Underwent Salvage Resection Research Articles

A phase I/II trial investigating weekly docetaxel and carboplatin (DC) given neoadjuvantly and then concurrently with concomitant boost radiotherapy (CB-XRT) for locally advanced squamous cell carcinoma of the head and neck

5543 Background: This study assessed the safety and efficacy of induction DC given weekly x 4, followed by weekly DC and CB-XRT. Methods: Eligible patients had Stage III or IV (M0) disease of the oropharynx, supraglottic larynx, or hypopharynx identified by ENT examination, contrast-enhanced CT, chest x-ray, and serum panels. Patients also had a baseline FDG-PET scan. Eligible patients could have resectable or unresectable disease. Patients initially received D 20 mg/m2 and C AUC 2 weekly x 4 and were reevaluated by direct laryngoscopy and CT. Given the short duration of induction, only patients with evidence for disease progression during induction were removed from study for salvage. Patients subsequently received D 10–20 mg/m2 and C AUC 1 weekly x 5 with CB-XRT (1.8 Gy qd x 15 days, followed by 1.8/1.5 Gy bid x 13 days). 19 patients have enrolled. Results: Fifteen patients are evaluable (5 Stage III, 10 Stage IV). Patients are currently receiving the target dose level of D 20 mg/m2 weekly with radiation. No dose limiting toxicities have been seen. Maximum toxicity during chemoradiotherapy has been limited to grade 3 mucositis, dysphagia, and/or fatigue. Five patients have required supportive G tube alimentation more than 4 months after treatment. Primary site responses following induction include 3 PR, 9 SD, and 3 patients who progressed. Twelve patients continued on to chemoradiotherapy, with 4 clinical CR and 8 PR at the primary site per follow-up CT. 7/8 patients with a radiographic primary site PR were shown to be disease free via direct laryngoscopy and biopsying. One patient had persistent disease and underwent salvage resection. 12/12 patients completing all treatment have remained disease free, with median follow-up of 13 months. Conclusions: This regimen has promising activity and acceptable toxicity. Patient accrual at the D 20 mg/m2 dose level during radiation is ongoing, and we continue to collect toxicity and outcome data. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Oncology Aventis Pharmaceuticals

A phase II, window study of SP1049C as first-line therapy in inoperable metastatic adenocarcinoma of the oesophagus

4195 Background: SP1049C is a block co-polymer incorporating doxorubicin resulting in broad in vitro activity and superior anti-tumour activity in 9 out of 9 in vivo animal tumour models compared to doxorubicin. Methods: Chemotherapy- or radiotherapy-naïve patients with measurable, inoperable or metastatic, biopsy-proven, adenocarcinoma of the oesophagus; KP ≥60; normal cardiac LVEF; adequate swallowing and adequate renal, hepatic and bone marrow function were eligible. Treatment: SP1049C 75mg/m2 IV 30-minute infusion was given q3w, for up to 6 cycles. Radiological response was assessed after cycles 2, 4 and 6. Upon disease progression (PD) patients were offered standard chemotherapy. Other assessments included: QoL (by QLQ-C30 and QLQ-OES24 questionnaires), toxicity, disease-related symptoms and cardiac function. Results: From February 2002 to date, 17 male patients; median age 62 years (range 49 – 78); 16 with stage IV disease and 1 unknown stage (TxN1M0); were enrolled. 10 patients are eligible for efficacy analysis. Radiological response after 2 cycles: one (10%) PR, 8 (80%) SD (including 4 (40%) with minor responses) and one (10%) PD. Further partial responses have been seen after cycles 4 and 6 (by investigator assessment) and will be reported in due course. One responding patient underwent salvage resection (pT2N0 (Stage 2A) tumour). Toxicity data is available for 2 cycles for the first 11 patients. Gd 3–4 haematological toxicity (by patient): neutropaenia 8 (73%), leucopaenia 7 (64%), anaemia (0%) and platelets (0%) resulting in six (55%) patients being dose-reduced to 55 mg/m2 at cycle 2. Non-haematological toxicity (Gd1–2,Gd3–4): nausea (73%,0%), anorexia (45%,9%), lethargy (55%,18%), febrile neutropaenia (0%,36%), weight loss (35%,0%), vomiting (45%,18%), mucositis (55%,9%), and Gd 1–2 alopecia in 55%. A significant fall in LVEF (pre-defined as an absolute ≥15% drop from baseline value) was seen in 2 patients. Conclusions: SP1049C appears to be active in advanced oesophageal adenocarcinoma based on the preliminary results of the first 10 patients and the study will continue accrual to a total of 24 evaluable patients. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Supratek Pharma, Inc. Supratek Pharma, Inc. Supratek Pharma, Inc. Supratek Pharma, Inc.

A phase II, window study of SP1049C as first-line therapy in inoperable metastatic adenocarcinoma of the oesophagus

4195 Background: SP1049C is a block co-polymer incorporating doxorubicin resulting in broad in vitro activity and superior anti-tumour activity in 9 out of 9 in vivo animal tumour models compared to doxorubicin. Methods: Chemotherapy- or radiotherapy-naïve patients with measurable, inoperable or metastatic, biopsy-proven, adenocarcinoma of the oesophagus; KP ≥60; normal cardiac LVEF; adequate swallowing and adequate renal, hepatic and bone marrow function were eligible. Treatment: SP1049C 75mg/m2 IV 30-minute infusion was given q3w, for up to 6 cycles. Radiological response was assessed after cycles 2, 4 and 6. Upon disease progression (PD) patients were offered standard chemotherapy. Other assessments included: QoL (by QLQ-C30 and QLQ-OES24 questionnaires), toxicity, disease-related symptoms and cardiac function. Results: From February 2002 to date, 17 male patients; median age 62 years (range 49 – 78); 16 with stage IV disease and 1 unknown stage (TxN1M0); were enrolled. 10 patients are eligible for efficacy analysis. Radiological response after 2 cycles: one (10%) PR, 8 (80%) SD (including 4 (40%) with minor responses) and one (10%) PD. Further partial responses have been seen after cycles 4 and 6 (by investigator assessment) and will be reported in due course. One responding patient underwent salvage resection (pT2N0 (Stage 2A) tumour). Toxicity data is available for 2 cycles for the first 11 patients. Gd 3–4 haematological toxicity (by patient): neutropaenia 8 (73%), leucopaenia 7 (64%), anaemia (0%) and platelets (0%) resulting in six (55%) patients being dose-reduced to 55 mg/m2 at cycle 2. Non-haematological toxicity (Gd1–2,Gd3–4): nausea (73%,0%), anorexia (45%,9%), lethargy (55%,18%), febrile neutropaenia (0%,36%), weight loss (35%,0%), vomiting (45%,18%), mucositis (55%,9%), and Gd 1–2 alopecia in 55%. A significant fall in LVEF (pre-defined as an absolute ≥15% drop from baseline value) was seen in 2 patients. Conclusions: SP1049C appears to be active in advanced oesophageal adenocarcinoma based on the preliminary results of the first 10 patients and the study will continue accrual to a total of 24 evaluable patients. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Supratek Pharma, Inc. Supratek Pharma, Inc. Supratek Pharma, Inc. Supratek Pharma, Inc.

Primary germ cell tumors in the mediastinum: a 50-year experience at a single Japanese institution.

Primary germ cell tumors (GCT) of the mediastinum share similar clinical and biologic characteristics, which are different from their testicular counterpart. The purpose of the current study was to review the authors' institutional experience of mediastinal GCT, emphasizing the clinical spectrum, time trends of treatment, and recent advances in therapeutic modalities for malignant GCT. Between 1951 and 2000, 129 patients (70 males and 59 females) underwent surgical treatment for GCT, which accounted for 16.0% of the mediastinal tumors during the same period. There were 95 patients with mature teratomas, 13 patients with seminomas, and 21 patients with nonseminomatous germ cell tumors (NSGCT) with median ages of 26.4 years, 27.6 years, and 28.5 years, respectively. Adult patients with mature teratomas were less symptomatic (33.3%) than pediatric patients (52.4%). All patients with mature teratoma were cured by resection alone. Eight of the 13 patients (61.5%) with seminoma were symptomatic and 10 of 13 patients (83.3%) survived after surgery and radiation with/without chemotherapy. Nineteen of 21 patients (90.5%) with NSGCT had dyspnea, chest pain, and superior vena cava syndrome. Before 1985, patients received radical resection and/or chemoradiotherapy. However, all patients died due to disease progression, with a median survival period of 7.6 months. After 1986, six of eight patients received cisplatin-based chemotherapy, including three who received additional high-dose chemotherapy with a supporting peripheral blood stem cell transplantation until tumor markers normalized. Five patients who underwent salvage resection are currently disease free with a median survival period of 58.3 months. The institutional experience indicates the benign nature of mediastinal mature teratomas and the excellent prognosis for patients with seminomas after resection. An improved survival advantage was ensured with cisplatin-based preoperative chemotherapy in patients with NSGCT.

Long-term results of local excision for rectal cancer.

To review the authors' experience with local excision of early rectal cancers to assess the effectiveness of initial treatment and of salvage surgery. Local excision for rectal cancer is appealing for its low morbidity and excellent functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome. Patients with T1 and T2 adenocarcinomas of the rectum treated by local excision as definitive surgery between 1969 to 1996 at the authors' institution were reviewed. Pathology slides were reviewed. Among 125 assessable patients, 74 were T1 and 51 were T2. Thirty-one patients (25%) were selected to receive adjuvant radiation therapy. Fifteen of these 31 patients received adjuvant radiation in combination with 5-fluorouracil chemotherapy. Median follow-up was 6.7 years. One hundred fifteen patients (92%) were followed until death or for greater than 5 years, and 69 patients (55%) were followed until death or for greater than 10 years. Recurrence was recorded as local, distant, and overall. Survival was disease-specific. Ten-year local recurrence and survival rates were 17% and 74% for T1 rectal cancers and 26% and 72% for T2 cancers. Median time to relapse was 1.4 years (range 0.4-7.0) for local recurrence and 2.5 years (0.8-7.5) for distant recurrence. In patients receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to patients not receiving radiotherapy. Among 26 cancer deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 patients who developed tumor recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only, 18% local and distant, and 32% distant only. Among the 17 patients with isolated local recurrence, 14 underwent salvage resection. Actuarial survival among these surgically salvaged patients was 30% at 6 years after salvage. CONCLUSIONS The long-term risk of recurrence after local excision of T1 and T2 rectal cancers is substantial. Two thirds of patients with tumor recurrence have local failure, implicating inadequate resection in treatment failure. In this study, neither adjuvant radiotherapy nor salvage surgery was reliable in preventing or controlling local recurrence. The postoperative interval to cancer death is as long as 10 years, raising concern that cancer mortality may be higher than is generally appreciated. Additional treatment strategies are needed to improve the outcome of local excision.

Local Excision of Rectal Carcinoma

The purpose of this study was to identify the recurrence rate, the salvage rate after recurrence, and the overall survival after local excision of rectal adenocarcinomas. A retrospective medical chart review was performed in 31 consecutive patients with rectal adenocarcinoma who underwent local excision at Roswell Park Cancer Institute from January 1990 through December 1999. After excision nine patients were excluded from further analysis because they were found to have advanced stage on pathologic examination (T2 primary tumors with vascular invasion or T3 tumors). Eight of the nine patients underwent abdominoperineal resection as definitive therapy. In the remaining 22 patients who underwent transanal excision as definitive surgical therapy there were 13 patients with T1 tumors and nine patients with T2 tumors. Overall seven patients (32%) developed local recurrences after local excision. This included four patients with T1 and three patients with T2 primary tumors. All recurrences occurred in the seven patients who did not receive adjuvant chemoradiation. All patients underwent salvage resection of the recurrence. Four patients who underwent salvage resection of the recurrence remain without evidence of disease at a median follow-up of 19.5 months. Local excision without adjuvant therapy has an unacceptably high rate of local recurrence. Although most patients who recur locally are salvaged by radical resection the long-term results after resection remain unknown. The use of adjuvant chemoradiation appears to reduce this high recurrence rate and may eventually become a standard adjunct to local excision of rectal cancer.