Stage IVA Disease Research Articles

Impact of staging on survival outcomes: a nationwide real-world cohort study of metastatic uveal melanoma.

No data exist regarding whether any first-line treatment for metastatic uveal melanoma provides overall survival (OS) benefit, if staged and compared to best supportive care (BSC). We analyzed OS in a nationwide, consecutive cohort diagnosed with metastatic uveal melanoma between January 1999 and December 2016. The Helsinki University Hospital Working Formulation was used to assign patients to stage IVa, IVb and IVc, corresponding to predicted median OS ≥12, <12-6 and <6 months, respectively. OS of 216 actively treated patients was compared by treatment and working formulation stage against 108 similarly staged, concurrent patients managed with BSC using Kaplan-Meier analysis and Cox regression. The median OS with active treatment was 18 (range, 0.7-162), 6.9 (range, 1.3-30) and 1.9 (range, 0.2-18) months in working formulation stage IVa, IVb and IVc, respectively. Patients who received chemoimmunotherapy, selective internal radiation therapy, or underwent surgical resection survived longer - median OS 13, 16 and 24 months, respectively - than those receiving conventional chemotherapy - median OS 5.1 months - but only with surgical resection their OS exceeded that with BSC, both overall and in stage IVa (P < 0.001, P = 0.010). In stage IVb and IVc, no difference in OS was observed in any comparison. Staging of patients is crucial when comparing survival after metastatic uveal melanoma. Only surgical resection for stage IVa disease provided longer OS in our national cohort. We additionally recommend stage-specific comparison of novel treatments against available BSC data.

Selecting the optimal neoadjuvant treatment approach based on the risk of an involved surgical margin in locally advanced adenocarcinoma of the esophagus and esophagogastric junction.

198 Background: Optimal neoadjuvant (NA) treatment for adenocarcinoma of the esophagus and esophagogastric junction is unknown. This study aims to evaluate an approach of offering NA chemoradiotherapy (CRT) to T3/T4 tumours with a threatened circumferential resection margin (CRM) on staging imaging (computerized tomography/endoscopic ultrasound/positron emission tomography) and NA chemotherapy (CT) to T3/T4 tumours with a non-threatened CRM. Methods: Cases with clinically staged T3/T4 tumours who underwent a radical esophagectomy at a single tertiary referral centre between 2013 and 2019 were retrospectively reviewed. NA CRT was given as 41.4Gqy in 23 fractions with weekly carboplatin/paclitaxel and NA CT was given as a platinum based combination. Survival outcomes are described using the Kaplan-Meier method and calculated from NA treatment start. Results: 81 patients were identified - 18 (22%) received CRT and 63 (78%) received CT. More cases had Stage IVA disease in the CRT group (28% vs. 8%). CT consisted of a platinum/fluoropyrimidine doublet (43%), triplet with epirubicin (51%) or FLOT (6%). Median follow up was 68 months. Median length of post-operative stay (11 days for both) and rate of death within 90 days of surgery (6% vs. 3%) were similar. Rates of R0 resection (100% vs. 67%) and tumour regression grade 1/2 (55% vs. 14%) favoured CRT. There was no difference in overall survival (HR 0.92 (95%CI: 0.45-1.87), p=0.81). Estimated 3 year relapse-free survival was 39% (95%CI: 14-64) for CRT and 45% (95%CI: 33-58) for CT. Location of first relapse was local, distant or both in 0%, 75% and 25% for CRT and 6%, 50% and 44% for CT. In the CT group, overall survival was inferior for patients with an R1 resection (HR: 6.30 (95%CI 3–14), p&lt;0.001). Conclusions: Neoadjuvant chemoradiotherapy for CRM-threatened cases of locally advanced adenocarcinoma of the esophagus and esophagogastric junction resulted in a very low rate of R1 resection and similar survival outcomes to non-CRM-threatened cases treated with neoadjuvant chemotherapy. Tailoring the neoadjuvant approach based on risk to CRM involvement appears feasible and warrants further investigation. [Table: see text]

Clinicopathological and prognostic features of nasopharyngeal carcinoma in children and adolescents: A retrospective study of 196 cases in South China.

Nasopharyngeal carcinoma (NPC) occurring in children and adolescence is extremely rare and till present there is a lack of understanding on their clinicopathological and prognostic features of this rare entity. For our study, data of 196 cases children and adolescents with NPC from the past 18 years at a high-volume cancer center from South China were retrospectively analyzed. Half of the evaluated NPC patients (83/166, 50.0%) were staged as Stage IVa disease, whereas 1.2% (2/166), 27.7% (46/166), 16.9% (28/166) and 4.2% (7/166) had Stage II, III, IVb and IVc disease, respectively. Serum EBV EA-IgA ≥1:10 and VCA-IgA ≥1:40 were found in 67.7% (113/167) and 76.6% (128/167) of the evaluated patients, respectively, whereas 56.8% (84/148) of the patients had plasma EBV DNA ≥1000 copies/mL. Histologically, all tumors were classified as nonkeratinizing squamous cell carcinoma (NK-SCC). Immunohistochemistrically, the expression of CK (AE1/AE3), P63, CK5/6 and P40 were observed in 100% (88/88), 93.2% (68/73), 84.1% (58/69) and 63.2% (12/19) of the detected cases, respectively. All cases show similar immunophenotype compared to that occurring in adult patients. All evaluated cases (71/71 100%) harbored EBER. Patients with plasma EBV DNA ≥1000 copies/mL and positive serum EBV antibodies had significantly inferior 3-year OS (88% vs 100%, P = .007) compared to other corresponding groups. The combination of EBV serology and plasma EBV DNA are useful to predict the outcome of patients with NPC in children and adolescents.

Does Operable Stage IV Gingivobuccal Cancers Need Further Prognostic Subgrouping?

Operable stage IV gingivobuccal complex cancer is classified as Stage IVA and IVB. Among patients with Stage IVA disease, different subgroups with likely different prognoses are combined. Patients with advanced nodal status tend to have a poorer prognosis. We divided these patients into four groups: group I (T4aN0), group II (T4aN1-2), group III (T1-3N2) constituting stage IVA category, and group IV (TanyN3) representing stage IVB. This study assesses if these patients can be prognostically subgrouped based on nodal status. It is a prospective observational study done at a tertiary care center from July 2017 to June 2020. This study aims to analyze survival outcomes in these subgroups using Kaplan Meir, univariate and multivariate analysis. The study enrolled 113 patients of operable gingivobuccal complex stage IVA cancer with a median follow up of26months, disease-free survival (DFS) was 74% for group 1, while it was 55%, 26% and 32.2% for group 2, group 3 and group 4 respectively. Patients with T4N3 disease had DFS of just 15%. Patients in group 3 and 4 had the worst outcomes in terms of DFS and Overall Survival(OS) with HR-3.7 and 3.3 and 3.3 and 3.8 respectively (p value-0.001). The nodal status is the most important prognostic factor affecting DFS and OS. Patients with small primary but advanced nodal stage do poorly than patients with advanced primary and node-negative disease. There is a need for subgrouping patients with Stage IVA tumors based on nodal status for better prognostication.

Importance of resection for locoregional disease control in Masaoka stage IVA thymic neoplasms.

It is unclear if a specific strategy for simultaneous treatment of primary thymic neoplasms and pleural metastases confers benefit for Masaoka stage IVA disease. We reviewed our experience with thymic neoplasms with concurrent pleural metastases to identify factors influencing outcomes. Records of patients who presented with stage IVA thymic neoplasms from 2000 to2018 were assessed. Multivariate Cox proportional hazards analyses were completed to determine predictors of progression-free and overall survival. Forty-eight patients were identified, including 34 (71%) who underwent surgery. Median overall and progression-free survival were 123 and 21 months, respectively. The extent of resection varied, and was most commonly thymectomy plus partial pleurectomy (22, 65%). Median progression-free survival for patients who underwent surgical resection versus those who had not was 24 versus 12 months (P = .018). Following surgical resection, mediastinal recurrence was uncommon (2, 6%, vs 7, 50% nonoperatively). Five-year survival rates in these groups were suggestive of possible benefit to surgery (87% vs 68%). Thymic neoplasms with pleural dissemination represents a treatment challenge. As part of a multidisciplinary approach, surgery appears to be associated with more favorable long-term results, although selection bias may account for some of the survival differences observed.

Efficacy and safety of neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin and oral metronomic chemotherapy (OMCT) in patients with technically unresectable oral cavity squamous cell carcinoma (SCC).

e18550 Background: NACT regimen for patients with oral cavity scc is based on maximum tolerated doses (MTD). Combination of MTD and metronomic chemotherapy schedule will lead to initial debulking of tumor and subsequent inhibition of angiogenesis, this may produce synergistic effect and overcome the drug resistance of MTD schedule. We assessed the efficacy and safety of this combination as NACT in patients with technically unresectable oral cavity SCC. Methods: This is retrospective analysis of prospectively maintained data. Fourteen patients having technically unresectable oral cavity SCC received NACT with paclitaxel (175mg/m2) plus carboplatin (AUC5) 3 weekly (MTD schedule) and OMCT (methotrexate 9mg/m2 once a week, celecoxib 200mg twice daily and erlotinib 150mg once daily). Patient were assessed clinically and radiologically after minimum of two cycles for resectability. Radiological response was evaluated as per RECIST 1.1. We report response rate, resectability and tolerance of this NACT regimen. Results: Median age of the patients was 38 years. Twelve patients (85%) were male. Twelve (85%) and two (15%) patients had buccal mucosa and oral tongue primary respectively. AJCC 2017 stage IVA and IVB disease was present in 85% and 15% patients respectively. Reason for technical unresectabilty was skin edema above zygoma in five (36%), high infratemporal fossa involvement in five (36%), nodal encasement of major vessels in two (14%) and posterior extent of oral tongue tumor into oropharynx in two (14%) patients. Median number of NACT administered were three. The tumor of nine (64%) patients showed partial response and none of the patients had tumor progression. Tumor of nine patients (64%) were deemed resectable after NACT. Common grade 3/4 toxicities (CTCAE 5.0) were neutropenia in eight (57%), thrombocytopenia in three (21%), febrile neutropenia, hypokalemia and diarrhoea in two patients (14%) each. Conclusions: Paclitaxel and carboplatin along with OMCT is well tolerated and easily administered NACT regimen with high response rate and resectabilty in patients with technically unresectable oral cavity SCC.

Outcomes analysis of pre-brachytherapy MRI in patients with locally advanced cervical cancer

IntroductionVarious brachytherapy options are available for treating cervical cancer. This study investigated whether pre-brachytherapy magnetic resonance imaging (MRI) findings could help identify the appropriate brachytherapy technique for cervical cancer.MethodsWe retrospectively...

Neoadjuvant chemotherapy, radical hysterectomy and chemoradiation for stage iva cervical carcinoma

Despite the efficacy of chemotherapy and radiotherapy in the management of locally advanced cervical carcinoma, the overall survival rates are relatively inauspicious. We recount a case involving a 56-year-old stage IVA cervical cancer patient who underwent neoadjuvant chemotherapy, a type V radical hysterectomy and adjuvant chemoradiation in April 2006. The patient remained in clinical remission for five years until she developed a metastatic pulmonary nodule in her right middle lobe that originated from the primary cervical cancer. Thereafter, the patient was diagnosed with a right metastatic cardiophrenic nodule that responded favorably to chemotherapy. However, in August 2014, she presented with a metastatic posterior cranial fossa tumor from which she ultimately expired; interestingly, radiologic imaging revealed no evidence of an abdominopelvic recurrence. While a radical hysterectomy is often indicated for advanced cervical cancer patients with residual disease or those who fail chemoradiation, perhaps in select cases (e.g., stage IVA disease), initial treatment with neoadjuvant chemotherapy and surgery followed by chemoradiation may improve patient survival.

Nation‐wide survival outcomes of metastatic uveal melanoma with best supportive care

AbstractPurposeTo report overall survival (OS) of patients with metastatic uveal melanoma who received best supportive care (BSC).MethodsRetrospective cohort study of patients with primary uveal melanoma treated between January 1999 and December 2016 at a national referral center and diagnosed with metastasis before December 2016. The patients who received BSC as the only treatment were enrolled. Complete data for all patients was requested from all hospitals that had participated in management. Age, gender, time from primary tumour to metastasis, presence of symptoms, locations of metastases, largest metastasis diameter, WHO performance index, and liver function tests were collected. Predicted median survival time calculated according to the Ophthalmic Oncology Group (OOG)‐validated Helsinki University Hospital Working Formulation (HUCH‐WF) was used to assign patients to stages IVa, IVb, and IVc, which correspond to predicted survival times of &gt;12, &lt;12–6, and &lt;6 months, respectively. Primary endpoint was OS estimated with Kaplan–Meier analysis.ResultsThe median OS was 1.6 months (range 0–65.8, 95% CI 1.0–3.4) from the beginning of treatment in 84 patients. According to the HUCH‐WF, 20 (23%) patients with known survival time were assigned to stage IVa, 16 (19%) to IVb, 41 (49%) to IVc, and 7 (8%) were missing data. OS according to the HUCH‐WF was 11.1 months (95% CI 8.3–22.0) in stage IVa, 3.4 months (95% CI 1.0–10.0) in IVb, and 0.7 months (95% CI 0.4–0.9) in IVc.ConclusionsHUCH‐WF can differentiate by OS patients who receive BSC. The OS for stage IVa disease was similar to the median OS of 12.8 months reported in a meta‐analysis for all patients who receive active treatment. However, divided by HUCH‐WF, comparison with our data suggest that patients who receive active treatment for stage IVa and IVb disease might live on average 7 months longer (OS 18.6, 10.7, and 4.6 months for stage IVa, IVb, and IVc, respectively, in the OOG validation study).

Survival benefits from concomitant chemoradiotherapy before radical surgery in stage IVA sinonasal mucosal melanoma?

BackgroundThe aim of the study was to review a local treatment protocol for sinonasal mucosal melanoma (SNMM) focusing on triple modality treatment (TMT), that is, neoadjuvant concomitant chemoradiotherapy (CRT) and surgery.MethodsIn a retrospective design, data on clinical presentation, treatment, and survival were retrieved for 22 consecutive patients from a tertiary referral center.ResultsThe mean overall survival (OS) for all patients (3 stage III, 16 stage IVA, and 3 stage IVB) was 62 months, and the 5‐year OS rate 50%. Four of the 22 patients received treatment with palliative intention. Of the 18 patients who received treatment with curative intention, patients with stage IVA disease who received TMT (n = 10) had a 5‐year OS of 70% and 10‐year OS of 20%. The median disease‐free survival for these patients was 51 months compared with 9 months for stage IVA not receiving TMT (n = 4).ConclusionA seemingly favorable survival outcome for a disease with characteristically poor prognosis was observed. The lead finding was a high survival rate (70% 5‐year OS) for stage IVA patients who received neoadjuvant TMT. The observations suggest the possibility that patients with advanced SNMM (stage IVA) might benefit from concomitant CRT before surgery by delaying the onset of local recurrences and distant metastases.Level of EvidenceLevel 4, case series (with or without comparison).

GR01.05 Site of Oligometastases

GR01.05 Site of Oligometastases

Laryngeal squamous cell carcinoma at a South African referral hospital

Introduction and aim: Laryngeal squamous cell carcinoma (LSCC) is the most common tumour of the head and neck region. The aim of this study was to determine the profile of patients with laryngeal carcinoma who presented to Universitas Academic Hospital over a 6 year period and to review their management.Methods: This was a retrospective descriptive cross-sectional study. The records of 250 patients with LSCC between 1 January 2010 and 31 December 2015 were reviewed.Results: The median age at presentation was 60.1 years, with 86.8% being males. Dysphonia was present in 99.6% of patients, but there was also a high prevalence of late symptoms. Most patients (51.6%) presented with Stage IVa disease and 21.6% presented with Stage IVb disease. Nodal metastases were present in 60.4% of patients, while 4.8% had systemic metastases. There was high rate of patients who defaulted treatment and poor patient follow-up.Conclusion: Late presentation is a significant problem at our institution with 95.6% of patients who presented with stage III and stage IV tumours.

Overall survival trends for cervical cancer in the modern era: A U.S.A. population based analysis.

e17024 Background: In the past two decades, several advancements have been made in the treatment of cervical cancer such as concurrent chemotherapy, robotic surgery, intensity modulated radiotherapy, 3D brachytherapy planning, and MRI visualization, yet most published survival data is based on historical treatment paradigms. We sought to report domestic treatment outcomes in the modern era to determine if current treatment paradigms resulted in higher overall survival rates. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients with cancers of the cervix uteri diagnosed between 2004-2010, had 5-year survival data recorded, and a specific AJCC 6th edition stage assigned. We excluded patients diagnosed after 2010 as the dataset only included survival information until the end of 2015. We used the FIGO 2006 report on cervical cancer as our historical comparator. Chi-square tests were used to determine statistical significance. Results: 32,028 patients in the database met the criteria specified above. The 5-year survivals by stage are compared in the table below. Survival was statistically inferior in SEER patients with stage IIa disease but superior in SEER patients with stage IIIb, IVa, and IVb disease. When comparing SEER patients diagnosed in the earlier (2004-2007) versus the later half of the study period (2008-2010), there were no clinically relevant differences in 5-year survival except in stage IVA patients (19.8% vs 26.6%, p &lt; 0.0001). Conclusions: The 5-year overall survival rates in women with cervical cancer here in the USA in the modern era were similar to those published in the 2006 FIGO report. Inferior outcomes were seen in stage IIa patients but superior outcomes were seen in stage IIIb+ patients. [Table: see text]

Nationwide treatment patterns of oropharyngeal cancer in the human papillomavirus era.

e17521 Background: Human papillomavirus-mediated (HPV+) oropharyngeal cancer is now defined as a clinically distinct entity from HPV-unrelated (HPV-) disease in the 8th edition AJCC staging system, which more accurately informs prognosis for HPV+ patients. Treatment decisions are currently made according to the AJCC 7th ed staging. HPV+ patients are associated with favorable outcome. This study aims to analyze the national pattern of practice for HPV+ disease. Methods: Patients with oropharyngeal squamous cell carcinoma (OPSCC) diagnosed from 2010-2012 were identified from the National Cancer Database (NCDB). Patients were staged using the AJCC 7th system. Chemotherapy, radiotherapy and surgery were counted as treatment modalities. Fisher’s exact test and chi-squared test were used to assess treatment patterns over time. Overall survival (OS) was compared with Cox proportional hazards model. Results: 5,928 HPV+ OPSCC patients were identified. Single modality (surgery or radiation) was the most common treatment choice, used in 53.6% of stage I and 48.8% of stage II patients. For stage I, the use of dual modality therapy (70.8% received surgery with radiation) decreased from 36% in 2010 to 19% in 2012 (p = 0.05), though no significant difference in OS was seen between dual modality and single modality. Dual modality with chemoradiation was the main approach for stage III (58.6%) and stage IVA (67.5%) disease. Use of trimodality decreased from 2010 to 2012 in both stage III (p = 0.03) and stage IVA (p &lt; 0.01). Conclusions: Using a national cohort of HPV+ patients from the NCDB, we showed that single modality was the most common for stages I/II and dual modality was the mainstay for stages III/IVA. Usage of aggressive approaches (dual modality for stages I/II and trimodality for stages III/IVA) decreased over time. Prospective studies would be needed to determine the optimized therapeutic choice for HPV+ patients given favorable outcome.

Clinical Factors Associated With Cost in Head and Neck Cancer: Implications for a Bundled Payment Model.

To determine which factors influence cost in head and neck cancer (HNC) to inform the development of a bundled payment model (BPM). Patients with stages 0 to IVB (by American Joint Commission on Cancer, 7th edition) HNC of various sites and histology treated definitively at a single tertiary care center during 2013 were included. Clinical variables and direct cost data were obtained, and their associations were investigated using χ2, t, Wilcoxon rank sum, and analysis of variance testing. Results were used to develop a BPM. One hundred fifty patients were included; 87% were white, 74% were men, 48% had oropharyngeal cancer, and 58% had stage IVA disease. Treatment consisted of surgery alone (17%), radiation alone (11%), surgery plus radiation (14%), chemoradiation (45%), and surgery plus chemoradiation (13%). On multivariable analysis, both increasing group stage and number of treatment modalities used were significantly associated with higher cost. Given that stage often dictates treatment, we developed three cost tiers that were based on overall treatment modality. Tier A, the least costly, consisted of single-modality therapy with either surgery alone or radiation alone (median cost divided by the median overall cost of treatment, 0.54; 25th to 75th percentile range, 0.29 to 1.02), followed by tier B, which consisted of bimodality therapy with either chemoradiation or surgery plus radiation (1.03; range, 0.81 to 1.35), followed by tier C, which consisted of trimodality therapy with surgery plus chemoradiation (1.43; range, 1.10 to 1.96). The number of treatment modalities required is the primary driver of cost in HNC. These data can simplify development of a comprehensive HNC BPM.

Epidemiology and prognostic factors for mycosis fungoides and Sézary syndrome in a multi-ethnic Asian cohort: a 12-year review.

Limited information exists regarding survival of Asian patients with mycosis fungoides (MF) and Sézary syndrome (SS). To evaluate the epidemiology, outcome and prognostic factors of these patients. A retrospective review of MF/SS cases diagnosed from 2000 to 2011 at a tertiary referral dermatology centre in Singapore was performed. Of 246 patients, 63% were male and the median age at diagnosis was 49years. 73.2% were Chinese, 12.6% Indian, 6.9% Malay and 7.3% Caucasian. A total of 239 patients (97.2%) had MF and seven had SS. Median follow-up duration was 6.3years, and median duration of symptoms at diagnosis was 13months. For patients with MF, the majority had early disease (92.8% stage IA-IIA). 3.8% were stage IIB, 1.7% stage III and 1.7% stage IV. Complete response to treatment occurred in 78.2%, partial response in 9.6%, persistent but non-progressive disease in 10.0% and disease progression in 4.1% of patients. Large cell transformation occurred in 4.1% of patients. Mean overall survival during this study was 12.7years, with death occurring in 2.5% of patients (all ≥stage IIB at diagnosis). For patients with SS, 71.4% presented with stage IVA disease, 28.6% stage IVB. Complete response to treatment occurred in 14.2%, persistent but non-progressive disease in 28.6% and disease progression in 57.2% of patients. Mean overall survival was 3.3years within this study, with death occurring in 42.9% of SS patients. Prognostic factors associated with favourable recurrence-free survival were male gender (P=0.008), early disease stage (T1) at diagnosis (P<0.001) and absence of maintenance treatment after remission (P=0.01). Compared to Caucasian and East Asian cohorts, MF in South-East Asians was diagnosed at a younger age and associated with lower mortality, largely due to greater prevalence of hypopigmented MF.

Validating the AJCC 8th Edition of the Oral Cavity Cancer Staging System: A Multi-institutional Collaborative Study

We conducted a multi-institutional study to interrogate survival outcomes in patients with oral cavity squamous cell carcinoma (OC-SCC) treated definitively grouped according to the AJCC 8th edition staging system and compared them to the 7th edition system for best fit analysis. An IRB approved collaborative database of patients with primary OC-SCC stage I-IVb (AJCC 7th edition) treated with primary surgical resection between 1/1/2005 and 1/1/2015 with or without adjuvant therapy was established from 6 academic medical centers. From a total sample size of 1282 patients, we identified 1037 patients who had sufficient staging data to be included. Survival rates were generated using Kaplan Meier analysis. A Cox proportional hazards model was generated for each staging system and Akaike information criterion (AIC) was calculated for each. The study population consisted of 647 men (62%), 868 Whites (84%) with a median age of 61 and a median f/u of 56 months (1-180). Oral tongue was the most common location (38%), followed by floor of mouth (18%), alveolus (14%) and other. All patients had primary resection, 91% had a neck dissection, 46% had postop radiation therapy alone and 37% had postop chemoradiation. The stage was changed in 388 pts (37%) in the 8th edition, all of whom were upstaged (see Table 1). Relative to stage I, AJCC 8 failed to show a significant difference in survival for stage II (HR 1.2; p=0.63) and stage III disease (HR 1.5; p=0.14), while stages IVa (HR 2.5; p<0.001) and IVb (HR 4.8; p<0.001) demonstrated significantly inferior survival. AJCC 8 5yr OS rates were similar compared to AJCC 7 for stage I (81%) and II disease (77% vs 75%), higher for stage III (72% vs 65%) and stage IVa disease (55% vs 47%), and lower for stage IVb disease (34% vs 44%), respectively. The AIC were smaller for AJCC 8 (5,804 vs. 5,841) indicating better fit. The AJCC 8th edition upstaged 37% of patients with OC-SCC leading to more uniform representation within each stage. The 8th edition outperformed the 7th edition in distinctiveness, most notably in stage IVa and IVb disease.Abstract 41; Table 1Distribution of patients according to AJCC stageAJCC 7AJCC 8TotalIIIIIIIVAIVBI804112--133II-6952--121III--11237-149IVA---379246625IVB----99Total801101764162551037 Open table in a new tab

Induction Chemotherapy with Paclitaxel Liposome, Nedaplatin, and Fluorouracil in Patients with Locally Advanced Nasopharyngeal Carcinoma: A Phase II Study

A previous study found that adding cisplatin, fluorouracil, and docetaxel (TPF) induction chemotherapy to concurrent chemoradiotherapy could improve failure-free survival in patients with locoregionally advanced nasopharyngeal carcinoma (NCT01245959). Paclitaxel liposome may have fewer side effects and work better than paclitaxel. Nedaplatin, a cisplatin analog, has been developed to decrease the toxicities induced by cisplatin, such as nephrotoxicity and gastrointestinal toxicity. In this study, we aimed to evaluate the safety and efficacy of induction chemotherapy with paclitaxel liposome, nedaplatin, and fluorouracil in patients with locally advanced nasopharyngeal carcinoma. In total we included 46 patients with newly diagnosed and pathologically confirmed stage III-IV nonkeratinized nasopharyngeal carcinoma in Nanjing University affiliated Drum Tower Hospital from 2015 May to 2017 June. Patients were treated with paclitaxel Liposome (135mg/m2), nedaplatin (60mg/m2), and fluorouracil (600mg/m2/day×5days), every 3 weeks for 2 cycles. If patients achieved partial response (PR) or complete response (CR) according to the RECIST criteria 1.0, another cycle was then added. Radiotherapy plus concurrent chemotherapy with nedaplatin was subsequently given with a total dose of 70Gy-74Gy with 2Gy per fraction in 35-37 fractions. Treatment response was evaluated 1 month after the end of the treatment. If patients achieved PR or CR, the treatment was consequently ended. The median age of studied patients was 50 years old (range, 25-74 years). Twenty-eight patients (60.9%, 28/46) had stage III disease, nine (19.6%, 9/46) had stage IVa disease and nine patients (19.6%, 9/46) were with stage IVb disease. Thirty-eight patients completed 3 cycles induction chemotherapy (80.1%, 38/47). CTCAE version 4.0 was referred to grade treatment-related toxicities. Three patients (6.5%, 3/46) developed grade 3 bone marrow suppression. Grade 1 nausea occurred in 3 patients (6.5%, 3/46) and grade 1 malaise occurred in 5 patients (10.9%, 5/46). After the induction chemotherapy, no patients achieved CR, 37 patients (80.4%, 37/46) achieved PR, 8 patients (17.4%, 8/46) were with stable disease (SD) and 2 patients (4.3%, 2/46) developed progressive disease (PD) (PR in primary tumor but with lung metastases). After induction chemotherapy plus concurrent chemoradiotherapy, all the patients achieved PR or CR. The median follow-up was 16 months (range, 8-33 months). Distant metastases occurred in 9 patients (5 patients with lung metastasis, 2 with bone metastasis, 2 with liver metastasis), and only 1 patient had in-field recurrence. Induction chemotherapy with paclitaxel liposome, nedaplatin, and fluorouracil is safe and efficient for patients locally advanced nasopharyngeal carcinoma. This regimen is well tolerated and might be especially helpful for patients with poor performance status. The long-term survival will be updated in future.

The Prognostic Value of Pretreatment Neutrophil-to-lymphocyte Ratio in Hypopharyngeal Cancer Receiving Definitive Radiation Therapy

Neutrophil-to-lymphocyte ratio (NLR) had been reported as an important prognostic factor in a variety of cancers. We aimed to examine the association between pretreatment NLR and treatment response and to determine the prognostic significance of pretreatment NLR in hypopharyngeal cancer treated with definitive radiation therapy. We retrospectively reviewed the medical records of patients with hypopharyngeal cancer who had undergone definitive radiation therapy at the National Cheng Kung University Hospital, Taiwan, during the period from September 2009 to March 2014. We retrieved the following prognostic factors from patients’ medical records: age, sex, body mass index (BMI), comorbidity, performance status, pretreatment hemoglobin level, TNM stage based on AJCC 7th edition, tumor differentiation, and treatment duration. Pretreatment NLR was obtained from the results of blood tests within two weeks before starting curative treatment and calculated by dividing the number of the absolute neutrophil count by the number of lymphocyte count. Treatment response to radiation therapy was assessed with RECIST version 1.0. We used the chi-square test for the evaluation of the correlation between pretreatment NLR and treatment response. Next, we calculated overall survival (OS) and progression-free survival (PFS) by the Kaplan-Meier method and utilized the Cox proportional hazards model to compare survival curves between high pretreatment NLR (NLR ≥ 4) and low NLR (NLR < 4) patients. All statistical analysis was conducted using MedCalc software (version 15.2.2, Ostend, Belgium). We included 114 patients in this study. Median follow-up time was 27.8 months. Most patients were male (n = 111, 97.4%), and their median age at diagnosis was 55 (range, 32–83) years. They had a good performance status (Eastern Cooperative Oncology Group 0–1, n = 100, 87.7%); their median BMI was 21.9 (range, 13.0–31.5). Eighty (70.2%) patients had no comorbidity or mild comorbidity, and 34 (29.8%) patients had moderate to severe comorbidity. Eight (7.0%) cases had stage I or II disease; 15 (13.2%) cases had stage III disease; 73 (64.0%) cases had stage IVA disease, and 18 (15.8%) cases had stage IVB diseases. Chi-square test results revealed that high pretreatment NLR (NLR ≥ 4) was correlated with poor treatment response (p = 0.04*). Cox proportional analysis showed that pretreatment NLR was an independent prognostic factor for OS (HR = 1.7562; 95% CI, 1.0252-3.0084; p = 0.0413*). In hypopharyngeal cancer patients treated with definitive radiation therapy, we found that pretreatment NLR was correlated with treatment response. After controlling for known prognostic factors, pretreatment NLR was still an independent factor for overall survival. Incorporating pretreatment NLR may improve the performance of prognostic models.

Treatment Outcome and Prognostic Factors of Anaplastic Thyroid Carcinoma: A Single Institution Experience in Egypt

Introduction: Anaplastic thyroid carcinoma (ATC) is a rare lethal malignancy. It is one of the most aggressivehuman malignancies with limited progress in finding effective therapies.Aim: We aimed to study the treatment outcome and prognostic factors of ATC patients treated at our institution.Methods: We retrospectively analyzed charts of 30 ATC patients, treated at the Clinical Oncology Department,Ain-Shams University from 2006 to 2017. The clinical characteristics and factors affecting survival were studied.Kaplan-Meier survival curve was used to analyze the overall survival (OS) of the patients.Results: The median age of patients was 60 years and males represented 63% of them. Almost half of patients(47%) had stage IVA disease. Equal number of patients received combined modality treatment versus singlemodality treatment (37% each). The median OS was 3 months (95% Confidence interval: 1.429-4.571). Variablesassociated with significantly better OS in univariate analysis included male sex (p=0.04), stage IVA disease(p=0.012), surgical treatment (p=0.034), radiotherapy (p=0.003), and combined modality treatment (p=0.005).However, only female sex was identified as significant poor prognostic variable of OS (p=0.043) by multivariateanalysis.Conclusion: Our results of treatment outcome and prognosis of ATC agree with most of the literature.Multimodality treatment is currently the standard of care. While still there is no successful treatment of this rapidlyfatal disease, exploration of novel therapies and approaches are warranted to help improve the outcome.