Treatment Tolerance In Patients Research Articles

Role of Radiotherapy for Adrenal Gland Metastases – A Single Institution Experience

Adrenal glands are often the metastatic site, that can be manifested as oligoprogressive or oligometastatic disease. Radiotherapy (RT) techniques such as stereotactic body radiation therapy (SBRT) and motion-management techniques (MMT) could be new promising modalities in this indication. The aim of the study was to assess the local effectiveness of RT for adrenal metastases (AM). The study group was a retrospective cohort of patients who received RT for AM in our institute between 2013-2019. The following parameters were analyzed: indication for RT, irradiated gland, pathology of primary tumor, RT technique, MMT, total dose (TD), equivalent 2-Gy dose (EQD2), dose per fraction (FD), early and late toxicity (CTCAE v4.0), local response (LR). Chi-squared test, and Fisher's exact tests were used to analyze proportions. The Spearman's rank correlation test was used to calculate correlation between EQD2 and best LR. Progression-free survival (PFS) was calculated using the Kaplan-Meier method, from the start of RT to the last follow-up (censored), disease progression or death. Totally n = 40 patients were found. Two patients were irradiated sequentially to both glands with at least two months interval, thus n = 42 RTs were analyzed. Two patients were irradiated to both glands at the same time, thus n = 31 left glands, n = 13 right glands were treated. The indications for RT were: oligometastases (n = 12), oligoprogression (n = 27), palliative (n = 3). The diagnoses were: melanoma (n = 21), lung cancer (n = 12), and others (n = 7). Data related to RT techniques and MMT were presented in the table. FD varied from 2 to 12 Gy, and TD from 20 to 50 Gy. EQD2 varied from 23 to 116 Gy. Acute grade 2 toxicities were observed in two patients. No significant late toxicity was observed. RT allowed to obtain complete response in two patients, partial response in 15 patients, stable disease in 14 patients and progressive disease in three patients. In eight patients, data regarding LR were not available. No correlation between EQD2 and the best LR was found (p = 0.31). In-field progression at any time occurred in nine patients. The occurrence of in-field progression did not differ between patients who were treated with MMT and those who did not (p = 1.00). PFS was 5.78 months. Table. Radiotherapy and motion-management techniques Modern RT allowed for high LR with good treatment tolerance in patients with AM. The MMT may be applied in selected patients, however, it might be not obligatory in RT for AM. The optimal dose/fractionation is unknown and should be limited by the tolerance of adjacent organs at risk.Abstract 2410; TableRTFusionMotion managementMRPETNoneBreath- hold4D-CT planningAbdominal compressionAbdominal compression + 4D-CT planningTrackingNone3D-conformal008001007IMRT/VMAT0010003007SBRT3318199320IMRT/VMAT - Intensity Modulated Radiation Therapy/Volumetric Modulated Arc Therapy; SBRT - Stereotactic Body Radiation Therapy Open table in a new tab

The Use of Nutraceuticals in Patients with “Dry” Form of Age-Related Macular Degeneration on the Background of Accelerated Aging

The lutein-containing vitamin-mineral complex Retinorm, developed on the basis of the formula AREDS 2, with an optimal content of vitamins and minerals involved in antioxidant protection, is a potentially promising ophthalmic geroprotector.Purpose: to evaluate the effectiveness of vitamin-mineral complex “Retinorm” in patients with the dry form of AMD and accelerated pace of aging.Patients and Methods. The study involved 40 patients with a dry form of AMD (stage 2.3 according to AREDS classification) with an accelerated rate of aging (biological age of patients was measured by the method of Tokar, 1990). Gender distribution: men — 15 (37.5 %), women — 25 (62.5 %). The mean age of patients was 67.3 ± 6.8 years. Patients were divided into 2 groups. Patients of the study group (n = 20) were assigned “Retinorm” 1 capsule 3 times a day for 16 weeks. Patients of the control group (n = 20) were treated with “Lutein Forte” 1 capsule 2 times a day for 16 weeks. Visometry, perimetry, optical coherence tomography of the macular zone, measurement of biological age at the beginning of the study, at 2 and 4 months of the study, the tolerability of treatment in patients with a dry form of age — related macular degeneration on the background of taking dietary supplements-vitamin and mineral complexes with lutein and zeaxanthin.Results and discussion. As a result of treatment, there were the positive dynamics in terms of visometry and perimetry in the main and control groups. There were no negative dynamics of the indicators of thickness of the retina (in the area of the fovea), and increased macular volume in the main group. In the control group there was a weak tendency to the growth of these indicators. We found a significant positive effect of Retinol on the biological age of patients to 4 months of therapy. It allows to consider the drug as a promising ophthalmoscopy an agent. The results of the study showed the effectiveness of the inclusion of “Retinorm” in patients with the dry form of AMD. The proven geroprotective effect of “Retinorm” with good tolerability of treatment and the absence of side effects from all organ systems with a long term of administration allows us to recommend it for wide use in patients with a dry form of age-related macular degeneration, including patients with an accelerated rate of aging.

Total Neoadjuvant Therapy (TNT) in Rectal Cancer

This review summarizes the relevant literature on the use of total neoadjuvant therapy (TNT) for patients with locally advanced rectal cancer. It highlights the most notable literature published and briefly discusses future directions. Recent randomized trials evaluating TNT show improved rates of pathologic complete response and patient treatment tolerance with this approach. The rationale for TNT includes the poor patient tolerance of adjuvant chemotherapy and the persistent risk of distant disease in patients with locally advanced rectal cancer, despite improvements in local control. Randomized trials have focused on short-term pathologic endpoints. Ongoing phase 3 trials are evaluating long-term disease-related outcomes, allowing for a more thorough evaluation of this treatment paradigm. TNT may also facilitate organ preservation in appropriately selected patients.

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer.

Rationale: It has been shown that early nutrition intervention improves nutrition status (NS) and treatment tolerance in patients with esophageal cancer. However, it remains unknown whether pretreatment parameters of NS are associated with treatment modifications (TMs) during neoadjuvant chemoradiation (CR) in patients who are intensively nutritionally supervised during treatment. Methods:All outpatients with esophageal cancer who were scheduled for CR in the VU medical center from 2006–2015 were included. NS was assessed by body mass index (BMI), weight loss in the past 6 months (WL), fat mass index (FMI) and fat-free mass index (FFMI), handgrip strength (HGS), and energy/protein intake. Logistic regression analyses, adjusted for age, sex, previous tumor, tumor stage, and physical status, were applied. TMs were defined as delay, dose reduction or discontinuation of chemotherapy and/or radiotherapy, hospitalization, or mortality (yes/no). Results: In total, 162 patients were included (73% male; mean age 65 ± 9 years). Mean BMI was 25.1 ± 4.5 kg/m2, and WL was 4.8 ± 5.1 kg. HGS and FFMI were below the 10th percentile of reference values in 21 and 37 patients, respectively. Thirty-five (22%) patients experienced at least 1 TM during CR; unplanned hospitalization (n = 18, 11%) was the most prevalent. After adjustments for confounders, only HGS was statistically significantly associated with TMs (odds ratio, 0.93; 95% confidence interval, 0.88–1.00). Conclusion: In this group of intensively supervised patients with esophageal cancer, pretreatment parameters of NS had little influence on TMs during CR. Only a lower HGS was associated with TMs.

Efficacy and Tolerability of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency at a Hospital Outpatient Clinic: A Retrospective Cohort Study of Real-World Clinical Practice.

Ferric carboxymaltose (FCM) is an intravenous iron formulation to correct iron deficiency. Although its use has been extensively studied in clinical trials, real-world evidence regarding FCM treatment is scarce. Our aim was to evaluate the efficacy and tolerability of FCM treatment in patients with iron deficiency, with or without anemia, at a hospital outpatient clinic. Data was collected retrospectively from medical records. During this 2-year study, 459 patients were included. Mean age was 58.6 ± 17.5 years and most patients received cumulative FCM doses of 501–1000 mg (63.2%). Six weeks after administration of FCM, efficacy endpoints hemoglobin increase ≥2 g/dL, hemoglobin increase ≥3 g/dL, and transferrin saturation > 20% were attained by 41%, 20%, and 63% of patients, respectively. Patients who received higher FCM doses showed significant reduced odds of not achieving hemoglobin increase ≥2 g/dL (501–1000 mg, adjusted odds ratio [OR]: 0.34, 95% confidence interval [CI] 0.18–0.62; 1001–3000 mg, OR: 0.19, 95% CI 0.07–0.49), compared to 500 mg doses. Treatment-emergent adverse events were documented in <4% of patients. In conclusion, FCM treatment was effective and well-tolerated by outpatients with iron deficiency at a hospital clinic, and its dosage should be adjusted to improve iron deficiency management in clinical practice.

Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma.

Background and aimTo evaluate the impact of percutaneous endoscopic gastrostomy (PEG) tube on nutritional status, treatment-related toxicity, and treatment tolerance in patients with locally advanced nasopharyngeal carcinoma (NPC) who underwent chemoradiotherapy.Patients and methodsWe enrolled 133 consecutive non-metastatic NPC (III/IV stage) patients, who were treated with prophylactic PEG feeding before the initiation of concurrent chemoradiotherapy (CCRT) between June 1, 2010 and June 30, 2014. Meanwhile, another 133 non-PEG patients, who were matched for age, gender, and tumor, node, metastases stage, were selected as historical control cohort. Weight and nutritional status changes from pre-radiotherapy to the end of radiotherapy were evaluated, and treatment tolerance and related acute toxicities were analyzed as well.ResultsWe found that significantly more patients (91.73%) in the PEG group could finish two cycles of CCRT, when compared with those in the non-PEG group (57.89%) (P<0.001). We also indicated that more patients (50.38%) in the non-PEG group experienced weight loss of ≥5%, while the phenomenon was only found in 36.09% patients in the PEG group (P=0.019). In addition, the percentage of patients who lost ≥10% of their weight was similar in these two groups. Changes in albumin and prealbumin levels during radiotherapy in the non-PEG group were higher than those obtained for the PEG group with significant differences (P-values of 0.023 and <0.001, respectively). Furthermore, patients in the PEG group had significantly lower incidence of grade III acute mucositis than those in the non-PEG group (22.56% vs 36.84%, P=0.011). Tube-related complications occurred only in 14 (10.53%) patients in the PEG group, including incision infection of various degrees.ConclusionPEG and intensive nutrition support may help to minimize body weight loss, maintain nutritional status, and offer better treatment tolerance for patients with locally advanced NPC who underwent CCRT.

Reversible sarcopenia in patients with gastrointestinal stromal tumor treated with imatinib.

BackgroundImatinib is a long-term, oral, targeted therapy for high-risk resected and advanced gastrointestinal stromal tumours (GIST). It is known that sarcopenia affects prognosis and treatment tolerance in patients with various solid cancers. We analysed lumbar skeletal muscle index changes in imatinib-treated GIST patients. Imatinib tolerance was also assessed to evaluate the influence of pre-treatment sarcopenia.MethodsThirty-one patients with advanced (n = 16) or high-risk resected (n = 15) GIST treated with imatinib (400 mg/day) were analysed retrospectively. Lumbar skeletal muscle indexes were evaluated on computed tomography images obtained before starting imatinib for all patients and at 6 months for those initially sarcopenic. Sarcopenia was defined using consensual cutoffs. Imatinib-induced toxicities were assessed after 3 months of administration.ResultsTwelve (38.7%) of the 31 patients were sarcopenic, including one unassessable at 6 months. Seven (63.6%) of the 11 assessable sarcopenic patients became non-sarcopenic after 6 months of imatinib. Pre-treatment sarcopenia was not associated with grades 3–4 toxicities, but the mean number of all-grade toxicities per sarcopenic patient was significantly higher for those non-sarcopenic (4.1 vs. 1.7, respectively, p < 0.01) after 3 months of treatment. Grades 1–2 anaemia and grades 1–2 fatigue were more frequent for sarcopenic than non-sarcopenic patients (83% vs. 26%, P < 0.01 and 42% vs. 5%, P = 0.02, respectively).ConclusionsSarcopenia is reversible in some GIST patients treated with imatinib. Pre-imatinib sarcopenia is predictive of non-severe toxicities, particularly anaemia and fatigue.

Abstract ES06-2: The impact of biological age

Abstract The prognosis of a woman with early breast cancer is dependent on both tumor and patient characteristics. Tumor-related prognostic factors, such as stage, grade, and biomarker expression are well-described in the breast cancer literature and remain the focus of considerable ongoing research efforts. However patient-related factors which may influence risks of death from competing causes of mortality or tolerance of adjuvant therapies receive less attention. Risks of death from other causes and likely tolerance of treatment are particularly important considerations in the management of the increasing number of older women who are now presenting with early breast cancer. Chronological age itself may be a useful predictor of these outcomes. However older patients represent a heterogeneous population in terms of co-morbidities, fitness, life expectancy, social situation, cognitive function as well as desire for treatment. Therefore an objective definition of “biological age” might be a more accurate predictor. Those involved in the care of older patients have therefore developed “Comprehensive Geriatric Assessments” (CGAs) which are based on questionnaires or simple physical measurements which may describe “biological age”. Furthermore blood-based biomarkers of biological age have also been developed. Co-morbidity is one component of a holistic patient assessment which has been shown to be a useful predictor of risk of death before recurrence in women with breast cancer (1). In addition questionnaires derived from CGAs may be good predictors of treatment tolerance in patients receiving chemotherapy (2). Ongoing studies are evaluating whether more extensive assessments, incorporating more domains of a CGA, such as functional status, cognitive function and nutrition add to the predictive model. Any incorporation of such measures into routine clinical practice will require further validation and confirmation of clinical utility. Nonetheless such tools assessing biological age do offer the promise to improve further on the advances made in personalising adjuvant therapies that pathological and molecular tumor characterisation have already achieved. As such it seems likely that assessment of these factors in order to more objectively take into account the risks of death from competing causes of mortality and likely tolerance of treatment will become core components to informed adjuvant treatment decisions in the future. 1. Ring A et al. J Clin Onc 2011; 29:4266-4272 2. Hurria A et al. J Clin Onc 2011;29:3457-3465. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr ES06-2.

Nutritional intervention for improving treatment tolerance in cancer patients

This study aims to assess various types of nutritional intervention for improving treatment tolerance in patients with malnutrition related to the cancer anorexia-cachexia syndrome. Malnutrition in cancer patients is associated with a poor prognosis, whereas weight loss is an important predictor of mortality. Disease and treatments have a major impact on nutritional status. By improving the latter, we can change the prognosis, quality of life and functional status, facilitating improved tolerance to treatment. Dietary counselling, recommended for patients at risk of malnutrition, should be introduced early in close collaboration with the patient. Administering oral nutritional supplements to malnourished patients has been shown to lead to a reduction in mortality, in complications and in the length of hospital stay. Supplementation with enteral nutrition has demonstrated an increase in appetite, energy intake, nutritional status and, above all, reduced gastrointestinal toxicity from cancer treatments due to a better response to them. Supplementation with home parenteral nutrition in aphagic and terminal patients has shown improved quality of life, energy balance, body composition and prolonged survival. Supplementation with ω3 fatty acids appears to offer benefits that are verifiable at a biochemical, clinical and functional level. Related literature, however, provides conflicting results; therefore further studies will be required to confirm their efficacy. Supplementation with glutamine appears to support the efficacy of chemoradiotherapy treatment while reducing toxicity of the tissues and improving outcomes. Oral supplementation with branched amino acid appears to reduce the length of hospital stay, decrease morbidity and improve the quality of life, without any changes in mortality. Perioperative supplementation with arginine has shown a reduced incidence of complications and a significant increase in long-term survival.

Thymoma: Results of treatment and role of radiotherapy

Purpose The aim of this study is to assess results of treatment, factors influencing prognosis with regard to causes of failure and treatment tolerance in patients with thymoma. Material and methods Between 1966 and 2006, 63 patients with thymoma had been treated at the Centre of Oncology in Krakow. Patients were treated by means of different treatment modalities: surgery followed by radiotherapy (52%), radiotherapy alone (13%), chemoradiotherapy alone (15%), surgery followed by chemoradiotherapy (5%), surgery alone (5%) and others. Results The 10-year locoregional recurrence-free survival (LRRFS) was 79%, disease free survival (DFS) was 57% and overall survival (OS) was 57%. Masaoka stage was the only independent prognostic factor for LRRFS. Masaoka stage and method of radiotherapy delivery (higher photon energies), were independent prognostic factors for OS. For DFS, the independent prognostic factors were age, type of treatment (favoured surgery followed by radiotherapy or chemoradiotherapy), Masaoka stage and year of start of treatment. Most common reactions were lung fibrosis in 36% of patients (mainly asymptomatic in most patients), pneumonitis (9%) and oesophagitis (4%). Conclusions Surgery combined with radiotherapy and chemoradiotherapy and modern radiotherapy techniques are correlated with improvement of survival in patients with early stage thymoma.

148 Analysis of early complications and treatment tolerance in patients treated with pulsed-dose-rate brachytherapy

148 Analysis of early complications and treatment tolerance in patients treated with pulsed-dose-rate brachytherapy

Tolerance of patients with human immunodeficiency virus and anal carcinoma to treatment with combined chemotherapy and radiation therapy.

To evaluate treatment tolerance in patients with and without the human immunodeficiency virus (HIV) who were undergoing treatment of anal cancer. The authors retrospectively reviewed the medical records of 62 patients with anal cancer who received radiation treatment. Seven patients had HIV, four of whom had acquired immunodeficiency syndrome. Fifty-five patients were HIV negative, including 11 patients identified as being at high risk for HIV infection whose status was unknown. Thirty of the 55 (55%) patients who were HIV negative required treatment breaks of a mean duration of 16.7 days. Four of those 55 (7%) patients required hospitalization. Three of 42 (7%) patients who were HIV negative receiving chemotherapy required chemotherapy dose reduction. All seven patients with HIV required treatment breaks of a mean duration of 21.7 days. Three of the seven (43%) patients required hospitalization. Four of the seven (57%) patients required chemotherapy dose reduction. Patients with HIV undergoing treatment of anal cancer have increased toxic reactions to chemoradiation. Treatment must be individually tailored on the basis of extent of disease and degree of compromise of the immune system.