer and in patients treated with chemotherapy (oral: –1.7%, P = 0.03; oropharynx: –3.3%, P < 0.001; radiochemotherapy: –3%, P = 0.028; induction chemotherapy preceded radiochemotherapy: –6%, P < 0.001). Furthermore, the 3-year overall survival rates were 93.4% and 85.4% in the NC along with oral nutritional supplements (NCONS) and oral nutritional supplement (ONS) groups, respectively (P = 0.031). ConclusionsPatients with HNC who received NC during radical treatment experienced reduced weight loss. This effect was particularly pronounced in patients with oral cavity or oropharyngeal cancer and those undergoing chemotherapy. Additionally, NC was associated with improved overall survival in this patient cohort. Nevertheless, further studies are required to validate and support these findings.

Abstract 61: Management of Clinically Localized Prostate Cancer: Guideline Concordance and Clinical Outcomes From Tertiary Institutions in Nigeria

Abstract Purpose: Patients with clinically localized prostate cancer have a potentially curable disease. However, there are gaps in the quality of care these patients receive in Nigeria. Granular clinical data are needed to design interventions for quality improvement. This study aims to describe guideline concordance of cancer management and its association with patient outcomes. Methods: A 3-year retrospective study of all patients with T1-T3a, N0, M0 prostate cancer at three tertiary hospitals in Nigeria was conducted. Data on clinicopathologic characteristics, D’Ámico risk group, TNM staging, treatment practices, post-treatment PSA and survival were collected. Concordance with the 2022 European Association of Urology guidelines was assessed. Primary endpoints were guideline concordance of staging and treatment, and associations between concordance and outcomes. Results: This study included 110 patients; mean age 68 years. Sixty-six patients (60%) were high-risk, 34 (31%) were intermediate-risk, and 9 (8%) were low-risk. Most patients were staged with abdominopelvic ultrasound (65%, n = 71). Guideline-concordant magnetic resonance imaging for T-staging was significantly higher in low-risk (44%, n = 4) than high-risk (12%, n = 8) patients (p = 0.041). Guideline-concordant axial imaging for N and M staging was used in 11% (n = 7) of high-risk patients. In the overall cohort, 16 patients (15%) received guideline-concordant definitive treatment with either radical prostatectomy (n = 10; 9%) or radiotherapy (n = 6; 5%), whereas 62 patients (56%) received non-concordant androgen deprivation therapy (ADT) alone and 21 (19%) received no treatment. Median time to biochemical recurrence was not significantly different between those who received surgery (18 months), radiation therapy (median not obtained), or ADT alone (11 months) (log-rank p = 0.103). After a median follow-up of 36 months, median overall survival was similar for guideline-concordant and non-concordant treatment groups (37 and 34 months, respectively; log-rank p=0.540). Conclusion: Prostate cancer staging was suboptimal across all risk groups. Only a minority of patients received radical treatment for this potentially curable disease. Our results will inform the development of tailored multifaceted interventions to improve the quality of care. Citation Format: Musliu Adetola Tolani, Muhammed Ahmed, Rufus Wale Ojewola, Christian Agbo Agbo, Shehu Salihu Umar, Ernie Kaninjing, Alan Paciorek, Rebecca DeBoer. Management of Clinically Localized Prostate Cancer: Guideline Concordance and Clinical Outcomes From Tertiary Institutions in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 61.

Soluble PD‑L1 reflects cachexia status in patients with gastric cancer and is an independent prognostic marker for relapse‑free survival after radical surgery.

Soluble programmed death-ligand 1 (sPD-L1) levels can be used as a biomarker for gastric cancer (GC). However, comprehensive information regarding the sPD-L1 expression profiles and their association with cachexia in GC is lacking. Therefore, the present study evaluated the association between clinicopathological findings and sPD-L1 levels in patients with GC. Serum samples were collected from patients with GC during their first visit to Department of Esophageal-Gastro-Intestinal Surgery, Chiba University Hospital, Chiba, Japan (January 2012-December 2017; n=173), and sPD-L1 levels were measured using an enzyme-linked immunosorbent assay. Survival rates among 116 patients, excluding cases with preoperative chemotherapy or no radical procedures, were analyzed. sPD-L1 levels were associated with factors such as neutrophil-to-lymphocyte ratio, hemoglobin (Hb) and albumin (Alb) levels, total cholesterol and C-reactive protein (CRP) levels, and related to inflammation and nutrition in patients. Notably, the higher the number of applicable indicators related to cachexia (Hb <12 g/dl, Alb <3.2 g/dl, CRP >0.5 mg/dl and low body mass index) was, the higher the sPD-L1 value was. However, the pathological stage did not significantly differ between the groups. Clinicopathologically, there was no association with tumor depth, lymph node metastasis or vascular invasion; however, patients with the intestinal type had significantly higher sPD-L1 levels than patients with the diffuse type (P=0.032; Wilcoxon test). The overall survival did not significantly differ between the groups with low and high sPD-L1 levels; however, among patients who received radical treatment, the relapse-free survival was significantly worse in the high-sPD-L1-level group than in the low-sPD-L1-level group (P=0.025; log-rank test). Multivariate Cox regression analysis revealed that a high sPD-L1 concentration was a sign of poor prognosis, independent of pathological stage and cancer antigen CA19-9 (P=0.0029). Therefore, the present findings suggest that sPD-L1 can reflect cachexia status in patients with GC and may serve as a prognostic marker for relapse-free survival after radical GC surgery.

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from NHS England between 2013 and 2019.

We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019. Hospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital. Registrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-week-wait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n= 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers. The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.

Persisting Gaps in Optimal Care of Stage III Non-small Cell Lung Cancer: An Australian Patterns of Care Analysis.

Wide variation exists globally in the treatment and outcomes of stage III patients with non-small cell lung cancer (NSCLC). We conducted an up-to-date patterns of care analysis in the state of Victoria, Australia, with a particular focus on the proportion of patients receiving treatment with radical intent, treatment trends over time, and survival. Stage III patients with NSCLC were identified in the Victorian Lung Cancer Registry and categorized by treatment received and treatment intent. Logistic regression was used to explore factors predictive of receipt of radical treatment and the treatment trends over time. Cox regression was used to explore variables associated with overall survival (OS). Covariates evaluated included age, sex, ECOG performance status, smoking status, year of diagnosis, Australian born, Aboriginal or Torres Strait Islander status, socioeconomic status, rurality, public/private status of notifying institution, and multidisciplinary meeting discussion. A total of 1396 patients were diagnosed between 2012 and 2019 and received treatment with radical intent 67%, palliative intent 23%, unknown intent 5% and no treatment 5%. Radical intent treatment was less likely if patients were >75 years, ECOG ≥1, had T3-4 or N3 disease or resided rurally. Surgery use decreased over time, while concurrent chemoradiotherapy and immunotherapy use increased. Median OS was 38.0, 11.1, and 4.4 months following radical treatment, palliative treatment or no treatment, respectively. Almost a third of stage III patients with NSCLC still do not receive radical treatment. Strategies to facilitate radical treatment and better support decision making between increasing multimodality options are required.

Cytochrome P450 2D6 (CYP2D6) and glucose-6-phosphate dehydrogenase (G6PD) genetic variations in Thai vivax malaria patients: Implications for 8-aminoquinoline radical cure.

Primaquine and tafenoquine are the only licensed drugs that effectively kill the hypnozoite stage and are used to prevent Plasmodium vivax malaria relapse. However, both primaquine and tafenoquine can cause acute hemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient people with varying degrees of severity depending on G6PD variants. Additionally, primaquine efficacy against malaria parasites was decreased in individuals with impaired cytochrome P450 2D6 (CYP2D6) activity due to genetic polymorphisms. This study aimed to characterize G6PD and CYP2D6 genetic variations in vivax malaria patients from Yala province, a malaria-endemic area along the Thai-Malaysian border, and determine the biochemical properties of identified G6PD variants. Multiplexed high-resolution melting assay and DNA sequencing detected five G6PD variants, including G6PD Kaiping, G6PD Vanua Lava, G6PD Coimbra, G6PD Mahidol, and G6PD Kerala-Kalyan. Biochemical and structural characterization revealed that G6PD Coimbra markedly reduced catalytic activity and structural stability, indicating a high susceptibility to drug-induced hemolysis. While Kerala-Kalyan had minor effects, it is possible to develop mild adverse effects when receiving radical treatment. CYP2D6 genotyping was performed using long-range PCR and DNA sequencing, and the phenotypes were predicted using the combination of allelic variants. Decreased and no-function alleles were detected at frequencies of 53.4% and 14.2%, respectively. The most common alleles were CYP2D6*36+*10 (25.6%), *10 (23.9%), and *1 (22.2%). Additionally, 51.1% of the intermediate metabolizers showed CYP2D6*10/*36+*10 as the predominant genotype (15.9%). Our findings provide insights about genetic variations of G6PD and CYP2D6 in 88 vivax malaria patients from Yala, which may influence the safety and effectiveness of radical treatment. Optimization of 8-aminoquinoline administration may be required for safe and effective treatment in the studied population, which could be a significant challenge in achieving the goal of eliminating malaria.

Definitive local therapy for extracranial single-organ oligorecurrent non-small-cell lung cancer: A single institutional retrospective study.

Oligometastatic non-small-cell lung cancer (NSCLC) is potentially curable. Oligo-recurrence occurs with oligometastatic disease characterized by well-controlled primary lesion. The purpose of the present study was to explore the value of definitive local therapy (DLT) for extracranial single-organ oligorecurrent NSCLC. A total of 81 patients with NSCLC who had extracranial single-organ oligorecurrence after receiving radical treatment at the Cancer Hospital of the University of Chinese Academy of Sciences from January 2010 to December 2017 were analyzed. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). The median follow-up time of the 81 patients was 65.8 months. A total of 39 patients received DLT. A large proportion of patients who did not accept DLTs received specific tyrosine kinase inhibitors (TKIs). The results of multivariate analysis showed that DLT and specific TKI therapy were favorable prognostic factors significantly related to PFS. Further analysis showed that for patients without specific TKI therapy, DLT significantly improved PFS and the 5-year PFS rate. The 5-year OS rate also improved, but the improvement was not significant. For extracranial single-organ oligorecurrent NSCLC, PFS was significantly superior in patients receiving DLT. Among them, for the subgroup of patients who did not receive specific TKI therapy, DLT is expected to improve long-term prognostic outcomes.

Clinical Outcomes in cN+M0 Bladder Cancer Patients: Can Bladder be Spared?

<h3>Purpose/Objective(s)</h3> Optimum management of patients initially presenting with clinically node positive non-metastatic (cN+M0) bladder cancer is a topic of debate with significant variation in practice worldwide. In the UK, fit patients are offered – after platinum-based chemotherapy - either radical cystectomy (RC) or radical radiotherapy (RadRT) – a bladder preserving treatment. There is a paucity of evidence to guide clinician and patient decision making on choice of treatment. A multi-center UK retrospective analysis was undertaken to assess clinical outcomes for cN+M0 bladder cancer. <h3>Materials/Methods</h3> A multicenter retrospective analysis was conducted on patients from four large UK Oncology Centers. Patients initially presenting with cN+M0 bladder cancer between 2012 and 2021 were identified. Data was collected on treatment received, clinical outcomes and patient and tumor factors. Overall survival (OS) was calculated as time from initial diagnosis of bladder cancer. Univariable and multivariable analysis was performed on patients receiving radical treatment using the variables; age, performance status (PS), T and N stage, primary chemotherapy and radical treatment received. <h3>Results</h3> 288/292 patients with cN+M0 bladder cancer identified had survival data available for analysis. Median OS of the whole analyzed cohort (n=288) was 1.54 years (95% CI 1.35-1.82). 163/288 patients received a treatment with radical intent. OS was significantly higher in the radical vs palliative treatment group (log-rank test, p<0.0001). Median OS in the radical and palliative groups were 2.41 years (95% CI,1.92-2.78) and 0.89 year (95% CI, 0.68-1.07) respectively. Patients treated radically received either RC (n=76) or RadRT (n=87) with no difference is OS between the two groups (log-rank test p=0.5). Median OS for those receiving RadRT was 2.53 years (95% CI, 2.02-3.44) vs 2.09 years (95% CI, 1.79-3.13) for RC. In a univariable analysis of patients receiving radical treatment, improved OS was positively associated with lower PS (HR 0.61 (95% CI 0.41-0.91) p=0.02), lower T stage (HR 0.59 (95% CI 0.37-0.95) p=0.03) and receiving primary chemotherapy (HR 0.6 (95% CI 0.4-0.9) p=0.01). No variables retained significance on multivariable analysis. <h3>Conclusion</h3> This multi-center retrospective analysis of survival outcomes gives real-world data on a large cohort of patients with cN+M0 bladder cancer. A limitation of our data is the risk of confounders when comparing retrospective cohorts. Overall survival unfortunately remains poor in this cohort but was significantly longer in patients who received radical-intent treatment. There was no difference in overall survival between patients receiving RC and RadRT. Given the equivalent survival outcomes in these patients whose overall prognosis remains poor, our data would support wider use of radiotherapy to avoid risks from major surgery in node-positive patients.

Acceptance and disparities of PET/CT use in patients with esophageal or gastro-esophageal junction cancer: Evaluation of mature registry data.

PET/CT plays a crucial role in esophageal (EC) and gastroesophageal junction cancer (GEJ) diagnosis and management. Despite endorsement in clinical guidelines, variation in acceptance of PET/CT exists. The aim of this study was to assess the early use of PET/CT among EC and GEJ patients in a regionalized setting and identify factors contributing to disparity in access. Retrospective cohort study of adults with EC or GEJ between 2012 and 2014 from the Population Registry of Esophageal and Stomach Tumours of Ontario and Ontario Health (Cancer Care Ontario). Receipt of PET/CT and relevant demographics were collected, and statistical analysis performed. Continuous data were analysed with t-tests and Wilcoxon rank sum test. Categorical data were analysed with chi-square test. Kaplan-Meier methods were used to estimate median survival. Fifty-five percent of patients diagnosed with EC or GEJ between 2012 and 2014 received PET/CT (1321/2390). Eighty-four percent of patients underwent surgical resection (729/870), and 80% receiving radical treatment (496/622) underwent PET/CT. The use of PET/CT increased from 2012 to 2014. Male patients received more PET/CT than females (85% vs.78% p < 0.001).Median survival for the overall cohort was 11.1 months, 17.2 vs. 5.2 months among those who did and did not receive PET/CT and 35 vs. 27 months among the surgical cohort (p = 0.16). We found that PET/CT use increased from 2012 to 2014 and that the majority of EC/GEJ patients being considered for curative therapy received PET/CT. There were also gender disparities identified. PET/CT appears to confer a potential survival benefit in our study, although our assessment is limited. Our findings may serve as learned lessons for other new imaging modalities, new indications for PET/CT or even for the introduction of new radiopharmaceuticals for PET/CT.

Microwave ablation therapy assisted by artificial pneumothorax and artificial hydrothorax for lung cancer adjacent to the vital organs.

ObjectivesThis study aimed to investigate the technical methods and safety of artificial pneumothorax and artificial hydrothorax in the treatment of lung cancer adjacent to vital organs by CT-guided microwave ablation.Subjects and MethodsThree of the six patients were men and three were women, with a mean age of 66.0 years (range 47–78 years). There patients had primary pulmonary adenocarcinoma, one had lung metastasis from liver cancer, one had lung metastasis from colon cancer, and one had lung metastasis from bladder cancer. There were four patients with a single lesion, one with two lesions, and one with three lesions. The nine lesions had a mean diameter of 1.1 cm (range 0.4–1.9). In three patients, the lung cancer was adjacent to the heart, and in the remaining three, it was close to the superior mediastinum. Six patients were diagnosed with lung cancers or lung metastases and received radical treatment with microwave ablation (MWA) assisted by artificial pneumothorax and artificial hydrothorax in our hospital. Postoperative complications were observed and recorded; follow-up was followed to evaluate the therapeutic effect.ResultsThe artificial pneumothorax and artificial hydrothorax were successfully created in all six patients. A suitable path for ablation needle insertion was also successfully established, and microwave ablation therapy was carried out. 2 patients developed pneumothorax after operation; no serious complications such as operation-related death, hemothorax, air embolism and infection occurred.Moreover, 4–6 weeks later, an enhanced CT re-examination revealed no local recurrence or metastasis, and the rate of complete ablation was 100%.ConclusionsMicrowave ablation, assisted by artificial pneumothorax, artificial hydrothorax, is a safe and effective minimally invasive method for treating lung cancer adjacent to the vital organs, and optimizing the path of the ablation needle and broadening the indications of the ablation therapy

Adenoid Cystic Carcinoma of the Breast May Be Exempt from Adjuvant Chemotherapy.

Consistent standards regarding whether postoperative adjuvant chemotherapy is required in the treatment of adenoid cystic carcinoma of the breast (ACCB) are currently lacking. Using clinical data from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2015), and the National Cancer Center of China (2004–2020), we retrospectively analyzed patients with ACCB who received radical treatment. A total of 661 patients were eligible. The median age at diagnosis was 61 years; 99.5% of patients were initially diagnosed with stage I and II breast cancer, and 76.7% had triple-negative breast cancer. Only 12.4% of patients received adjuvant chemotherapy. Multivariate analysis showed that patients with lymph node metastasis and non-radiotherapy had worse overall survival (OS) (p < 0.05). Patients with lymph node metastasis, stage IIB and III, histological grade ≥ 2, and non-radiotherapy had worse breast cancer-specific survival (BCSS) (p < 0.05). Adjuvant chemotherapy did not improve the OS or BCSS. Patients treated with adjuvant chemotherapy also had no better survival outcomes after propensity score matching. External data verification confirmed that chemotherapy did not improve disease-free survival or OS. Adjuvant chemotherapy cannot improve the clinical outcomes of ACCB, even in subgroups with a high risk of recurrence and metastasis.

Intensity-Modulated Radiotherapy Associated With Improved Survival Outcome in Anal Cancer.

PurposeTo describe the survival and toxicity outcome from a single-centre experience in patients with squamous cell cancer of the anal canal (SCC-AC), related to the impact of technological advances in diagnostics and radiation techniques.Material and MethodsA retrospective cohort study was performed after the approval of the institutional ethical committee (EK 478-21). We identified 142 patients in our registry, who received radical treatment for SCC-AC between 2000 and 2020. Fifty-five patients had FDG PET/CT for initial staging and target volume delineation, 87.33% received concomitant chemoradiotherapy (CRT), 64 patients were treated with 3-dimensional conformal radiotherapy (3DRT) between 2000-2009, and 78 patients with intensity-modulated radiotherapy (IMRT) between 2009-2020. Endpoints for the analysis included locoregional relapse-free survival (LRFS), disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). Acute and late toxicities were also reported.ResultsAt a median follow-up of 31.2 months, the median overall survival was 135 months, 5-year LRFS was 73.1%, 5-year DFS was 65.3%, and 5-year CSS was 75.3%. The use of IMRT was associated with shorter treatment duration. In the univariate analysis, IMRT was associated with significantly improved DFS and CSS for the whole cohort and significantly improved DFS, OS, and CSS for patients who received CRT. In the multivariate analysis, IMRT was associated with the improvement of all survival paraments. The use of FDG PET/CT did not translate into an improvement in the survival outcomes in both univariate and multivariate analyses. Grade-3 and more dermatological toxicities occurred less frequently, but hematological toxicities were more frequent in the IMRT-group. Late side effects and colostomies were less frequently reported in the IMRT group.ConclusionThe use of IMRT in the management of SCC-AC was associated with improvement of the oncological outcomes with improved toxicity profiles in this long-term single-centre experience.