Weeks Of Chemotherapy Research Articles

The Study Progress and Analysis of Preventive Measures of Nursing Care for Chemotherapy-Induced Oral Mucositis in Pediatric Patients with Hematologic Malignancies: A Retrospective Study.

To analyze the preventive and therapeutic effects of comprehensive nursing interventions on chemotherapy-induced oral mucositis in pediatric patients with hematologic malignancies. A retrospective analysis was conducted, and 80 pediatric patients with hematologic malignancies who underwent chemotherapy in our hospital from January 2020 to December 2023 were selected as the research subjects. According to different nursing intervention methods, the patients were divided into an experimental group (45 cases) and a control group (35 cases). The experimental group received comprehensive nursing interventions, including oral care, dietary guidance, and psychological support; the control group received routine care. The observation indicators included the incidence of oral mucositis, Oral Mucositis Daily Questionnaire (OMDQ) scores, pain index (Visual Analog Scale), and levels of inflammatory markers (IL-6 and CRP) in saliva. In the first, second, and fourth weeks of chemotherapy, the incidence of oral mucositis in the experimental group was significantly lower than in the control group (P < 0.05), with a total incidence of 51.11% compared to 77.14% (P = 0.017). Before chemotherapy, no significant difference was observed in OMDQ or VAS scores between the groups (p>0.05). However, in the first, second, and fourth weeks, OMDQ and VAS scores in the experimental group were significantly lower than those in the control group (P < 0.001). Similarly, levels of IL-6 and CRP showed no baseline difference between groups but were significantly reduced in the experimental group during these weeks (P < 0.001). Comprehensive nursing interventions significantly reduce the incidence and severity of chemotherapy-induced oral mucositis in pediatric patients with hematologic malignancies, alleviate oral pain in pediatric patients, and effectively reduce the levels of inflammatory markers in saliva. The application of comprehensive nursing interventions in clinical nursing practice can improve the quality of care for pediatric patients with hematologic malignancies.

Risk-Stratified Radiotherapy in Pediatric Cancer

While the cure rate of cancer in children has markedly improved in the last few decades, late effects continue to be a problem in survivors. Radiotherapy, which is a major component of treatment in many cancers, is one of the major agents responsible for late toxicity. In the past decade, radiotherapy has been omitted in patients achieving excellent response to chemotherapy, such as in Hodgkin lymphoma and some Wilms tumors with lung metastases. Likewise, response to chemotherapy has been used to determine whether lower doses of radiation can be delivered in intracranial germinoma and pediatric nasopharyngeal carcinoma. Molecular subtyping in medulloblastoma is currently being employed, and in WNT-pathway M0 tumors, the reduction in radiotherapy dose to the craniospinal axis and tumor bed is currently being investigated. Finally, dose escalation was recently evaluated in patients with rhabdomyosarcoma &gt; 5 cm who do not achieve a complete response to initial 9 weeks of chemotherapy as well as for unresectable Ewing sarcoma patients to improve local control.

896P Day of the week of chemotherapy (CT) during concurrent chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC)

896P Day of the week of chemotherapy (CT) during concurrent chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC)

ETMR-06. PNOC031 - INTERNATIONAL TRIAL FOR EMBRYONAL TUMOR WITH MULTILAYERED ROSETTES

Abstract Embryonal tumors with multilayered rosettes (ETMR) are aggressive central nervous system neoplasms with unfavorable prognosis, exhibiting rapid disease progression and frequent post-therapeutic relapse. The rarity of ETMR necessitates global collaboration to advance therapies. Radiotherapy (RT) has been associated with improved survival outcomes in ETMR with case series revealing that nearly half of ETMR patients treated without RT relapse within six months of diagnosis. However, RT is often withheld due to young patient age and neurodevelopmental considerations. This high-rate of on-treatment relapse is unique to ETMR and suggests that radiation-sparing regimens may be suboptimal. PNOC031 is an international collaboration, establishing a global clinical trial to innovate and improve therapeutic interventions for children with ETMR. Eligible patients with newly-diagnosed ETMR are stratified into three cohorts: Cohort 1 - gross total resection/RT-eligible patients to receive early focal radiotherapy (RT); Cohort 2 – gross total resection/not RT-eligible to receive high-dose chemotherapy with autologous stem cell rescue; and Cohort 3 – less than gross total resection or with metastatic disease to receive RT or high-dose chemotherapy per RT eligibility, based on age and tumor location. Cohort 1 will test the hypothesis if early RT improves outcomes in a pilot cohort of 20 patients. Patients will receive six weeks of induction chemotherapy, followed by focal irradiation and an additional six weeks of chemotherapy. Six-month progression-free survival will be assessed to determine the impact of radiotherapy on the rate of early relapse. Cohorts 2 and 3 will allow collection of uniform prospective clinical data using a common treatment backbone, to inform future clinical trial design for ETMR. Incorporating a myriad of correlative studies, including next-generation sequencing, cerebrospinal fluid analyses, microbiome profiles, and evaluations of social determinants of health alongside cognitive outcomes, will enhance comprehensive understanding of clinical responses and advance therapeutic options for this high risk disease.

Hysterectomy versus chemotherapy for low-risk non-metastatic gestational trophoblastic neoplasia (GTN): A cost-effectiveness analysis

ObjectiveDetermine the cost-effectiveness for hysterectomy versus standard of care single agent chemotherapy for low-risk gestational trophoblastic neoplasia (GTN). MethodsA cost-effectiveness analysis was conducted comparing single agent chemotherapy with hysterectomy using decision analysis and Markov modeling from a healthcare payer perspective in Canada. The base case was a 40-year-old patient with low-risk non-metastatic GTN that completed childbearing. Outcomes were life years (LYs), quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and adjusted 2022 costs (CAD). Discounting was 1.5% annually and the time horizon was the patient's lifetime. Model validation included face validity, deterministic sensitivity analyses, and scenario analysis. ResultsMean costs for chemotherapy and hysterectomy arms were $34,507 and $17,363, respectively, while effectiveness measure were 30.37 QALYs and 31.04 LYs versus 30.14 QALYs and 30.82 Lys, respectively. The ICER was $74,526 (USD $54,516) per QALY. Thresholds favoring hysterectomy effectiveness were 30-day hysterectomy mortality below 0.2% and recurrence risk during surveillance above 9.2% (low-risk) and 33.4% (high-risk). Scenario analyses for Dactinomycin and Methotrexate led to similar results. Sensitivity analysis using tornado analysis found the cost to be most influenced by single agent chemotherapy cost and risk of resistance, number of weeks of chemotherapy, and probability of postoperative mortality. ConclusionCompared to hysterectomy, single agent chemotherapy as a first-line treatment costs $74,526 for each additional QALY gained. Given that this cost falls below the accepted $100,000 willingness-to-pay threshold and waitlist limitations within public healthcare systems, these results support the continued use of chemotherapy as standard of care approach for low-risk GTN.

Measurement of metabolite levels and treatment-induced changes in hepatic metastases of gastro-esophageal cancer using 7-T phosphorus magnetic resonance spectroscopic imaging.

Methods for early treatment response evaluation to systemic therapy of liver metastases are lacking. Tumor tissue often exhibits an increased ratio of phosphomonoesters to phosphodiesters (PME/PDE), which can be noninvasively measured by phosphorus magnetic resonance spectroscopy (31P MRS), and may be a marker for early therapy response assessment in liver metastases. However, with commonly used 31P surface coils for liver 31P MRS, the liver is not fully covered, and metastases may be missed. The objective of this study was to demonstrate the feasibility of 31P MRS imaging (31P MRSI) with full liver coverage to assess 31P metabolite levels and chemotherapy-induced changes in liver metastases of gastro-esophageal cancer, using a 31P whole-body birdcage transmit coil in combination with a 31P body receive array at 7 T. 3D 31P MRSI data were acquired in two patients with hepatic metastases of esophageal cancer, before the start of chemotherapy and after 2 (and 9 in patient 2) weeks of chemotherapy. 3D 31P MRSI acquisitions were performed using an integrated 31P whole-body transmit coil in combination with a 16-channel body receive array at 7 T, with a field of view covering the full abdomen and a nominal voxel size of 20-mm isotropic. From the 31P MRSI data, 12 31P metabolite signals were quantified. Prior to chemotherapy initiation, both PMEs, that is, phosphocholine (PC) and phosphoethanolamine (PE), were significantly higher in all metastases compared with the levels previously determined in the liver of healthy volunteers. After 2 weeks of chemotherapy, PC and PE levels remained high or even increased further, resulting in increased PME/PDE ratios compared with healthy liver tissue, in correspondence with the clinical assessment of progressive disease after 2 months of chemotherapy. The suggested approach may present a viable tool for early therapy (non)response assessment of tumor metabolism in patients with liver metastases.

Combined Therapy of Chemotherapy and Radiofrequency Ablation for Pancreatic Cancer Patients With Metachronous Hepatic Metastatic Lesions After Radical Pancreatic Resection.

Hepatic metastasis frequently occurs in patients who have undergone radical pancreatic resection for pancreatic cancer. Besides chemotherapy, various local treatment approaches targeting hepatic lesions have been explored. However, research on radiofrequency ablation (RFA) as a localized therapy for hepatic metastasis is limited. Therefore, we conducted this retrospective study to provide clinical evidence. This is a single-center, retrospective, cohort study. After radical pancreaticoduodenectomy, 32 patients developed metachronous hepatic metastasis with fewer than 3 lesions, the largest of which was less than 3cm in diameter. These patients underwent combined treatment with chemotherapy and RFA. After 8 weeks of chemotherapy, patients received RFA for hepatic lesions. Additional chemotherapy was administered, and the patients' tumor status and survival were monitored. The primary endpoint of this study was overall survival (OS). Factors affecting OS were analyzed using the Cox risk model. Among the 32 patients, the mean OS was 28.4 months. Univariate and multivariate Cox regression analysis revealed that the time (in months) of liver metastasis (HR = 0.04, 95% CI: 0.01 to 0.19; P < 0.001), the number of liver metastases (HR = 7.08, 95% CI: 1.85 to 27.08, P = 0.004), and PD (progressive disease) response to the second round of chemotherapy (HR = 29.50, 95% CI: 1.46 to 597.27; P = 0.027) were independent predictors of poorer survival. Combined therapy with RFA and chemotherapy is safe in patients with hepatic metastasis after radical pancreaticoduodenectomy. Early recurrence (≤12months), three liver metastatic lesions, and a poor response to the second round of chemotherapy were associated with poor survival.

Electroacupuncture use for treatment of taxane-induced peripheral neuropathy in patients with breast cancer: protocol for a pilot, randomised, blinded, sham-controlled trial (EA for CIPN)

IntroductionChemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect of neurotoxic chemotherapy. Acute symptoms of CIPN during treatment can lead to dose reduction and cessation. Trials using electroacupuncture (EA)...

The effects of chemotherapy on resting energy expenditure, body composition, and cancer-related fatigue in women with breast cancer: a prospective cohort study

BackgroundBreast cancer (BC) is the most prevalent tumor in women. Improvements in treatment led to declined mortality, resulting in more survivors living with cancer- or therapy-induced comorbidities. In this study, we investigated the impact of neoplasia and chemotherapy on resting energy expenditure (REE) and body composition, in relation to cancer-related fatigue. Inflammatory parameters were checked as possible explanation for changes in REE.MethodsFifty-six women participated: 20 women with BC and 36 healthy controls. Patients were assessed at baseline (T0) and follow-up (T1) after 12 weeks of chemotherapy. Controls were measured once. REE was assessed with indirect calorimetry: body composition (body weight, fat mass, fat-free mass) by air plethysmography. The multidimensional fatigue index (MFI-20) was used to analyze fatigue. Baseline measurements of patients were compared to results of the healthy controls with the independent-samples T-test. The paired-samples T-test investigated the effects of chemotherapy from T0 to T1. A Pearson correlation analysis was conducted between REE, body composition, and fatigue and between REE, body composition, and inflammatory parameters. A linear regression analysis was fitted to estimate the contribution of the significantly correlated parameters. The measured REE at T0 and T1 was compared to the predicted REE to analyze the clinical use of the latter.ResultsAt baseline, patients with BC had significantly higher REE in the absence of differences in body composition. From baseline to T1, REE and body weight did not change. In contrast, fat-free mass declined significantly with concordant increase in fat mass. Fatigue deteriorated significantly. C-reactive protein at baseline predicted the change in energy expenditure. Predicted REE significantly underestimated measured REE.ConclusionsWomen with BC have higher REE in the tumor-bearing state compared to healthy controls. Chemotherapy does not affect REE but alters body composition. Predictive equations are invalid in the BC population. Results of our study can be used to implement personalized nutritional interventions to support energy expenditure and body composition and minimize long-term comorbidities.

Outcomes and Prognostic Factors in Patients with Primary Mediastinal B Cell Lymphoma: An Experience from Hematology Cancer Consortium

The treatment of Primary Mediastinal B Cell Lymphoma(PMBCL) has evolved from R-CHOP and V/MACOP-B chemotherapy to the use of dose-adjusted R-EPOCH(DA-R-EPOCH) after the pivotal NCI trial showed an improved 5 year EFS of 93% and 5 year OS of 97%. The former relied on consolidative RT, whereas the latter omitted RT for most of its patients. Being a rare disease, data from India is minimal. The need for inpatient care for continuous infusion and increased toxicity associated with DA-R-EPOCH, viz., neutropenic fever, mucositis, and neuropathy, makes it a resource-intense protocol. This retrospective multicentric study collected the data from seven- member centers of Hematology Cancer Consortium (www.hemecancer.org) using an electronic database, to analyze the clinical characteristics, treatment patterns, outcomes, and prognostic factors in newly diagnosed PMBCL diagnosed between 2015-2020. Patients who had received more than 2 weeks of chemotherapy or steroids prior to presentation were excluded. The data included demographic details, performance status (ECOG), CNS involvement, stage, treatment type, response to treatment, and treatment-related mortality as assessed by the investigator of the respective center. The primary objective was to evaluate event-free survival at 2 years. Secondary objectives were to evaluate the 2-year overall survival, the impact of age, Performance Status, stage, treatment regimen, and use of RT on the EFS and OS. Other endpoints included the evaluation of end of treatment response based on the protocol used and to assess the treatment-related toxicities. A total of 103 patients were included in this study. Of these, 95 patients received treatment and were analysed for outcomes and prognostic factors. There was no significant difference between the treated and untreated cohort. The baseline characteristics of the treated patients are summarized in Table 1. The median age of the patients was 28 years (IQR: 23 - 36). More than half the patients were men(male - 54.7%). B symptoms were present in 42 (44.7%) patients. Close to 60% of patients had baseline PS of 0 or 1 and 70% had only supradiaphragmatic disease. Bulky disease(&amp;gt;7 cm) at presentation was present in 60 patients(63%), &amp;gt;10 cm in 42 patients(44.2%), 21 patients (22.1%) had extra-nodal disease, and 40 patients(42%) had stage III/IV disease. The median LDH at presentation was 673 units/Litre(IQR: 405 - 1117.5). A total of 79 patients(83.2%) received DA-R-EPOCH as first-line chemotherapy, 9 patients(9.5%) received R-CHOP and the remaining patients received other regimens(COP, CHOP-E). Dose of chemotherapy was compromised in 23 patients (24.2%). Amongst the patient who received DA-R-EPOCH, maximum dose level of 3 or more was achieved in 51 patients(64.55%). Close to 90% of the patients received 6 or more cycles of chemotherapy. End-of-treatment response of CR/PR was achieved in 69 patients(72.7%). Radiation therapy was administered in 44 patients(46.3%) of which 38 (40%) received RT as consolidation after the first line chemotherapy. After a median follow-up of 35 months, 22 patients relapsed, and 8 patients died. 2 year EFS was 74% (95%CI: 69% - 79%) and 2 year OS was 92% (95%CI: 89% - 95%). On univariate analysis, achievement of CR at end of treatment(HR - 0.18; 95%CI- 0.06,0.56; P = 0.003) and receipt of 6 or more cycles of chemotherapy(HR - 0.17; 95%CI - 0.05 - 0.58; P = 0.005) positively impacted the EFS. On multivariate analysis, achievement of CR at the end of treatment (HR - 0.18; 95%CI - 0.06 - 0.56; P - 0.003) was the only factor which impacted the EFS. The treatment-related mortality was 8.4% (8/95). Febrile neutropenia was the most common toxicity seen in 48 patients (50.5%) followed by neuropathy in 10 patients (10.5%). Our data, one of the largest datasets of PMBCL, highlights the efficacy of DA-R-EPOCH in PMBCL in the Indian setting, albeit with survival lesser than the pivotal NCI trial and the North American retrospective data. The inferior outcomes could have been contributed by the heterogeneity in the first line chemotherapy (16 patients (16.8%) received non-DA-REPOCH regimen), dose compromise (seen in 23% of this cohort) and administration of DAREPOCH at lower dose levels (Dose level of less than 3 in 27%). In contrast to the previous DA-REPOCH trials, close to 40% of the patients received RT as consolidation. Being a retrospective study, selection bias remains a major limitation of this analysis.

Leveraging electronic patient-reported outcomes collected at six cancer centers to identify symptom clusters across the first four weeks of chemotherapy.

366 Background: Symptom clusters are groups of two or more related concurrent symptoms. Interventions that target symptom clusters may be more efficient than those which address individual symptoms, yet few studies have identified symptom clusters using patient-reported outcomes collected in routine practice. The purpose of this study was to identify symptom clusters de novo using data reported in eSyM, an electronic health record-integrated cancer symptom management program deployed across six large and diverse health systems. Methods: Adults starting chemotherapy to treat thoracic, gastrointestinal, and gynecologic cancers used eSyM to report symptoms twice weekly for up to six months. We analyzed patient-reported symptom data from cycle 1, day 2 (T0), one week (T1), and two (T2), three (T3), and four (T4) weeks later. Patients reported attributes (i.e., frequency, severity, and interference) of 12 symptoms using items derived from the PRO-CTCAE. We calculated a composite grade (0, 1, 2, or 3) for each symptom and conducted an exploratory factor analysis using polychoric correlations and unweighted least squares estimation to identify symptom clusters at each time point. We considered rotated factor loadings ≥|0.30| meaningful and assessed the Eigenvalues, structure, and clinical relevance of two- through four-factor (i.e., cluster) models. Finally, we labeled each cluster according to its predominant symptoms using labels adopted from prior studies of symptom clusters in patients undergoing chemotherapy. Results: Our analytic sample at each time point included 730 (T0), 1605 (T1), 1571 (T2), 1617 (T3), and 1456 (T4) symptom reports. Of the two-, three-, and four-factor models, the two-factor model had the least cross-loading and was the most clinically relevant across time points. The two-factor model accounted for 100% of the total variance in symptoms. In this model, a gastrointestinal symptom cluster was comprised of vomiting, nausea, decreased appetite, trouble drinking, and diarrhea at all time points, while a psychoneurological symptom cluster was comprised of fatigue, pain, anxiety, shortness of breath, and constipation at all time points. Rash was present in the psychoneurological cluster at T0 but was not present in any cluster at T1-T4. Conclusions: Patients experience gastrointestinal and psychoneurological symptom clusters in the first four weeks of chemotherapy. Our findings suggest it is feasible to use routinely collected data to identify symptom clusters using composite PRO-CTCAE grades. Future research will investigate the prevalence of symptom clusters, clinical and demographic characteristics of patients at high risk for severe symptoms, and how to better manage symptom clusters.

Feasibility and safety of exercise during chemotherapy in people with gastrointestinal cancers: a pilot study

PurposeSarcopenia is a poor prognostic factor in cancer patients, and exercise is one of the treatments to improve sarcopenia. However, there is currently insufficient evidence on whether exercise can improve sarcopenia in patients with advanced cancers. This study examined the feasibility of exercise in advanced gastrointestinal (GI) cancer patients treated with palliative chemotherapy.MethodsBetween 2020 and 2021, 30 patients were enrolled in a resistance and aerobic exercise program for six weeks. The exercise intervention program (EIP) consisted of low, moderate, and high intensity levels. Patients were asked to select the intensity level according to their ability. The primary endpoint was the feasibility of the EIP measured by compliance during the six weeks. A compliance of over 50% was considered acceptable. The secondary endpoints were changes in weight and muscle mass, safety, quality of life (QoL) and overall survival (OS).ResultsThe median age of the study’s participants was 60 (30–77). The total compliance to the EIP was 63.3% (19/30 patients). Sixteen (53.3%) patients had a compliance of over 80%. The attrition rate was 30.0% (9/30). The mean exercise time was 41.4 min, and the aerobic exercise was 92.3% and the resistant exercise was 73.7%, and both exercise was 66.5%. Most patients performed the moderate intensity level exercises at home or near their home. The mean skeletal muscle index (SMI) was 43.5 cm2/m2 pre-chemotherapy and 42.2 cm2/m2 after six weeks of chemotherapy, with a decrease of -1.2 ± 2.8 cm2/m2 (-3.0%) (p = 0.030). In the poor compliance group, the mean SMI decrease was -2.8 ± 3.0 cm2/m2 which was significantly different (p = 0.033); however, in the good compliance group, the mean SMI decrease was -0.5 ± 2.5 cm2/m2 which was maintained over the six weeks (p = 0.337). The good compliance group had a significantly longer median OS compared with the poor compliance group (25.3 months vs. 7.9 months, HR = 0.306, 95% CI = 0.120–0.784, p = 0.014). The QoL showed a better score for insomnia (p = 0.042). There were no serious adverse events.ConclusionsThe EIP during palliative chemotherapy in advanced GI cancer patients showed good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The EIP was safe, and the QoL was maintained. Based on this study, further research in exercise intervention in advanced cancer patients is needed.Clinical trial registrationThe clinical trial registration number is KCT 0005615 (CRIS, https://cris.nih.go.kr/cris/en/); registration date, 23rd Nov 2020.

Parameters of Complete Blood Count and Blood Chemistry during Treatment of Patients with MDR/XDR Pulmonary Tuberculosis with a Short-Course Regimen Containing Bedaquiline, Pretomanid, and Linezolid

The objective: assessment of changes in the parameters of complete blood count, clinical urine tests, and blood chemistry during chemotherapy of patients with MDR/XDR pulmonary tuberculosis receiving the short-course regimen containing bedaquiline, pretomanid, and linezolid (B-Pa-L).Subjects and Methods. 18 patients with MDR/pre-XDR/XDR pulmonary tuberculosis were enrolled into the study. They all received treatment at Central Tuberculosis Research Institute from 2015 to 2022.Results. In the course of chemotherapy of these patients, changes in laboratory test results were noted at different times. Abnormal changes in complete blood count were detected in 10/18 (55,6%) patients during chemotherapy for the 1st time. Hemoglobin levels, erythrocyte and leukocyte counts decreased. Hematuria and bacteriuria were detected by clinical urine test. Proteinuria was observed in almost in half of the patients. Elevated serum potassium level was frequently noted. Blood chemistry demonstrated elevated levels of ALT and AST, which is typical of cytolytic effect on hepatocytes of drugs within chemotherapy. In most cases, all above abnormalities were degree 1 of toxicity and resolved within 2-4 weeks after they were detected. Abnormalities in grade 2-3 of toxicity were mainly observed in patients receiving linezolid at the dose of 1200 mg/day. In most cases, the above abnormalities were detected during the first 4 weeks of chemotherapy.

Anlotinib hydrochloride combined with tislelizumab, paclitaxel liposome, and nedaplatin regimen for preoperative neoadjuvant therapy of esophageal cancer: A single-arm, single-center, phase II exploratory clinical study.

e16082 Background: Local recurrence and distant metastasis are important causes of high mortality in patients with locally advanced esophageal cancer. Neoadjuvant therapy combined with surgery can significantly improve the prognosis of patients with locally advanced esophageal cancer. Based on the clinical data of anlotinib (a multi-targeted tyrosine kinase inhibitors) and tislelizumab (anti-pd-1 antibodies), paclitaxel liposome (a cytotoxic anti-tumor drugs) and nedaplatin (a platinum-based anti-tumor drugs) in patients with esophageal cancer, to evaluate the efficacy and safety of anlotinib hydrochloride combined with tislelizumab, paclitaxel liposome and nedaplatin in preoperative neoadjuvant therapy for patients with stage IIB-IVA esophageal cancer. Methods: This study included 18-75 years old, ECOG PS 0-1 patients with potentially resectable stage IIB-IVA esophageal cancer with a predicted survival time of ≥12 weeks and confirmed by histopathology or cytology. Patients who met the inclusion criteria received anlotinib (oral, 12mg/d1-14,Q3W) combined with tislelizumab (intravenous drip, 200mg/d1,Q3W), paclitaxel liposome (intravenous drip, 175mg/m2/d1,Q3W) and nedaplatin (intravenous drip, 80mg/m2/d1,Q3W). After 2 cycles of neoadjuvant therapy, surgery was performed, and 4-6 weeks of chemotherapy combined with targeted immune adjuvant therapy was performed after the operation, and then Anlotinib combined with tislelizumab targeted immune maintenance therapy was performed until the disease progressed. Subjects who failed to complete at least one cycle of clinical trials according to this program due to non-experimental drug factors, and seriously violated this research program, such as: failure to follow the prescribed dose, method and course of medication, will be excluded from this study. The primary endpoint was objective response rate (ORR), and secondary endpoints included progression-free survival (PFS), R0 resection rate, and pathological complete response rate. Results: From October 2021 to February 2023, 38 patients were included in this study, and clinical data of 27 patients can be used to track and evaluate clinical efficacy. The median age of the subjects was 58.5 years (range 47-75 years). the primary study end point was an ORR of 77.8% (95% CI，61%-94.5%). Conclusions: We will strictly implement the research protocol and objectively evaluate the anti-tumor activity and safety of anlotinib hydrochloride combined with tislelizumab, paclitaxel liposome and nedaplatin regimen in the treatment of patients with stage IIB ~ IVA esophageal cancer. In order to provide a safe and reliable neoadjuvant therapy for patients with locally advanced esophageal cancer. Clinical trial information: ChiCTR2100049693 .

Factors associated with the sleep disturbances of people with breast cancer during chemotherapy in China: A cross-sectional study.

The aim of the study was to investigate the incidence of sleep disturbance and its relationship with anxiety and depression symptoms, social support and hope in breast cancer patients in China during chemotherapy. A single-centre cross-sectional study. A total of 329 breast cancer patients were selected via convenience sampling method before they began chemotherapy (n = 115), before the 5th week of chemotherapy (n = 117) or 1 month after chemotherapy ended (n = 97) and administered paper-and-pencil questionnaires to evaluate sleep quality, depression and anxiety symptoms, social support and hope. Risk factors significantly associated with sleep disturbance during bivariate were incorporated in the multivariate analysis. Bivariate analyses showed that age, menopausal status, depression and anxiety symptoms, emotional/informational support, tangible support, affectionate support, positive social interaction and total support were predictors of sleep disturbance. Sleep disturbance was prevalent in breast cancer patients before (27.0%), during (32.5%) and after (39.2%) chemotherapy, with 37.4%, 41.9% and 52.6% of participants, respectively, reporting sleeping below the recommended 7 h. Only 8.6%-15.5% of patients reported taking sedative-hypnotic drugs during the chemotherapy. Multivariate analyses found that participants reporting clinically significant anxiety (HADS > 8) were 3.5 times more likely to report sleep disturbance (PSQI > 8) than participants without clinically significant anxiety, and each increment in emotional/informational support was associated with a 9.04% reduced risk of sleep disturbance. Moreover, age was an independent predictor of sleep disturbance during multivariate modelling.

Impact of Cancer and 12 Weeks of Chemotherapy on the Balance of the Autonomic Nervous System in Cancer Patients

Cancer and its treatment itself (especially chemotherapy) is associated with number of negative effects on the human body. These include mainly cardiac toxicity, peripheral neuropathy, bone loss, depression, anxiety, nausea, pain, cognitive changes, fatigue, fitness reduction and more. Fatigue is one of the most common negative effects, often persists long after treatment and is described as insurmountable and is associated with lower parasympathetic activity. The autonomic nervous system (ANS) is the main homeostatic regulatory system of the body, it regulates involuntary physiological processes. We believe that this part of the peripheral nervous system can be negatively affected by cancer and chemotherapy, which can have a negative impact on all the processes that control this system. Most drugs used in oncology lead to chemotherapy-induced peripheral neuropathy and are expected to have an influence on the autonomic nervous system. Activity and balance of the autonomic nervous system depend on a range of dynamically changing and quantitatively different conditions such as age, stress, physical activity, sleep, illness, fatigue and more. Methods: To evaluate ANS activity, spectral analysis of heart rate variability (HRV) was assessed. During treatment, 19 oncological patients with prescribed adjuvant chemotherapy measured HRV 3 times a week using a chest strap with a HRV monitor mySASY and mySASY software. Parasympathetic activity (PA), sympathetic activity (S), total score (TS) and total power (TP) were selected as indicators of ANS activity. The patients were women aged 50.38 ± 10,29 with BMI 25,72 ± 4,16. The mean values for the first 14 days of treatment and then for 14 days after 12 weeks of treatment were compared. Data normality was verified by Kolmogorov-Smirnov test (K-S) and static significance was calculated by t-test. All statistical tests were performed at a significance level of 5%. Results: There was a significant decrease in values for three parameters. The PA decreased from 3,80 ± 1,56 to 3,14 ± 1,67 (p = .03), TP decreased from 3,65 ± 1,87 to 2,82 ± 2,08 (p = .04), TS decreased from 3,40 ± 1,67 to 2,67 ± 1,73 (p = .01). Sympathetic activity was somewhat but not significantly higher, increased from 6,74 ± 1,22 to 6,80 ± 1,44 (p = .83). Conclusion: During the 12 weeks of treatment with adjuvant chemotherapy, there was a significant reduction in parasympathetic activity, total score, and total power. A decrease in PA is usually associated with lower regenerative abilities of the organism, a decrease in TP is associated with a decrease in the activity of the entire ANS. TS evaluates the total power and balance of both ANS branches. The higher the values, the more the body is regenerated and ready for further stress and response to stress.

Priapism and pyrexia of unknown origin presenting as a relapse of multiple myeloma

Pyrexia of unknown origin (PUO) is defined as a body temperature &gt;38.3°C on several occasions for &gt;3 weeks with failure of diagnosis despite one week of inpatient investigations or three outpatient visits. Aetiology for PUO may be infective, inflammatory, autoimmune, malignant, miscellaneous or remains undiagnosed. We describe a patient diagnosed with multiple myeloma (ISS-stage II) who completed induction chemotherapy and presented with PUO and extensive thrombosis as a complication of relapsed myeloma (very rare; 0.2% in myeloma). A 62-year-old man, with diagnosed multiple myeloma, achieved a very good partial remission after 6 cycles of bortezomib-thalidomide-dexamethasone regimen, presented with PUO and right lower limb deep vein thrombosis. His thrombosis was managed successfully with anticoagulation. While on therapeutic anticoagulation with warfarin and being investigated extensively for PUO without a focus, he developed priapism due to bilateral internal pudendal vein thrombosis. His anticoagulation was intensified to a target INR of 2.5-3.5. He recovered without residual damage. Despite broad spectrum antimicrobial agents, trial of antimalarial and anti-tuberculosis treatment, he remained pyrexial with rising inflammatory markers (ESR, CRP). Relapsed multiple myeloma was confirmed with 30% bone marrow plasma cells and raised serum monoclonal para-protein levels of 23.78g/L. He was restarted on chemotherapy with bortezomib-lenalidomide-dexamethasone. His PUO of two months subsided with one week of chemotherapy.&#x0D; This case illustrates an atypical presentation of relapsed myeloma and highlights the importance of achieving early diagnosis with a systematic approach and making optimum treatment choice after careful evaluation of previous treatment, drug toxicities, patient’s condition and available treatment options.

A congenital spindle cell auricular rhabdomyosarcoma in a newborn

Rhabdomyosarcomas make up 5% of all pediatric malignant tumors. They are extremely rare in neonates. Furthermore, the external ear as a primary tumor site is very uncommon. In this paper, a neonate with a congenital auricular rhabdomyosarcoma is presented. At birth, a newborn male was noted to have a right posterior auricular mass. He is admitted to a children's hospital where he has diagnostic imaging, undergoes a biopsy, and then surgical resection of the auricular mass. Pathology confirms an infantile spindle cell rhabdomyosarcoma. He completes 22 weeks of chemotherapy without incident. At one year of age, there is no evidence of metastasis or recurrence of the auricular tumor. A rare case of a neonate with a congenital auricular rhabdomyosarcoma is presented. The prognosis of congenital auricular rhabdomyosarcomas tends to be favorable.

Prognostic Factors and Outcomes of Adolescent and Adult Burkitt Lymphoma and Leukemiafrom a Low-Middle Income Country: An Experience from Hematology Cancer Consortium

The treatment of BL/L has evolved on the principles of short-course, intensive, non-cross resistant, alternating chemotherapy. These intensive high-dose methotrexate-based treatment regimens (CODOX-M/IVAC, Hyper-CVAD, BFM, LMB) have led to high response rates and cures in a significant proportion of children and young adults. The addition of rituximab has led to overall survival benefit. There is limited data that dose adjusted EPOCH-R provides a low intensity treatment option for patients who may not be able to tolerate high-dose methotrexate-based regimens. Efficacy of these regimens in real-world, more so in an LMIC setting need to be evaluated given the delays in seeking care, higher risk of treatment-related complications including infections and antecedent treatment interruptions. This retrospective multicentric study collected the data from eight-member centers of Hematology Cancer Consortium (www.hemecancer.org) using an electronic database, to analyze the clinical characteristics, treatment patterns, outcomes and prognostic factors in adolescent and adult newly diagnosed Burkitt lymphoma and leukemia diagnosed between 2012-2019 (including HIV positive). Patients who had received more than 2 weeks of chemotherapy or steroids prior to presentation were excluded. The data included demographic details, performance status (ECOG), HIV serology, bone marrow and CNS involvement, stage, treatment type, use of rituximab, response to treatment, and treatment-related mortality as assessed by the investigator of the respective centre. The primary objective was to evaluate event-free survival at 2 years. Secondary objectives were to evaluate the overall survival, impact of the treatment protocol, use of rituximab, stage, age, performance status, CNS involvement, and HIV positive status on the overall and event-free survival. A total of 312 patients were included in this study. Out of these 257 patients received treatment and were analyzed for the outcome and prognostic factors. The treated and untreated cohorts differed in age [ median age 37 years (range-25-49 years) versus 42 years (range-32-51 years); with the untreated cohort being older. Table 1 provides the baseline characteristics of the patients who received treatment. The HIV positive patients (in treated cohort) had higher LDH [median - 967.5 (range, 509- 2355) vs 589 (311-1141), p=0.003). A total of 100 (42%) patients received intensive and high-dose methotrexate-based chemotherapy, 81 (34%) patients received dose-adjusted EPOCH-based treatment whereas 56 (24%) received other low-intensity or palliative chemotherapy. Patients with HIV were largely treated with a dose-adjusted EPOCH-based regimen (25/32 patients). Patients who received a high-dose methotrexate-based regimen were younger than those who received dose-adjusted EPOCH and other lower intensity regimens (Mean age 29 years versus 42.4 and 43.9 years) At the median follow-up of 36.5 months, the 2-year EFS was 61% and 2-year OS was 73%. There was no significant difference in outcomes in HIV-positive and negative patients. On univariate analysis lack of use of rituximab and use of protocols other than high-dose methotrexate and dose-adjusted EPOCH negatively affected EFS and OS. Age had an adverse impact on the OS but not EFS whereas stage 2 or above had a negative impact on EFS. On multivariate analysis use of regimens other than high-dose methotrexate-based and dose-adjusted EPOCH was a negative prognostic factor for both EFS and OS. The HR favored high dose methotrexate and dose-adjusted EPOCH-based regimen for both EFS and OS; HR- 0.42 (95% CI,0.22,0.77) and 0.27(95% CI,0.13-0.59), respectively. Use of rituximab was associated with better OS HR-0.44(95% CI,0.21-0.93) and a trend toward better EFS - HR-0.58 (95%CI, 0.31-1.07). The treatment-related mortality was 11.2% (29/257) and high serum LDH was associated with higher mortality (p=0.003). Treatment of adolescent and adult Burkitt lymphoma and leukemia with intensive regimens (high-dose methotrexate-based) and dose-adjusted EPOCH regimen resulted in similar survival. Dose-adjusted EPOCH-based regimen was preferred in older patients. The use of rituximab in these patients adds to the overall survival benefit. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Zhengyuan capsules for the treatment of chemotherapy-induced cancer-related fatigue in stage IIIB-IV unresectable NSCLC: study protocol for a randomized, multi-center, double-blind, placebo-controlled clinical trial.

Patients with advanced non-small cell lung cancer (NSCLC) frequently experience cancer-related fatigue (CRF) during or after chemotherapy. Traditional Chinese medicine (TCM) can effectively relieve CRF, although the clinical evidence is insufficient due to the absence of extensive and rigorous clinical studies. Zhengyuan capsules have both tonifying and dispersing effects, and its ability to alleviate CRF has been verified in mice. This study aimed to provide evidence for the role of proprietary Chinese medicines in alleviating CRF in advanced NSCLC patients. A multi-center, randomized, double-blind, placebo-controlled clinical trial has been designed to evaluate the efficacy and safety of Zhengyuan capsules for CRF in stage IIIB-IV unresectable NSCLC patients undergoing chemotherapy. Thirty eligible participants will be randomized into two groups at a 1:1 ratio during chemotherapy using the centralized interactive web response system. All patients will receive conventional platinum-based dual-drug chemotherapy and Zhengyuan capsules or simulant for 42 consecutive days starting on the first day of the first week of chemotherapy. The primary outcome is the difference between baseline and post-treatment CRF in the two groups, which will be assessed using the Brief Fatigue Inventory (BFI) score. Secondary outcome measurements include the Revised Piper's Fatigue Scale (RPFS)-Chinese Version, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Module C30 (EORTC QLQ-C30) v3.0 combined with EORTC QLQ-LC13 (Lung Cancer 13), clinical symptom score, hematology exploratory index, and progression-free survival. And safety indicators such as blood, urine, fecal routine, liver and kidney function, coagulation, and electrocardiogram will be performed before chemotherapy. Data will be analyzed according to intention-to-treat (ITT) and per-protocol (PP) principles; Empowerstats and R will be applied for statistical analysis. This trial will provide data on the efficacy and safety of Zhengyuan capsules for treating CRF in stage IIIB-IV unresectable NSCLC patients undergoing chemotherapy. It will also provide a basis for the feasibility of a large-scale clinical trial. The clinical trial was registered on 19 November 2020 through https://www.chictr.org.cn (registration number: ChiCTR2000040061).