Phase II trial of preoperative bevacizumab (Bev), irinotecan (I), cisplatin (C), and radiation (RT) in esophageal adenocarcinoma: Preliminary safety analysis

4573

Background: Preo chemoRT with weekly I/C and 5040 cGy followed by surgery is well tolerated [JCO 24: Abstract 4032; 2006]. ECOG trial E1201recently reported a median survival of 34 months with this preop regimen [JCO 26: Abstract 4532; 2008]. Bev + chemo improves response rate (RR) and time to progression (TTP) when added to weekly I/C in advanced esophagogastric cancer but does not increase chemo toxicity [JCO 24: 5201; 2006]. We are now combining in a Phase II trial Bev/I/C with concurrent radiotherapy (RT) in esophageal adenocarcinoma (EA) with the primary endpoint of safety. Methods: Patients (pts) with resectable Siewert's I or II EA were staged by EUS, PET, and CT. Induction chemo consisted of I-50–65 mg/m2 and C-30 mg/m2 weeks 1,2,4,5, Bev-7.5 mg/kg weeks 1 and 4; and, during RT (180 cGy daily to 5040 cGy), I/C was given weeks 7,8,10,11 and Bev weeks 7,10. Esophagectomy was 6–8 weeks after RT. A planned toxicity analysis was made in 10–15 pts completing chemoRT, and in 10 pts undergoing surgery: toxicity was acceptable if grade 3 / 4 hematologic toxicity remained < 72% and non hematologic toxicity < 40% during combined chemoRT (based on our prior phase II trial of I/C/RT [JCO 24: Abstract 4032; 2006]); and if pts undergoing surgery had no surgical complication related to Bev. Results: 18 pts have been enrolled, 12 male: 6 female; 7 Siewert I: 11 Siewert II; T3N1 12: T3N0 5: T2N0 1. 14 are evaluable for toxicity, 2 are too early, one progressed prior to RT, and one was taken off due to a CVA from a patent foramen ovale. Grade 3/4 neutropenia occurred in 4 pts (29%). Grade 3/4 non heme toxicity occurred in 5 pts (36%), including esophagitis 2 pts (14%), neutropenic fever 1 pt (7%), and pulmonary embolism 1 pt (7%). No grade 3 / 4 hypertension was seen, and 3 pts (21%) developed grade 1 proteinuria. Ten pts underwent surgery, and there were no unexpected surgical or wound complications; there were 2 anastomotic leaks. Pathologic responses: 1 pathologic CR and 1 T0N1. Conclusions: In a preliminary analysis of pts treated with Bev + preop chemoRT in EA, there was no increase in hematologic/non hematologic toxicity or Bev related surgical complications. Accrual will continue to 33 patients. Supported by Genentech.

[Table: see text]

Concurrent chemoradiotherapy with weekly docetaxel and cisplatin for locally advanced head and neck cancer: Phase I study

e17026

Background: This phase I study was performed to determine maximum tolerated dose of docetaxel when administered concomitantly with radiotherapy and cisplatin in patients with locally advanced head and neck cancer. Methods: Fifteen patients were treated at varying levels of docetaxel (level 1: 0 mg/m2, level 2: 10 mg/m2, level 3: 15 mg/m2, and level 4: 20 mg/m2, once per week for a total 6 weeks) with a fixed dose of 20 mg/m2 cisplatin weekly on an outpatient basis. Radiotherapy was delivered as a standard regimen (1.8–2.0 Gy/day, 5 fraction/week) to a total dose of 66–72 Gy. Results: One out of six patients presented with dose-limiting toxicity at the 10 mg/m2/week dose of docetaxel (grade 4 febrile neutropenia which results in treatment-related death). No DLTs was noticed at the 15 mg/m2, and 20 mg/m2 dose level. Thus, the weekly docetaxel dose of 20 mg/m2 was considered as the maximum tolerated dose. Radiotherapy was completed in all patients except one, and more than 95% of the scheduled cisplatin and docetaxel were given in 93% of patients. Acute grade 3–4 toxicities were dominated by anorexia (26.7%), xerostomia (13.3%), and febrile neutropenia (6.6%). Eight (57.1%) and six (42.9%) patients had complete response and partial response. The 2-year actuarial overall survival rate and local control rate were 93.3%, and 87.5%, respectively. With a median 17.5 months (1.25–23.6) of follow-up, 13 out of 14 patients are still alive without evidence of diseases, and only one is alive with evidence of diseases. Conclusions: We determined the MTD of docetaxel to be 20 mg/m2 administered once weekly concurrently with combined with conventionally fractionated RT and weekly 10 mg/m2 CDDP. This chemoradiotherapeutic regimen serves as a promising treatment modality, in which level 3 is the recommended dose for a phase II study.

No significant financial relationships to disclose.

Prediction of tumor necrosis fraction using combined volumetric and metabolic indices derived from FDG-PET/CT in osteosarcoma patients receiving neoadjuvant chemotherapy

10539

Background: Maximum standardized uptake values (mSUV) might not reliably reflect the chemotherapy response in osteosarcoma especially when treatment response within tumors is heterogenous. The purpose of this study was to compare the usefulnesses of various FDG PET/CT indices for predicting tumor response to neoadjuvant chemotherapy and to identify the most appropriate one in osteosarcoma. Methods: Thirteen patients with primary osteosarcoma (age 14±2.9 yrs, ranged 10–19 yrs) that had undergone FDG PET/CT scans before and after neoadjuvant chemotherapy were enrolled. The authors measured mSUV, metabolic tumor volumes (MTV), and total lesion glycolysis (TLG) in each PET/CT scan. MTVs were calculated by summing voxels with SUV greater than 1.5, 2, 2.5 and 3.0, and with % mSUV greater than 20%, 25%, 30% and 35%. Histopathologic necrosis fractions were compared with the above-mentioned PET/CT parameters and their pre- to post-treatment ratios (MTV ratio, rMTV; mSUV ratio, rSUV; TLG ratio, rTLG). Results: Histopathologic necrosis fractions ranged from 3% to 99% (62.2%±37.7%). rMTV and rTLG values were found to be correlated with histopathologic necrosis fractions (R2=0.45–0.65, p<0.05), whereas, mSUV and MR image volumes (MRV), both before and after treatment, rSUV values, and rMRV values were not. With regard to rMTV and rTLG values obtained using various MTV criteria, the highest correlation was observed for a rTLG value of 2.5 mg/ml (R2=0.65, p=0.001). Five patients were classified as responders and 8 as poor-responders to neoadjuvant chemotherapy defined as those with chemotherapy-induced necrosis fractions of ≥90% and <90%, respectively. The rSUVs of responders and poor-responders were not different, but rMTV and rTLG values showed a trend toward difference, although statistically not significant (p=0.110 and 0.106, respectively). The sensitivity and specificity of rTLG were 100% and 62.5%, respectively, at an SUV cut-off of 0.13. Conclusions: In our osteosarcoma patient population, TLG and MTV, which represent combined metabolic and volumetric indices, were found to predict tumor response better than pre- or post-treatment mSUV or rSUV.

No significant financial relationships to disclose.

A phase II trial of gemcitabine, ifosfamide, dexamethasone, and oxaliplatin (GIDOX) for patients with refractory or relapsed non-Hodgkin's lymphoma

8559

Background: Gemcitabine combined with cisplatin has been known as an effective regimen for lymphoma treatment in salvage setting. However, this regimen has the modest response with severe nephrotoxcity and neurotoxicity, especially to heavily treated patients. We investigated the response rate and toxicity of gemcitabine, ifosfamide, dexamethasone, and oxaliplatin (GIDOx) for recurrent or refractory aggressive B-cell non-Hodgkin lymphoma (NHL), looking for the more effective and less toxic therapy. Methods: Patients with recurrent or refractory diffuse large B-cell NHL or mantle cell lymphoma, measurable disease, and more than one previous chemotherapy regimen were eligible. Treatment consisted of gemcitabine 1000 mg/m2 intravenously (i.v.) on Days 1 and 8, ifosfamide 2000 mg/m2 i.v. on Day 1, dexamethasone 40 mg orally on Days 1–4, and oxaliplatin 130mg/m2 i.v. on Day 2, every 21 days. The primary end point was a response after three cycles. Patients could then proceed to stem cell transplantation (SCT) or receive up to six treatment cycles. Results: Twenty-seven eligible patients were evaluable for toxicity and response. The median age of the patients was 54 years (range, 18–75 years) and most had diffuse large-cell lymphoma. After 3 cycles, there were 4 complete responses (CR; 15%) and 10 partial responses (PR; 37%). There was an overall response rate (RR) of 52%. The RR after completion of all protocol chemotherapy including SCT was 44% (10 CR, 2 PR). In total 88 cycles of GIDOx, grade 3 and 4 neutropenia occurred in 33% and 16% of cycles, respectively. Grade 3 and 4 thrombocytopenia occurred in 14% and 16% of cycles, respectively. Tow patients (2%) experienced febrile neutropenia. Seven patients (26%) proceeded to SCT. Conclusions: GIDOx is an active salvage regimen in aggressive B-cell NHL and can be administered with acceptable toxicity.

No significant financial relationships to disclose.

Does hormone receptor (HR) positivity affect the prognosis in breast cancers with human epidermal growth factor receptor 2 (HER2) overexpression?

e22091

Background: Biologically, there is an unclear issue about the role of HR positivity in HER2 positive breast cancer. These HER2(+)/ HR(+) pts were grouped into luminal B type apart from HER2(+)/ HR(-) pts in molecular profiling. However, from the clinical point of view, these pts have been categorized and been treated as either the only HER2(+) disease regardless of HR status or vice versa. Thus, we investigated the impact of HR status on clinical outcomes in HER2-overexpressed breast cancers. Methods: We retrospectively reviewed medical charts of HER2-positive breast cancer pts who underwent curative surgical resection from 1996 to 2001 in the Severance hospital, Korea. Demographic comparisons were performed by Chi-square tests. Tumor size, nodal stage, TNM stage, HR status, and adjuvant tamoxifen use were included in the Cox proportional hazards model. Results: Among the total 174 HER2-positive pts, HR (n=93) was positive in 53.5% (n = 93) and HR-positive tumors were more likely to be premenopausal (73% v 52%; P=0.01) and well- differentiated (grade 1or 2; 77% v 62%; P=0.04). There were no significant differences according to HR status in terms of tumor size, nodal stage, TNM stage, operation methods, and chemotherapy regimen. In these HER2-positive pts, the 5-year disease free survival (DFS) was longer in HR(+) pts than in HR(-) pts (DFS; 82.9% v 61.5%; P= 0.01). In a subset analysis, the 5-year DFS of HER2(+)/ER(+) pts without adjuvant tamoxifen (n=26) was not different from that of HER2(+)/ ER(-) pts (DFS; 57.7% v 61.5%; P= 0.32). However, the 5-year DFS of HER2(+)/ ER(+) pts with adjuvant tamoxifen was significantly prolonged compared with that of HER2(+)/ ER(-) pts (DFS; 91.5% v 61.5%; P< 0.001). In a multivariate analysis of DFS, tumor size and adjuvant tamoxifen use significantly affected DFS with an adjusted hazard ratio of 2.56 (95% CI, 1.2–4.9; P= 0.01) and 6.58 (95% CI, 2.8–20.3; P< 0.001), respectively. Conclusions: In an analysis of HER2-overexpressed breast cancer, the presence of HR itself did not affect the prognosis. However, most of the survival benefit seems to be driven from adjuvant tamoxifen therapy not the HR status itself.

No significant financial relationships to disclose.

Clinicopathological factors affected no 18FDG uptake in 18FDG-PET CT: only invasive ductal cancer

Abstract #6007

Background: Positron emission tomography with fluorine-18 fluoro deoxy-glucgose (18FDG-PET CT) recently used is suggested more useful tool for accurate, non-invasive imaging modality of the prediction of prognosis and staging of breast cancer. The aim of this study was to evaluate whether no enhanced 18FDG uptake would be associated with the biological non-aggressiveness of invasive ductal carcinoma and suggest limitation of using 18FDG-PET CT for preoperative evaluation.&#x2028; Materials and Methods: The patients were consisted of 124 female patients raging in age from 29-80 years (average 51.1 years) with primary invasive ductal carcinoma. All patients had histologically or cytologically proven invasive ductal carcinoma before performing 18FDG-PET CT sacn. All patients were examined with 18FDG-PET CT sacn before neoadjuvant chemotherapy. Patients undergoing excisional biopsy were excluded from this study.&#x2028; Results: 20 patients had primary tumor with no enhanced 18FDG uptake and 18FDG-PET CT showed hypermetabolic axillary foci in 25 patients. In these 25 patients, two was false positive findings. Histologic examination was confirmed 56 patients had axillary lymph node metastasis. The mean tumor diameter was 2.2 cm (range 0.4-6 cm). With regard to histopathologic grading, 117 were grade 1 and 2, and 7 were grade 3. It was correlation with no enhanced 18FDG uptake (p=0.003). No enhanced 18FDG uptake in invasive ductal carcinoma depended on presence of axillary lymph node metastases (p=0.014). Small tumor (&lt; 2.0cm) also was significantly correlated with no enhanced 18FDG uptake. The relationship between no enhanced 18FDG uptake and presence of lymphovascular invasion, necrosis and calcification was not significant. The immunohistochemical stain of ER/PR/p53/c-erbB2 did not correlate with no enhanced 18FDG uptake. Triple negative tumor also was not significant (p=0.072). 123 specimens were examined with Ki-67. Ki-67 positivity ranged from 0% to 60% (mean 15%). 67 specimens showed immunoreactivity to Ki-67 antigen in &lt; 10% of tumor cell. This revealed a significant correlation between no enhanced 18FDG uptake and Ki-67 (p=0.003). Logistic regression analysis between these factors was shown that histologic grade, status of axillary lymph node metastases and Ki-67 were correlated with no enhanced 18FDG uptake.&#x2028; Discussion: The our results demonstrated that an association exists between no 18FDG uptake and good prognostic factors in invasive ductal cancer, such as low histologic grade (1 & 2), no axillary lymph node metastases and low Ki-67 (&lt;10%). Although further studies are needed, 18FDG-PET CT may be suggested more useful tool for accurate, non-invasive imaging modality of the prediction of prognosis and we purpose the limitation of using 18FDG-PET CT for follow-up study in these patient.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6007.

Identification of tumor necrosis factor signaling-related proteins during Epstein-Barr virus-induced B cell transformation

Epstein-Barr virus (EBV) infection in vitro transforms primary B cells into continuously proliferating lymphoblastoid cell lines (LCLs) that have been widely used as a genomic resource for variety of immunological and genetic studies. However, the biochemical and biological characteristics that distinguish LCLs from the B cells have not been thoroughly investigated. Our proteomic approach showed that EBV infection induced changes in the profiles of tumor necrosis factor (TNF) signaling-related proteins in LCLs including heat shock protein family members TNF receptor-associated protein 1 (TRAP-1), heat shock 70-kDa protein 9 (HSPA9)) and superoxide dismutase 2 (SOD2). In addition, our literature co-occurrence study placed TNF at the center of a gene cluster network of differentially expressed proteins in LCLs. This study suggested that deregulation of TNF signaling pathway could contribute to the cellular transformation and immortalization of the EBV-infected B cells.

Irinotecan monotherapy as second-line treatment in advanced pancreatic cancer

15111

Background: The aim of this phase II study was to determine whether second line therapy with single agent irinotecan could provide any clinical benefit in patients with gemcitabine- pretreated advanced pancreatic cancer. Methods: From January 2004 to October 2006, patients with advanced pancreatic cancer previously treated with gemcitabine alone or combination were treated with single agent irinotecan(150 mg/m2, biweekly), until unacceptable toxicity or disease progression. Primary endpoint was response rate with single stage design. Results: Twenty-eight patients were enrolled(22 male, 6 female, median age : 54.5 years (39–76)). Nine patients are still alive and 3 remain on therapy with stable disease. The median number of cycles was 3.5(1–12). Twenty-four patients were assessable for toxicity and 21 for response. The most common toxicities was diarrhea (grade 3, 12.5%). Grade 3 neutropenia in 1 patient was observed. Other hematological and non-hematological toxicities were mild and manageable. Partial responses were observed in 3 patients (3/21, 14%). An additional 9 patients (9/21, 43%) had stable disease as their best response. 12 patients have progressed with a median time-to-progression of 4.0 months. Conclusions: Single-agent irinotecan was tolerated with manageable toxicity, offering encouraging activity as second-line treatment of patients with advanced pancreatic cancer, refractory to gemcitabine.

No significant financial relationships to disclose.

Clinical implication of distinction from clinical features and treatment outcome of malignant lymphoma in Korean childhood and young adult

18534

Background: The Clinicopathologic features of malignant lymphomas vary to geography and differ to age. The goal of this study was to find the implication of distinction from biology, clinical features and treatment outcome of malignant lymphoma in childhood and young adult. Methods: We analysed the clinical features including age, gender, histologic type, and treatment outcome of 294 children and young adults during 13-year period (from May 1993 to November 2005) in Samsung medical center and compared our study to all age group and western childhood and adolescence group on clinical features or treatment outcome in malignant lymphoma. Results: Median age at diagnosis was 20.7 years (range: 0.1–30.1 years). Male to female ratio was 1.37:1, Of 294 cases, there were 248 cases of non-hodgkin’s lymphoma (NHL) (84.3%) and 44 cases of hodgkin’s disease (HD) (15%). This rate was significantly different to rate of all age group (HD= 5.3%) (p=0.001). Of 248 cases of non-hodgkin’s lymphoma, 134 cases (54.0%) were B-lineage and 113 cases (45.6%) were T- or NK-cell lineage. Our study group had higher rates of T- or NK-cell NHL compared to all age group (p=0.001) and western group (p=0.001). Among 248 cases of NHL, the most common histologic type was diffuse large cell lymphoma (DLBL) in our study group. Burkitt’s lymphoma (BL) was the most common histologic types in Western study group. 5-year survival rate (5YSR) was 80.4% and was superior for BL and was inferior for NK/T cell lymphoma. However male T-LBL patients had better outcome in western study group. NHL and T-cell NHL had significantly worse outcomes than HD and B-cell NHL (p=0.049, 0.001, respectively). Comparing age-groups 0–10, 10–20 and 20–30, 5YSR was inferior for the oldest patients only in NHL-, T-cell NHL- and T-cell LBL-groups. Conclusions: Our study suggested environmental and genetic factor was associated with the development of malignant lymphoma.

No significant financial relationships to disclose.

Bilateral breast cancer

17073

Background: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. The aim of this study is to assess the impact of bilateral breast cancer on the prognosis compared with unilateral breast cancer and examine clinicopathologic characteristics of Bilateral and Unilateral breast cancer. Methods: 108 patients included in this study from Jan 1980 to Dec 2005 and all information regarding medical and family history of breast cancer came from medical records and questionnaires. Results: There were 108 patients with bilateral breast cancer and its incidence was 2.3% of total breast cancer. The incidence of bilateral breast cancer after 1998 was 3.5% (90/2548) compare with the incidence before 1998 (0.9%). The mean age of patients with bilateral and unilateral breast cancer was 45.34 and 47.54 years, respectively. (p=0.032) Compared to unilateral breast cancer, bilateral group did not differ in gravida, marital status, use of HRT, but the number of case which was diagnosed with breast cancer among close relatives was more frequent (7 cases/6.5% vs 126 cases/2.8%, p=0.024). Although the most frequent histopathologic subtype was ductal carcinoma in both groups, the distribution of the histopathologic subtypes was different between the groups as invasive lobular carcinoma was present in a higher percentage of patients with bilateral breast cancer than in patients with unilateral breast cancer (6.5% vs 2.1%, p=0.002). It suggested that risk factors of developing bilateral breast cancer were family history, lobular tumor, use of hormonal therapy based on the result of multivariate regression analysis. There were no statistically significant difference in 5-year disease free survival and overall survival in both groups (bilateral: 83.25%, 89.52% vs unilateral: 82.74%, 88.79%), (p=0.3934, p=0.3114). Conclusion: In lobular carcinoma patients with family history of breast cancer during follow-up, the possibility of contralateral breast cancer should be considered more carefully and the therapeutic strategy for secondary tumor should resemble the treatment procedure for the primary tumor.

No significant financial relationships to disclose.

Comparison of the epidermal growth factor receptor gene mutation in matched primary tumor and lymph node metastasis of non-small cell lung cancer

7614

Background: Mutations in epidermal growth factor receptor (EGFR) are considered as a strong predictive marker to EGFR tyrosine kinase inhibitors (TKIs) in non-small-cell lung cancer (NSCLC). Recent studies suggested EGFR status may change between primary NSCLC and corresponding metastatic site. However, it has not fully been evaluated whether EGFR mutation differs in metastases compared to primary NSCLC. Methods: In total, 128 tumor samples from 64 NSCLC patients were investigated comparing matched 64 primary tumors, and 64 lymph node metastases. The epidermal growth factor receptor mutation status was analyzed by a direct sequencing method (exons 18–21 in EGFR) on tumor samples of primary NSCLC and corresponding lymph node metastasis. Results: In 17.2% of patents (11/64), EGFR mutation was identified in either primary NSCLC or metastasis by DNA sequencing. Six (54.5%) out of eleven cases showed discordance of EGFR mutation in the primary tumor/metastasis site. Two cases showed EGFR mutation in the metastasis but not in the primary tumor, while, in four cases, EGFR mutation was detected in the primary tumor but not in the metastasis site. The majority of discordance of EGFR mutations was identified in exon 19 (83.3%, 5/6). The median overall survival (OS) was 17.7 months (95% confidence interval, 9.4–20.0). Median OS was not varied by the discordance of EGFR mutation status between primary NSCLC and corresponding metastatic site. Conclusions: The status of EGFR mutation in primary NSCLC and that in corresponding metastasis site varied in considerable cases by DNA sequencing. Whether the status of EGFR mutation changes during the process of metastasis remains to be evaluated. Future study to evaluate the correlation of tumour response to TKIs and the discordance of the EGFR mutation status is warranted.

No significant financial relationships to disclose.

Clinical significance of ERCC1 expression in advanced squamous cell carcinoma of the head and neck treated with cisplatin- based concurrent chemoradiation

6061

Background: The cytotoxic effect of cisplatin is based on the DNA cross linking. Nucleotide excision repair is associated with resistant to platinum-based chemotherapy. The excision repair cross-complementation group 1 (ERCC1) enzyme plays a rate-limiting role in nucleotide excision repair pathway. We evaluated the expression of ERCC1 as a predictive factor for survival in patients of squamous cell carcinoma of the head and neck (SCCHN) treated with cisplatin-based concurrent chemoradiotherapy (CCRT). Methods: We reviewed the clinical records and pathologic specimens of locally advanced SCCHN patients who had been treated with cisplatin-based definitive CCRT between 1995 and 2005. ERCC1 expression of the biopsy specimen was assessed by immunohistochemical (IHC) staining and a semi- quantitative grading system (H-score) was used for the evaluation. The median value of the H-score was chosen as the cutoff point for positive ERCC1 expression. Results: A total of 44 specimens and clinical data of the patients were reviewed. The median age was 59 years (range; 27–75), and 81.8% were male; 94.2% had ECOG performance status 0–1. The positive ERCC1 expression rate was 54.5% of all specimens (N=24/44). Overall tumor response rate for CCRT was 90.9% (CR=65.9%; PR=25.0%). With a median follow-up of 45.9 months (range; 5.4–133.0), 5-year progression free survival (PFS) rate was 58.0% and 5-year overall survival (OS) rate was 57.2%. Patients in group of positive ERCC1 expression showed poor survival in terms of PFS and OS (p=0.04; p=0.05), compared with negative ERCC1 expression group. Conclusions: The positive ERCC1 expression might be a predictive factor for poor survival and early progression in patients with locally advanced SCCHN treated with cisplatin-based CCRT.

No significant financial relationships to disclose.

Recent clinical experience with multimodality therapy in thymic carcinoma

18003

Background: Thymic carcinomas typically carry a poor prognosis and are quite rare. As such, their management has not been standardized. We reviewed our recent experience with multimodality treatment for thymic carcinoma for outcomes. Methods: Retrospective review of a single institution surgical database. Data included patient demographics, pre-operative staging and treatment, peri-operative events, pathologic findings, and postoperative outcomes. Results: During the 10 year period from 1996–2006, 115 thymic tumors were primarily resected, including 17 patients who had thymic carcinoma. Patient characteristics are listed in the table below. Twelve patients underwent preoperative, platinum-based chemotherapy, and nine patients underwent postoperative radiation. At a mean follow-up of 28.4 months (range 2.1–141.7, median 10.9), 59% (10/17) are disease-free, 2 have died of disease, 4 are alive with disease. In the 10 patients who underwent complete resection, there have been no recurrences. There was one operative mortality. There were no adverse events of CTCAE Grade III or higher. Median length of stay was 5 days (range 3–8). Median survival has not yet been reached. Overall 5-year survival was 80%. Conclusions: Multimodality therapy for thymic carcinoma can result in good long-term survival.

[Table: see text]

No significant financial relationships to disclose.

A phase II trial of concurrent chemoradiaiton with paclitaxel/carboplatin in high-risk cervical cancer patients after radical hysterectomy: A multicenter prospective Korean study

5598

Background: In 1999, five randomized studies demonstrated that cisplatin based chemoradiation had a benefit over radiotherapy in cervical cancer. However, paclitaxel has been known to be safe and effective as a radiosensitizer, and carboplatin to be less toxic than cisplatin with simpler administration. Therefore, the object of this study was to evaluate the 2 year disease free survival and toxicity of high risk cervical cancer patients who received chemoradiation with paclitaxel/carboplatin. Methods: Seventy-one patients with at least one high risk factor after radical hysterectomy (metastasis to pelvic lymph nodes (LNs), invasion of parametrial tissue (PMs), positive vaginal resection margin) were administered 135 mg/m2 of paclitaxel, carboplatin (AUC = 5) every 3 weeks for 3 cycles as an adjuvant treatment. Radiotherapy was concomitantly administered to the whole pelvic region in 28 fractions totaling 4.5∼5.4Gy. Results: Median age was 49 (range: 26–80). Seven women were dropped from the study due to noncompliance and two patients did not complete treatment due to anaphylactic shock and prolonged infection. In total, sixty-two patients completed the protocol treatment. Of 211 chemotherapy cycles administered, grade 3 or 4 neutropenia occurred in 85 (40.3%) and the majority were transient. Dose reductions were in 7 cycles due to prolonged (over 4 days) neutropenia (6), and elevated liver enzyme (1). Febrile neutropenia occurred in only two patients. 14 patients experienced grade 3 or 4 non-hematologic toxicities: 1 sensory neurotoxicity, 2 fatigue, 4 diarrhea, 3 allergic reaction, 2 genitourinary, 2 hepatic, with no treatment related deaths. With a median follow-up of 20.1 (16–28) months, 8 patients experienced recurrences, 2 distant lung metastasis and 6 pelvic side wall or paraaortic recurrences (DFS: 87.1%, 95CI:78.8∼95.4). Conclusions: Concurrent chemoradiation with paclitaxel/carboplatin is well tolerated and appears effective in early stage high risk cervical cancer patients. Considering the advantages of lower toxicity and shorter treatment schedule, this regimen shows promise and should be further tested on a larger number of patients with a prolonged follow-up.

No significant financial relationships to disclose.

Effects of sex and APOE epsilon4 on object recognition and spatial navigation in the elderly

To determine effects of APOE epsilon4 (epsilon4) on cognitive performance of healthy elderly, 116 nondemented elders (mean age 81 years) were cognitive tested. The established tests Faces, Family Pictures, Spatial Span Forward and Backward, and the object recognition and spatial navigation tests developed in our laboratory were used as cognitive tests. Salivary samples were collected to determine APOE genotype and salivary testosterone and cortisol levels. Non-epsilon4- and epsilon4-carrying men and women did not differ in age, Mini-Mental State Examination, Wide Range Achievement Test-Reading, Beck Anxiety Inventory, or reaction time scores. There was an effect of epsilon4 on the object recognition and spatial navigation tests, with non-epsilon4 carriers outperforming epsilon4 carriers, but not in the other cognitive tests. No relationship was found for sex and epsilon4 status or sex and performance during the hidden session of Memory Island. In men, salivary cortisol levels correlated with object recognition. These results show that object recognition and spatial navigation tests are useful to assess cognitive function in the elderly.