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QUAD SHOT radiotherapy and doublet immunotherapy in the management of anal mucosal melanoma: A case series of efficacy and toxicity of a novel treatment approach and a review of the literature. Clin Colorectal Cancer 2022; 21:e179-e186. [DOI: 10.1016/j.clcc.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
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kiattikul C, Narayan K, Bernshaw D, Dyk S, Tzovaras A, Lin M. Tumor control after palliative hypofractionated, “Quad-shot,” external beam radiotherapy followed by brachytherapy: An effective approach in medically compromised and/or elderly patients with cervix cancer. J Cancer Res Ther 2022; 18:173-179. [DOI: 10.4103/jcrt.jcrt_1346_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lin MY, Rajasooriyar C, Kondalsamy-Chennakesavan S, Narayan K. Should Adenocarcinoma of Cervix be Treated Differently to Squamous Cell Carcinoma? INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Differences in Treatment Outcomes and Prognosis between Elderly and Younger Patients Receiving Definitive Radiotherapy for Cervical Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124510. [PMID: 32585933 PMCID: PMC7345764 DOI: 10.3390/ijerph17124510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/20/2020] [Indexed: 12/24/2022]
Abstract
The aim was to compare the clinical outcomes and prognostic factors of cervical cancer between elderly and younger women, and to explore which treatment strategy is more appropriate for elderly patients. We retrospectively reviewed patients with cervical cancer receiving definitive radiotherapy (RT) between 2007 and 2016, and divided them into two age groups: age < 70 vs. age ≥ 70. The clinical outcomes were compared between the two age groups. The median follow-up was 32.2 months. A total of 123 patients were eligible, 83 patients in group 1 (age < 70), and 40 patients in group 2 (age ≥ 70). Patients in group 2 received less intracavitary brachytherapy (ICRT) application, less total RT dose, and less concurrent chemoradiotherapy (CCRT), and tended to have more limited external beam radiotherapy (EBRT) volume. The treatment outcomes between the age groups revealed significant differences in 5-year overall survival (OS), but no differences in 5-year cancer-specific survival (CSS), 66.2% vs. 64.5%, and other loco-regional control. In multivariate analyses for all patients, the performance status, pathology with squamous cell carcinoma (SCC), International Federation of Gynecology and Obstetrics (FIGO) stage, and ICRT application were prognostic factors of CSS. The elderly patients with cervical cancer had comparable CSS and loco-regional control rates, despite receiving less comprehensive treatment. Conservative treatment strategies with RT alone could be appropriate for patients aged ≥ 70 y/o, especially for those with favorable stages or histopathology.
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Purohit S, Ferris DG, Alvarez M, Tran PMH, Tran LKH, Mysona DP, Hopkins D, Zhi W, Dun B, Wallbillich JJ, Cummings RD, Wang PG, She JX. Better survival is observed in cervical cancer patients positive for specific anti-glycan antibodies and receiving brachytherapy. Gynecol Oncol 2020; 157:181-187. [PMID: 31955861 DOI: 10.1016/j.ygyno.2020.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To measure anti-glycan antibodies (AGA) in cervical cancer (CC) patient sera and assess their effect on therapeutic outcome. PATIENTS AND METHODS Serum AGA was measured in 276 stage II and 292 stage III Peruvian CC patients using a high content and throughput Luminex multiplex glycan array (LMGA) containing 177 glycans. Association with disease-specific survival (DSS) and progression free survival (PFS) were analyzed using Cox regression. RESULTS AGAs were detected against 50 (28.3%) of the 177 glycans assayed. Of the 568 patients, 84.5% received external beam radiation therapy (EBRT) plus brachytherapy (BT), while 15.5% only received EBRT. For stage-matched patients (Stage III), receiving EBRT alone was significantly associated with worse survival (HR 6.4, p < 0.001). Stage III patients have significantly worse survival than Stage II patients after matching for treatment (HR = 2.8 in EBRT+BT treatment group). Furthermore, better PFS and DSS were observed in patients positive for AGA against multiple glycans belonging to the blood group H, Lewis, Ganglio, Isoglobo, lacto and sialylated tetrarose antigens (best HR = 0.49, best p = 0.0008). CONCLUSIONS Better PFS and DSS are observed in cervical cancer patients that are positive for specific antiglycan antibodies and received brachytherapy.
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Affiliation(s)
- Sharad Purohit
- Center for Biotechnology and Genomic Medicine, USA; Department of Obstetrics and Gynecology, Medical College of, Georgia; Department of Undergraduate Health Professionals, College of Allied Health Sciences, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Daron G Ferris
- Department of Obstetrics and Gynecology, Medical College of, Georgia
| | - Manual Alvarez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | - David P Mysona
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | | | - Wenbo Zhi
- Center for Biotechnology and Genomic Medicine, USA; Department of Obstetrics and Gynecology, Medical College of, Georgia
| | - Boying Dun
- Center for Biotechnology and Genomic Medicine, USA; Department of Obstetrics and Gynecology, Medical College of, Georgia
| | | | - Richard D Cummings
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Peng George Wang
- Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, USA; Department of Obstetrics and Gynecology, Medical College of, Georgia.
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Abstract
This article reviews the most common oncologic emergencies encountered by the radiation oncologist, including malignant spinal cord compression, intramedullary spinal cord metastasis, superior vena cava syndrome, hemoptysis, and airway compromise caused by tumor. Important trials evaluating different treatments for these emergencies are reviewed. The role of corticosteroids, surgery, chemotherapy, and radiation therapy in these patients is discussed and patient-specific treatment guidelines are suggested.
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Affiliation(s)
- Mannat Narang
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - William Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group. Cancers (Basel) 2019; 11:cancers11030371. [PMID: 30884827 PMCID: PMC6468336 DOI: 10.3390/cancers11030371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023] Open
Abstract
The management of older cancer patients remains difficult because of data paucity. Radiation oncologists need to identify potential issues which could affect treatment of those patients. A workshop was organized in Barcelona among international radiation oncologists with special interest in the management of older cancer patients on April 22, 2018. The following consensus was reached: 1. Older cancer patients often faced unconscious discriminating bias from cancer specialists and institutions because of their chronological age. 2. Advances in radiotherapy techniques have allowed patients with multiple co-morbidities precluding surgery or systemic therapy to achieve potential cure in early disease stages. 3. The lack of biomarkers for frailty remains an impediment to future research. 4. Access to healthcare insurance and daily transportation remains an issue in many countries; 5. Hypofractionation, brachytherapy, or stereotactic techniques may be ideally suited for older cancer patients to minimize transportation issues and to improve tolerance to radiotherapy. 6. Patients with locally advanced disease who are mentally and physically fit should receive combined therapy for potential cure. 7. The role of systemic therapy alone or combined with radiotherapy for frail patients needs to be defined in future clinical trials because of targeted agents or immunotherapy may be less toxic compared to conventional chemotherapy.
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Shimamoto K, Saito T, Kitade S, Tomita Y, Nagayama R, Yamaguchi S, Ariyoshi K, Okadome M. A study of treatments and outcomes in elderly women with cervical cancer. Eur J Obstet Gynecol Reprod Biol 2018; 228:174-179. [PMID: 29960201 DOI: 10.1016/j.ejogrb.2018.06.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE With the population aging, development of safe and effective treatments for elderly patients with cancer is needed. Although old age is considered a poor prognostic factor, this is not only because of the patient's disease condition or response to treatment, but also because of treatment strategy and intensity. The purpose of this study was to clarify the influence of age on treatment and prognosis in patients with cervical cancer. METHODS Women with stage Ib-IV cervical cancer treated at our institution between 1997 and 2014 were retrospectively analyzed. Patients were stratified by age into groups for analysis, <65 years and ≥65 years. Categorical variables were compared using chi-squared and Fisher's exact tests. Survival analyses were performed using the Kaplan-Meier method, and comparisons were made using the log-rank test. Subsequently, Cox proportional hazards models were developed to find independent prognostic factors. RESULTS Of 959 patients included in our study, 247 were ≥65 and 712 were <65 years of age. Elderly patients tended to be at a more advanced stage than younger patients (p < 0.001). Elderly patients more commonly had comorbidities. More received standard treatment in the younger patient group at any disease stage than in the elderly patient group (p < 0.001). Similar rates of adverse effects caused by surgery or radiotherapy were seen in patients from both groups. Although overall survival was statistically shorter in elderly patients (74.7 vs. 57.1%, p < 0.001), there was no significant difference in disease-specific survival for patients treated only with standard treatment. In multivariate analyses, clinical stage, histological type, treatment intensity, and primary surgery remained independent prognostic factors. Age was not an independent prognostic factor. CONCLUSIONS The influence of age on prognosis in patients with cervical cancer was less than we expected. Elderly patients might have better outcomes depending on the type of standard treatment they receive. The appropriate modality and intensity of treatment should be based on the patient's general condition and background.
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Affiliation(s)
- Kumi Shimamoto
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
| | - Toshiaki Saito
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shoko Kitade
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yui Tomita
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Rina Nagayama
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shinichiro Yamaguchi
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuya Ariyoshi
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masao Okadome
- Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Lancellotta V, Kovács G, Tagliaferri L, Perrucci E, Colloca G, Valentini V, Aristei C. Age Is Not a Limiting Factor in Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2178469. [PMID: 29581964 PMCID: PMC5822774 DOI: 10.1155/2018/2178469] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/04/2017] [Accepted: 12/25/2017] [Indexed: 01/23/2023]
Abstract
This review examines the role of interventional radiotherapy (IRT otherwise known as brachytherapy) in cancer treatment for elderly patients. Despite their advanced age and associated comorbidities, elderly patients should receive definitive cancer therapies, including surgery and radiotherapy (RT). In fact, RT becomes first-line option for patients who are not eligible for surgery (due to comorbidities, anticoagulant drugs, and risk of disfigurement) or those who refuse it. It emerged from this review of the literature as effective, simple, safe, and comfortable and was associated with good local control, low toxicity rates, and excellent cosmesis and provided a cost benefit. IRT may be used as sole treatment for small cancers or as a useful adjunct to surgery or external beam radiotherapy (EBRT) in more advanced (or lymph node positive) cases, especially when the aim is local control with adequate preservation of normal tissue function. As palliative treatment, IRT preserves quality of life and/or improves survival. It is to be hoped that this review will serve as a helpful guide for members of multidisciplinary teams that are involved in treating elderly patients with cancer.
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Affiliation(s)
- Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH-CL, Lübeck, Germany
| | - Luca Tagliaferri
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giuseppe Colloca
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Gruppo Italiano di Oncologia Geriatrica (GIOGER), Roma, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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Swanick CW, Eifel PJ, Huo J, Meyer LA, Smith GL. Challenges to delivery and effectiveness of adjuvant radiation therapy in elderly patients with node-positive vulvar cancer. Gynecol Oncol 2017; 146:87-93. [PMID: 28506563 DOI: 10.1016/j.ygyno.2017.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine adjuvant radiation therapy (RT) use, patterns of RT delivery, and clinical outcomes in older patients with node-positive vulvar cancer. METHODS Using SEER-Medicare linked data, we identified 444 patients (age≥66years) with node-positive squamous cell vulvar carcinoma, without distant metastases, and treated with primary surgery between 1991 and 2009. We used claims to examine RT use and the following delivery metrics: 1) completion of ≥20 fractions, 2) treatment duration <8weeks, 3) <1week of intra-treatment break, and 4) treatment interval from surgery to start of RT <8weeks. We tested associations between RT use and metrics with overall (OS) and cause-specific survival (CSS) using multivariate proportional hazards regression. RESULTS Median age was 78years (interquartile range [IQR]=74-83). Median follow-up was 17months (IQR=9-40). Three hundred six patients (69%) received RT. Three delivery metrics were associated with improved outcomes: completion of ≥20 fractions, treatment duration <8weeks, and <1week of intra-treatment break. Patients who achieved these 3 metrics demonstrated better disease outcomes compared with surgery alone (OS hazard ratio [HR] for death=0.62, 95% confidence interval [CI]=0.46-0.82, P=0.001; CSS HR=0.58, 95% CI=0.40-0.85,P=0.005). Patients not achieving RT metrics demonstrated marginal improvements in disease outcomes over surgery alone (OS HR=0.73, 95% CI=0.55-0.99,P=0.04; CSS HR=0.76, 95% CI=0.52-1.11, P=0.16). Notably, only 51% of patients who received RT achieved all benchmarks. CONCLUSIONS In this cohort of older women with node-positive vulvar cancer, achieving metrics for RT delivery was an important factor for optimizing disease benefits from treatment.
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Affiliation(s)
- Cameron W Swanick
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jinhai Huo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Larissa A Meyer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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