Use Of Adjuvant Treatment Research Articles

Effect of age on likelihood of treatment and outcome in pancreatic cancer.

332 Background: Pancreatic cancer is a disease primarily diagnosed in elderly patients; however, a significant number of young patients will also be affected. We hypothesized young patients with pancreatic cancer would be treated more aggressively and therefore have better prognosis. Methods: A retrospective review of a prospectively maintained cancer database was queried for all patients treated for pancreatic cancer at our institution. Age 50 years was selected to stratify pancreatic cancer patients as young or old. Results: Of 320 pancreatic cancer patients identified from the database, 56 (18%) were ≤ 50 years old. Exocrine cancer was the most common histology (90%). Young patients were significantly more likely to have an endocrine cancer (23% vs. 7%, p<0.001). For all tumor histologies, there was no difference between young and old patients regarding stage, grade, or likelihood curative intent surgery; however, young patients were more likely to receive chemotherapy (59% vs. 40%, p=0.008) and radiation therapy (27% vs. 15%, p=0.03). There was a trend toward improved overall survival in young patients (23.9 months vs. 13.8 months, p=0.06). When only exocrine pancreatic cancers were considered, there was no difference between young and old patients regarding stage, grade, location, or likelihood of undergoing surgical treatment. In this group, young patients were again more likely to receive chemotherapy (65% vs. 40%, p=0.002) and radiation therapy (35% vs. 16%, p=0.003). There was no difference in overall survival between young and old patients with exocrine pancreatic cancer. Conclusions: A considerable number of patients with pancreatic cancer are ≤ 50 years old. Exocrine cancers are the most common pancreatic neoplasm regardless of age; however endocrine tumors are more common in young patients. Despite more frequent use of adjuvant treatment in exocrine pancreatic cancer patients ≤ 50 years old, there is no improvement in overall survival. Significant improvements in pancreatic cancer survival are not dependent on aggressive use of adjuvant therapies, but await the development of new treatment strategies. No significant financial relationships to disclose.

Long Term Sequelae of Pediatric Craniopharyngioma ? Literature Review and 20 Years of Experience

Craniopharyngioma are rare histologically benign brain tumors that develop in the pituitary–hypothalamic area. They may invade nearby anatomical structures causing significant rates of neurological, neurocognitive, and endocrinological complications including remarkable hypothalamic damage. Information regarding long term implications of the tumors and treatment in the pediatric population is accumulating, and treatment goals appear to be changing accordingly. In this review we aim to present data regarding long term complications of craniopharyngioma in children and adolescents and our experience from a large tertiary center. Hypothalamic dysfunction was noted to be the most significant complication, adversely affecting quality of life in survivors. Obesity, fatigue, and sleep disorders are the most notable manifestations of this dysfunction, and treatment is extremely difficult. Changes in management in recent years show a potential for improved long term outcomes; we found a trend toward less aggressive surgical management and increasing use of adjuvant treatment, accompanied by a decrease in complication rates.

Cutaneous melanoma in the elderly: epidemiology, prognosis and treatment

The incidence and mortality of cutaneous melanoma (CM) has increased over the last decades in fair-skinned populations. Incidence and mortality, as well as rates of increase, have been significantly higher in elderly people compared with younger age groups. Lower survival rates from CM among elderly are mainly the result of late diagnosis of tumors with dismal prognostic features. Expansion of current preventive strategies to include older age groups is therefore warranted. Despite differences in clinical presentation and pathological characteristics of CM in the elderly, there is no evidence that primary surgical treatment should differ from that proposed generally for melanoma. However, the rate of positive sentinel node dissection decreases with age, even though overall survival is shorter in older patients, a paradox that remains to be explained. The use of adjuvant treatment with interferon-alpha in elderly patients requires careful discussion of the risks and benefits, especially when serious illness coexists. For metastatic melanoma, complete metastasectomy is the only treatment associated with benefit for overall survival. However, careful selection of surgical oncogeriatric candidates is necessary, probably with the use of tools to provide a comprehensive geriatric assessment, to identify patients more likely to benefit from this treatment. In the absence of any effective systemic treatment for disseminated CM, new therapeutic agents are urgently needed. Practical means to improve accrual of older patients in clinical trials are necessary to provide better evidence for their treatment.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

The influence of MDT meetings on use of neo-adjuvant therapy, cancer recurrence and surgical resection rates for rectal cancer

Introduction: Formal multi-disciplinary team (MDT) meetings to discuss the management of cancer patients are considered current best practice. This study reviews the influence of MDT meetings on use of adjuvant treatment and local recurrence after treatment of rectal cancer at our hospital.

Lung metastases from colorectal cancer: surgical resection and prognostic factors☆

To analyse our experience with excision of lung metastases from colorectal carcinoma (CRC), and to evaluate clinically relevant prognostic factors, identifying the cluster of patients who would benefit from this procedure. Sixty-one patients, 42 men (69%), with primary CRC who underwent 94 curative resections of pulmonary metastases were retrospectively reviewed. Age was 30-80 years (mean 61.2+/-15). Population was analysed for age, sex, disease-free interval (DFI), prethoracotomy carcinoembryonic antigen (CEA) level, location and histology of primary tumour, number of lung lesions (and size of largest resected metastasis), type of lung resection, nodal involvement (hilar/mediastinal), use of adjuvant treatment, morbid-mortality and immediate and follow-up survival. Mean DFI was 29+/-22 months (range 5-132 months). There was no hospital mortality and significant morbidity occurred in five patients (8.2%). Mean follow-up was 39+/-4 months (range 4-173 months). Mean overall survival and disease-free survival were 67+/-16 months and 52+/-6 months, respectively. Three-, 5- and 10-year survival rates from date of primary colorectal resection were 83%, 71% and 43%, respectively. Three-, 5- and 10-year survival rates from date of lung resection were 61%, 48% and 11%, respectively. Five-year survival was 57% in patients with normal prethoracotomy CEA levels and 18% for those with high levels (>5 ng/ml) (p=0.039). Pulmonary metastasectomy has potential survival benefit for patients with metastatic colorectal carcinoma. Low morbidity and mortality rates, contrasting with lack of any other effective therapy, justify aggressive surgical management. Single deposits, DFI >36 months and normal prethoracotomy serum CEA were significant independent prognostic factors.

Improved survival for women with stage I breast cancer in south-east Sweden: A comparison between two time periods before and after increased use of adjuvant systemic therapy

Purpose. Continuous minor steps of improvement in the management of breast cancer have resulted in decreased mortality rates during the last decades. The aim of this study was to compare the clinical outcome of patients with stage I breast cancer diagnosed during two time periods that differed with respect to adjuvant systemic therapy. Material and methods. The studied population consisted of all women < 60 years of age, who were diagnosed breast cancer stage I between 1986 and 1999 in south-east Sweden, a total of 1 407 cases. The cohort was divided into two groups based on the management programmes of 1986 and 1992, hereafter referred to as Period 1 and Period 2. Before 1992 the only adjuvant systemic therapy recommended was tamoxifen for hormone receptor positive patients aged 50 years or older. During Period 2 the use of adjuvant treatment was extended to younger patients at high risk, identified by a high tumour S-phase fraction, with either hormonal or cytotoxic treatment. Results. The estimated distant recurrence-free survival rate was significantly higher during Period 2 than during Period 1 (p = 0.008). Subgroup analysis showed that the most evident reduction of distant recurrence risk was among hormone receptor-negative patients (HR = 0.58, 95% CI 0.31–1.09, p = 0.09) and among patients with a high tumour S-phase fraction (HR = 0.53, 0.30–0.93, p = 0.028). The risk reduction between the periods was still statistically significant in multivariate analysis when adjusting for different tumour characteristics and treatment modalities, indicating an influence of other factors not controlled for. One such factor may be the duration of tamoxifen treatment, which likely was more frequently five years during Period 2 than during Period 1. Conclusions. We conclude that the causes of the increase in distant recurrence free survival for women with breast cancer stage I are complex. The results support though that high-risk subgroups of stage I breast cancer patients did benefit from increased use of systemic therapy as a consequence of an updated management programme.

A Tracking and Feedback Registry to Reduce Racial Disparities in Breast Cancer Care

Black and Hispanic women with early-stage breast cancer are more likely than white women to experience fragmented care and less likely to see medical oncologists to get effective adjuvant treatment. We implemented a tracking and feedback registry to close the referral loop between surgeons and oncologists. We compared completed oncology consultations and use of adjuvant treatment among a group of 639 women with newly diagnosed stage I or II breast cancer who had undergone surgery at one of six New York City hospitals from 1999 to 2000 with the same outcomes for a different group of 300 women with breast cancer whose surgeries occurred in 2004-2006, after the implementation of the tracking registry. Underuse of adjuvant treatment was defined as no radiotherapy after breast-conserving surgery, no chemotherapy for estrogen receptor (ER)-negative tumors, or no hormonal therapy for ER-positive tumors 1 cm or larger. We used hierarchical modeling to adjust for clustering within hospital and surgeon practice. Odds ratios were converted to adjusted relative risks (aRRs). All statistical tests were two-sided. Implementation of the tracking and feedback registry was accompanied by a statistically significant increase in oncology consultations (83% before vs 97% after the intervention; difference = 14%; 95% confidence interval [CI] = 11% to 18%; P < .001) and decrease in underuse of adjuvant treatment (23% before vs 14% after the intervention; difference = -9%, 95% CI = -12% to -6%; P < .001). Underuse declined from 34% to 14% among black women, from 23% to 13% among Hispanic women, and from 17% to 14% among white women (chi-square of change in underuse from before to after among the three racial groups; P = .001). In multivariable models adjusting for clustering by hospital and surgeon, the intervention was associated with increased rates of oncology consultation (aRR = 1.6, 95% CI = 1.3 to 1.8), and reduced underuse of adjuvant treatment (aRR = 0.75, 95% CI = 0.6 to 0.9). Compared with the preintervention findings, minority race was no longer a risk factor for low rates of oncology consultation (aRR = 1.0, 95% CI = 0.7 to 1.3) or for underuse of adjuvant therapy (aRR = 1.0, 95% CI = 0.8 to 1.3). A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment.

Variation in surgical methods used for total laryngectomy in Australia

Deglutition disorders (dysphagia) are common following total laryngectomy. As the aetiology of the disorder is poorly understood, its incidence is probably under-estimated. Dysphagia may result from many factors, including the type of laryngectomy surgery employed and the use of adjuvant treatments (e.g. radiotherapy and chemotherapy). Dysphagia may also be compounded by other co-morbid factors, such as ageing and depression. To investigate the methods of surgical closure used by Australian ENT and head and neck surgeons after undertaking total laryngectomy surgery. In order to audit surgical variation, 56 short questionnaires were sent to all Australian ENT and head and neck surgeons who were registered members of the Australia and New Zealand Head and Neck Society. Twenty-eight questionnaires (50 per cent) were completed and returned. Respondents reported using a variety of different reconstructive methods after total laryngectomy surgery. Specifically, there were differences in the type and levels of pharyngeal closure employed and the suturing techniques used. Currently, there is no scientific evidence to direct surgeons to the optimal pharyngeal reconstruction technique(s) ensuring for good swallowing results post-laryngectomy. An analysis of the effect of surgical reconstruction technique on laryngectomees' post-operative swallowing ability is needed, in order to provide evidence to determine optimal surgical techniques.

La PET/TAC con 18F-FDG en la evaluación de la respuesta de los tumores del estroma gastrointestinal al tratamiento con imatinib

ObjectiveSeveral studies have demonstrated the effective use of adjuvant treatment with Imatinib mesylate for unresectable, metastatic or recurrent gastrointestinal stromal tumours (GIST). We retrospectively evaluated the role of 18F-FDG PET/CT scanning in assessing the response of GIST patients to imatinib mesylate therapy. Materials and methodsEight consecutive patients with GIST confirmed by surgery (4 stomach, 2 small bowel, 1 small bowel and peritoneum, and 1 rectum) underwent eighteen 18F-FDG PET/CT imaging after beginning imatinib mesylate therapy (400 mg/day or greater if disease progression). PET/CT scan was acquired 60-90 minutes after the intravenous injection of 333-707 MBq of 18F-FDG. Visual and semiquantitative (standardized uptake value [SUV]) analysis of images was performed. Response to therapy was assessed according to EORTC recommendations for PET. Results were confirmed by clinical follow-up, radiographic findings or histological analysis. ResultsComplete response to imatinib mesylate was observed in 5 patients. Four had abdominal lymph nodes, associated with liver metastases in 2, and the other had a residual tumour mass. Partial response (reduction in SUV and in the extent of FDG uptake) was demonstrated in a patient with lung nodules. Disease progression was observed in one patient who had developed new liver metastases on the PET/CT scan. One patient with multiple peritoneal implants and abdominal mass was a non-responder and died 2 months after the 18F-FDG PET/CT. Conclusion18F-FDG PET/CT scan identified the degree of GIST response to imatinib therapy. Patients who responded to therapy showed normalisation of FDG uptake or a decrease in the SUV of lesions.

Referral patterns and adjuvant chemotherapy use in patients with stage II colon cancer

17515 Background: Little is known about the rate of use of adjuvant chemotherapy in stage II colon cancer and about referral patterns that give patients access to this treatment. We studied patients from a tertiary referral center with stage II colon cancer to determine the factors associated with referral to medical oncology and adjuvant chemotherapy administration. Methods: We searched the tumor registry at Baylor University Medical Center Dallas to identify patients with stage II colon cancer who underwent resection between 1995- 2003. Pathologic stage was confirmed and referral information and patient characteristics were recorded from individual chart review. The rates of referral to medical oncology and adjuvant chemotherapy use were calculated and potential predictive variables including age, sex, insurance status, bowel obstruction at diagnosis, co-morbidity score, tumor grade and T stage were analyzed using univariate and multivariate techniques. Results: We identified 287 patients with stage II colon cancer, of which only one hundred and sixty patients (56%) were referred to a medical oncologist. Only poorly differentiated histology was a significant predictor of referral using multivariate analysis. Using univariate analysis, age younger than 50, private insurance status and poorly differentiated histology were significant predictors of referral. Eighty patients (28%) received adjuvant chemotherapy. Age younger than 50, private insurance status, lower co-morbidity score, higher T stage, and poor tumor differentiation were significant predictors of adjuvant chemotherapy use in univariate and multivariate analysis. Conclusions: During 1995–2003 just over half of patients at this large tertiary referral center with resected stage II colon cancer were referred to medical oncology, potentially limiting patient discussion and access to the full spectrum of cancer care options. Adjuvant chemotherapy was used frequently for the patients who were referred to medical oncology. In addition to accepted high-risk features such as T stage and tumor grade, patient age and co-morbidity score were significant predictors for the use of adjuvant treatment. No significant financial relationships to disclose.

Residual Treatment Disparities After Oncology Referral for Rectal Cancer

Black patients with rectal cancer are considerably less likely than white patients to receive adjuvant therapy. We examined the hypothesis that the lower treatment rate for blacks is due to underreferral to medical and radiation oncologists. We used 1992-1999 Surveillance, Epidemiology, and End Results-Medicare data to identify elderly (> or = 66 years of age) patients who had been hospitalized for resection of stage II or III rectal cancer (n = 2716). We used chi(2) tests to examine associations between race and 1) consultation with an oncologist and 2) receipt of adjuvant therapy. We then used logistic regression to analyze the influence of sociodemographic and clinical characteristics (age at diagnosis, sex, marital status, median income and education in area of residence, comorbidity, and cancer stage) on black-white differences in the receipt of adjuvant therapy. All statistical tests were two-sided. There was no statistically significant difference between the 134 black patients and the 2582 white patients in the frequency of consultation with a medical oncologist (73.1% for blacks vs 74.9% for whites, difference = 1.8%, 95% confidence interval [CI] = > 5.9% to 9.5%, P = .64) or radiation oncologist (56.7% vs 64.8%, difference = 8.1%, 95% CI = > 0.5% to 16.7%, P = .06), but blacks were less likely than whites to consult with both a medical oncologist and a radiation oncologist (49.2% vs 58.8%, difference = 9.6%, 95% CI = 0.9% to 18.2%, P = .03). Among patients who saw an oncologist, black patients were less likely than white patients to receive chemotherapy (54.1% vs 70.2%, difference = 16.1%, 95% CI = 6.0% to 26.2%, P = .006), radiation therapy (73.7% vs 83.4%, difference = 9.7%, 95% CI = 0.4% to 19.8%, P = .06), or both (60.6% vs 76.9%, difference = 16.3%, 95% CI = 4.3% to 28.3%, P = .008). Patient and provider characteristics had minimal influence on the racial disparity in the use of adjuvant therapy. Racial differences in oncologist consultation rates do not explain disparities in the use of adjuvant treatment for rectal cancer. A better understanding of patient preferences, patient-provider interactions, and potential influences on provider decision making is necessary to develop strategies to increase the use of adjuvant treatment for rectal cancer among black patients.

18F-FDG PET/CT in response evaluation of gastrointestinal stromal tumours treated with imatinib

Objective Several studies have demonstrated the effective use of adjuvant treatment with Imatinib mesylate for unresectable, metastatic or recurrent gastrointestinal stromal tumours (GIST). We retrospectively evaluated the role of 18F-FDG PET/CT scanning in assessing the response of GIST patients to imatinib mesylate therapy. Materials and methods Eight consecutive patients with GIST confirmed by surgery (4 stomach, 2 small bowel, 1 small bowel and peritoneum, and 1 rectum) underwent eighteen 18F-FDG PET/CT imaging after beginning imatinib mesylate therapy (400 mg/day or greater if disease progression). PET/CT scan was acquired 60-90 minutes after the intravenous injection of 333-707 MBq of 18F-FDG. Visual and semiquantitative (standardized uptake value [SUV]) analysis of images was performed. Response to therapy was assessed according to EORTC recommendations for PET. Results were confirmed by clinical follow-up, radiographic findings or histological analysis. Results Complete response to imatinib mesylate was observed in 5 patients. Four had abdominal lymph nodes, associated with liver metastases in 2, and the other had a residual tumour mass. Partial response (reduction in SUV and in the extent of FDG uptake) was demonstrated in a patient with lung nodules. Disease progression was observed in one patient who had developed new liver metastases on the PET/CT scan. One patient with multiple peritoneal implants and abdominal mass was a non-responder and died 2 months after the 18F-FDG PET/CT. Conclusion 18F-FDG PET/CT scan identified the degree of GIST response to imatinib therapy. Patients who responded to therapy showed normalisation of FDG uptake or a decrease in the SUV of lesions.

Improvements in breast cancer survival over time, related to adjuvant treatment and node status

Background There has been an increase in the use and effectiveness of adjuvant treatment for operable breast cancer and the aim of this study was to examine whether this has resulted in improved survival for all prognostic groups. Methods A retrospective study of 1517 patients with invasive breast cancer treated between 1980 and 2002 was carried out. The use of adjuvant treatment was compared between two time periods in patients based on nodal status, and survival was calculated by Kaplan–Meier life table analysis. Independent predictors for recurrence-free survival (RFS) were determined by Cox regression analysis. Results The use of adjuvant therapy increased for all prognostic groups. On multivariate analysis the use of radiotherapy and endocrine therapy was positively associated with RFS which was significant in the second time period. Outcome in node positive patients improved: five-year RFS from 59% to 76%, p < 0.01 and breast cancer specific survival (BCSS) from 70% to 83%, p < 0.01. However, there was no survival improvement in the larger group of node negative patients; BCSS 93% versus 95%, p = 0.99. Within the node negative group, patients with tumours ≥ 2 cm had an improved RFS from 80% to 88%, p = 0.02. Conclusion The increased use of adjuvant therapy was associated with an improved outcome in node positive patients. For node negative patients with good prognostic features the evidence of benefit was marginal.

Single‐institution experience of adjuvant 5‐fluorouracil‐based chemotherapy for stage III colon cancer

Adjuvant 5-flourouracil-based chemotherapy is standard care for patients with stage III colon cancer. Limited data are available regarding use of adjuvant treatment in routine clinical practice, where patients are often frail and/or elderly. A review of patients with stage III colon cancer over a 7-year period at Western Hospital using a prospective, comprehensive colorectal database was carried out. Results were compared to recent clinical trial data. We identified 554 patients with colon cancer, including 165 patients (30%) with stage III disease. Median patient age was 69 years, with a median follow up of 38 months. There were nine early postoperative deaths. Thirty other patients (19%) were not offered adjuvant chemotherapy, mainly because of advanced patient age and/or comorbidity. Of 124 patients offered adjuvant therapy 12 (10%) elected not to pursue treatment. Thirty-four of the 112 patients that commenced treatment had a dose reduction, with 30 not completing treatment because of toxicity (14) or other reasons (16). The 5-year progression-free survival was 50% and 5-year overall survival 59%. In routine practice many patients with stage III colon cancer do not receive adjuvant chemotherapy. For those receiving treatment the experience is not significantly different from that reported in the carefully selected clinical trial group.

More Controversy than Ever – Challenges and Promises Towards Personalized Treatment of Gastric Cancer

Clinical decisions for the treatment of localized gastric cancer have become much more sophisticated and complicated than ever. Two recent large-scale trials published in NEJM for East Asian 1 and Western patients 2 strongly support the routine use of adjuvant chemotherapy. However, differences in design, extent of surgery, kind of chemotherapy timing of administration, and survival results in the two trials as well as potential differences in genetic background of Asian and Western gastric caner patients raise critical questions and grow confusion and uncertainty. Which is the optimum update treatment for Western patients? Is the Japanese model with standardized D2 surgery followed by one year S-1 chemotherapy applicable in the West and can it produce similar excellent results or should treatment decisions be based on Western patients data from the UK MAGIC trial 2 and the USA INT-0116 trial? 3 This editorial approaches this critical question towards a live-saving decision. Emphasis is given to current advances in network biology, 4 cancer genome and functional studies 5–10 as well as a current comprehensive benchto-bedside genomic-based protocol for biomarkersbased personalized treatment of gastric cancer. 11 The landmark ACTS-GC Japanese study demonstrated excellent survival results with primary standardized D2 surgery followed by S-1 chemotherapy for advanced stages II and III. 1 Most patients (89%) had node-positive disease; these advanced tumor stages are associated with poor prognosis in the West. 12 Despite this advanced disease, the overall 3year survival rate was 70% after D2 surgery alone and 80% in the S-1 chemotherapy group. The hazard ratio for death in the S-1 group, as compared with the surgery-only group, was 0.68 (95% CI, 0.52–0.87; p = 0.003). Because of this significant survival difference the trial was stopped. Local control is now increasingly recognized to have a crucial role in the treatment strategy not only of gastric cancer 13–15 but also for many other solid tumor including breast cancer despite the use of adjuvant treatment. 16,17 Appropriate surgery alone

Role of Adjuvant Chemoradiation Therapy in Adenocarcinomas of the Ampulla of Vater

The role of adjuvant chemoradiation therapy (CRT) in the treatment of ampullary cancers remains undefined. We retrospectively compared treatment outcomes in patients treated with pancreaticoduodenectomy alone versus those who received additional adjuvant CRT. Between May 1990 and January 2006, 54 of 96 patients with ampullary adenocarcinoma who underwent potentially curative pancreaticoduodenectomy also received adjuvant CRT. The median preoperative radiation dose was 45 Gy (range, 30-50.4 Gy) and median postoperative dose was 50.4 Gy (range, 45-55.8 Gy). Concurrent chemotherapy included primarily 5-fluorouracil (52%) and capecitabine (43%). Median follow-up was 31 months. Univariate and multivariate statistical methodologies were used to determine significant prognostic factors for local control (LC), distant control (DC), and overall survival (OS). Actuarial 5-year LC, DC, and OS were 77%, 69%, and 64%, respectively. On univariate analysis, age, gender, race/ethnicity, tumor grade, use of adjuvant treatment, and sequencing of adjuvant therapy were not significantly associated with LC, DC, or OS. However, on univariate analysis, T3/T4 tumor stage was prognostic for poorer LC and OS (p = 0.02 and p < 0.001, respectively); node-positive disease was prognostic for poorer LC (p = 0.03). On multivariate analysis, T3/T4 tumor stage was independently prognostic for decreased OS (p = 0.002). Among these patients (n = 34), those who received adjuvant CRT had a trend toward improved OS (median, 35.2 vs. 16.5 months; p = 0.06). Ampullary cancers have a distinctly better treatment outcome than pancreatic adenocarcinomas. Higher primary tumor stage (T3/T4), an independent adverse risk factor for poorer treatment outcomes, may warrant the addition of adjuvant CRT to pancreaticoduodenectomy.

Concomitant chemoradiotherapy in adjuvant treatment of breast cancer: A retrospective study of 296 cases

11099 Background: Concomitant chemo-radio-therapy in adjuvant treatment of breast cancer is an attractive method which is under ongoing research program. We are trying by this retrospective study to document and support the feasibility of concomitant methods at the Oncology Institute in Rabat. Methods: Two hundred ninety six patients having breast cancer were investigated in a retrospective study. All patients were either treated by radical chirurgy (86.5%) or conservative treatment (13.5%). The study compares two adjuvant treatments associating concomitant chemotherapy and radiotherapy. In the first treatment (first brace) the patients were treated by chemotherapy and radiotherapy in concomitant way using anthracycline [(doxorubicine 60mg and cyclophosphamide 600mg/m2 (AC60), 5-fluorouracile 500mg/m2, doxorubicine 50mg/m2, and cyclophosphamide 500mg/m2 (FAC50), 5- fluorouracile 500mg/m2, epirubicine 75mg/m2, and cyclophosphamide 500mg/m2 FEC75)] (N=123). In the second treatment (second brace) the chemotherapy was CMF type (cyclophosphamide 500mg/m2, methotrexate 60mg/m2 and 5-fluorouracil 500mg/m2) (N=173). Chemotherapy was administered in six cycles, one each 3 weeks. Radiotherapy delivered a radiation dose of 50 Gy on the breast (or on the external layer) Results: With an average time of 37 months after the end of the treatment, only one patient was recidivist of the breast cancer disease as a loco regional breast cancer when the treatment was based on anthracycline. So in 3 years the rate of recidivism of the disease was 0.6%. All the other recidivists were metastasic. The survival rate without disease, after 3 years, in the anthracycline brace was 87% compared to 86.5% in the CMF brace (p&gt; 0,5). The global survival probability after 3 years was 93% in the anthracycline brace and was 90.84% in the CMF treatment. Conclusions: From the three year retrospective investigation we showed a similarity of the two cancer treatment results with higher haematological toxicity in the concomitant treatment based on anthracycline. Waiting for the results of ongoing research we recommend the use of adjuvant treatments in sequential mode by using the chemotherapy prior to radiotherapy. No significant financial relationships to disclose.

Exenteração: estudo retrospectivo

To review all cases of orbit exenteration performed at the Orbit Sector, Ophthalmology Department - Federal University of São Paulo, from 1998 to 2003. We reviewed conditions leading to orbital exenteration in 21 patients at the Orbit Sector of Unifesp-EPM from August 1998 to May 2003. Data regarding sex, age, race, primary lesion site, visual acuity at the moment of diagnosis, previous surgeries related to the exenteration, type of performed surgery, histopathologic diagnosis, postoperative complications and use of adjuvant treatment were collected. 21 patient charts were retrospectively analyzed. Ages ranged from 5 to 91 years (mean of 58.5 years). Of these, 12 were male and 9 were female, most of them Caucasian. All lesions that led to exenteration were malignant neoplasias; however, none were metastatic. Lesions originated from eyelids in twelve patients, from bulbar conjunctiva in six and from the orbit in three. Cases were also classified as squamous cell carcinoma (eleven cases), basal cell carcinoma (four cases), sebaceous gland carcinoma (two cases), rhabdomyosarcoma (two cases), mucoepidermoid carcinoma (one case) and adnexal microcistic carcinoma (one case). Visual acuity at the moment of diagnosis ranged from 20/40 to no light perception. Only six patients had been submitted to previous surgeries related to the exenteration. After surgery, three patients suffered graft necrosis, one presented ethmoidal sinus fistula to the orbit and one presented orbital socket shrinkage. Six patients needed postoperative radiotherapy and two had been previously submitted to chemotherapy. Most patients analyzed in our study presented lesions that are usually small in the beginning; however, they can disseminate to the orbit in the absence of adequate treatment.

The prognostic impact of the time interval to recurrence for the mortality in recurrent colorectal cancer

The risk of a cancer recurrence has been correlated with the stage of the primary tumour at the time of presentation. However, once a recurrence has developed, the primary tumour stage may not be the determining prognostic factor anymore. The objective of this study was (i) to evaluate the association between the recurrence interval and the outcome of the recurrence, and (ii) to determine whether that interval was affected by the use of adjuvant radiation and/or chemotherapy. This retrospective study analysed 212 patients who developed recurrent colorectal cancer from 1987 to 1993. Primary parameters such as age, gender, primary tumour site and stage, and use of postoperative adjuvant treatment were correlated with the recurrence interval, the type and site of the recurrence (i.e. locoregional vs distant metastases), and the outcome. Uni- and multivariate analysis was used to compare the recurrence interval and survival between different subgroups as defined by risk factors. The mean time between the primary and the recurrent tumour was 25 months (range 1-252 months) with 82% of the recurrences developing within 3 years after surgery. The recurrence interval was inversely correlated with the initial tumour stage. Poor survival was associated with a short recurrence interval (less than 12 months) and a distant recurrence site. Even after adjusting for the initial tumour stage, the use of adjuvant treatment did not prolong the interval, i.e. delay the onset of recurrent cancer. The recurrence interval of colorectal cancer is a prognostic factor. However, the use of adjuvant therapy did not prolong that interval.