1
|
Nwogu CE, Ezeome EE, Mahoney M, Okoye I, Michalek AM. Regional cancer control in south-eastern Nigeria: a proposal emanating from a UICC-sponsored workshop. West Afr J Med 2011; 29:408-11. [PMID: 21465450 DOI: 10.4314/wajm.v29i6.68278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an impending cancer epidemic in Africa. In Nigeria, this disease is causing untold devastation, and control measures are desperately needed. Breast, cervical, prostate, and liver cancers are the most common types in Nigerian adults. In children, the predominant malignant diseases are Burkitt's lymphoma, acute lymphoblastic leukemia, neuroblastoma, and Wilm's tumor (nephroblastoma). The focus of efforts to control cancer in Nigeria should be directed at prevention with adequate attention to planning/policy making, early detection, accurate diagnosis, treatment and palliative care. National and regional allocation of sufficient resources is required, accompanied by measurable objectives and appropriate emphasis on accountability.
Collapse
Affiliation(s)
- C E Nwogu
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo NY, USA.
| | | | | | | | | |
Collapse
|
2
|
Khushalani NI, Yang G, Tan W, Miecznikowski J, Wang D, Iyer RV, Yendamuri SS, Nwogu CE, Nava HR, Javle MM. Gene expression profile (GEP) for the prediction of pathologic complete response (pCR): Preliminary data from a neoadjuvant study of capecitabine (C), oxaliplatin (OXP), and radiation (RT) for esophageal cancer (EC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
3
|
Sharma R, Yang GY, Nava HR, Demmy TL, Nwogu CE, Yendamuri SS, Lamonica D, Tan W, Iyer RV, Khushalani NI. A single institution experience with neoadjuvant chemoradiation (CRT) with irinotecan (I) and cisplatin (C) in locally advanced esophageal carcinoma (LAEC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15619 Background: Multimodal therapy is considered standard for LAEC with cisplatin and 5FU-based CRT being commonly used, though with significant toxicity. Novel agents are needed to improve pathologic response (pCR) which predicts for better prognosis. We analyzed our experience with CRT using I + C in LAEC. Methods: LAEC patients (PTS) who underwent surgery preceded by CRT with I + C were identified from the Roswell Park tumor registry. Treatment consisted of Day 1,8 of C 30mg/m2 and I 65mg/m2in a 21 day cycle. PTS concurrently received 45–50.4 Gy radiation in1.8Gy fractions. Data retrieved included toxicity, pCR rate and survival. Results: 44 eligible PTS, median age 61 yr, 43 males and 1 female. Histology included adenocarcinoma (n=38), squamous cell (n=4), mixed (n=2); 12 PTS had signet-ring cell features. 29 PTS had poorly differentiated tumors. Clinical stage was II (n=5), III (n=24), IVa(n=6), IVb(n=1), not available (n=8). ECOG PS was 0 (n=34) and 1 (n=10). Most common toxicities observed were fatigue (n=24), diarrhea (n=19), vomiting (n=15), hematologic (n=11), constipation (n=11) and neurologic (n=7). Dose delay or reduction was required in 10 PTS, usually from hematologic toxicity. Of these,1 week delay in 45% and 2 weeks in 36%; 1 PT discontinued treatment due to toxicity. There was no CRT-related mortality. 2 PTS died post-operatively (anastamotic leak and sepsis). Dyphagia improved in 33/35 (94%) PTS following CRT. All PTS underwent R0 resection and pCR rate was 25% (11/44). 15 PTS have experienced recurrence. The median disease-free and overall survival is 24 months and 34 months, respectively; 3-yr overall survival is 46%. Available pre- and post-CRT FDG uptake on PET imaging in 28 PTS did not correlate with pCR status (p=0.77). Conclusions: Neo-adjuvant CRT with I + C has modest efficacy in the treatment of LAEC and can be given safely in the out-patient setting. PTS should be monitored closely for toxicity, specifically diarrhea that requires prompt intervention. Efficacy results appear better than those reported in ECOG 1201. This regimen is being evaluated in CALGB 80302 and results are awaited. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. Sharma
- Roswell Park Cancer Institute, Buffalo, NY
| | - G. Y. Yang
- Roswell Park Cancer Institute, Buffalo, NY
| | - H. R. Nava
- Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | - W. Tan
- Roswell Park Cancer Institute, Buffalo, NY
| | - R. V. Iyer
- Roswell Park Cancer Institute, Buffalo, NY
| | | |
Collapse
|
4
|
Pande AU, Iyer RV, Rani A, Maddipatla S, Yang GY, Nwogu CE, Black JD, Levea CM, Javle MM. Epidermal growth factor receptor-directed therapy in esophageal cancer. Oncology 2008; 73:281-9. [PMID: 18477853 DOI: 10.1159/000132393] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 11/19/2007] [Indexed: 01/12/2023]
Abstract
Esophageal adenocarcinoma (EAC) is one of the fastest growing malignancies in the US. The long-term survival of patients with this cancer remains poor; only 25% of patients undergoing surgical excision are alive after 5 years. Multimodal programs that incorporate radiotherapy, chemotherapy and surgery for localized tumors may result in a modest survival advantage. However, significant strides in this disease can result from the inclusion of targeted therapies. The epidermal growth factor receptor (EGFR) family represents one such target and is receiving increasing attention due to the advent of specific inhibitors. Studies conducted by us and others have shown that the overexpression of EGFR family signaling intermediates is common in Barrett's esophagus and EAC. In the latter case, EGFR expression may have prognostic significance. EGFR inhibitors, including oral tyrosine kinase inhibitors and monoclonal antibodies, result in a synergistic antitumor effect with chemotherapeutic agents or with radiotherapy. Therefore, several ongoing studies include EGFR-directed therapy either alone or in combination with chemoradiotherapy for this disease. Our study of gefitinib, oxaliplatin and radiotherapy suggested that gefitinib can be safely incorporated into an oxaliplatin-based chemoradiation program for esophageal cancer, although the clinical activity of this combination is modest. Herein, we review the current literature on this subject.
Collapse
Affiliation(s)
- A U Pande
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Javle MM, Nwogu CE, Donohue KA, Iyer RV, Brady WE, Khemka SV, Smith JL, Demmy TL, Yang GY, Nava HR. Management of locoregional stage esophageal cancer: a single center experience. Dis Esophagus 2006; 19:78-83. [PMID: 16643174 DOI: 10.1111/j.1442-2050.2006.00544.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Therapeutic options for locoregional esophageal cancer (EC) include primary surgery, neoadjuvant or definitive chemoradiation and systemic chemotherapy. The role of surgery in these multimodal strategies has recently been debated and definitive chemoradiation is being offered as an alternative to surgery at many centers. We examined our results with multimodal therapy and surgery in this patient population. We conducted a retrospective analysis of 172 patients with locoregional (AJCC stages I-III) EC treated at RPCI between February 14, 1990 and September 20, 2002. Median age was 65 years (range, 36-95); there were 136 male patients. There were 100 regional (stages IIB-III), 69 local (stages I-IIA) and three in situ cases. Initial therapy was either combined modality (n = 122) or single modality (surgery) (n = 50). There was 0%, 30-day, postoperative mortality. Median survival for all patients was 25.3 months and was better for local stage with surgery alone (75 months) than with neoadjuvant (35.7 months) or definitive chemoradiation (19.1 months, P < 0.001). Survival for patients with regional disease treated with surgery alone, neoadjuvant or definitive chemoradiation was 21.5, 24.4 and 11.8 months, respectively (P = not significant). The associations of prognostic factors with overall survival were evaluated using Cox proportional hazards regression analysis and 2-sided Wald's chi-square test. On multivariate analysis, carefully selected patients treated with surgery alone had better outcomes compared with those treated with definitive chemoradiation (P < 0.001). Patients with locoregional esophageal cancer who are eligible for surgical resection either alone or as a part of multimodal therapy may have better outcomes than those treated with non-surgical approaches.
Collapse
Affiliation(s)
- M M Javle
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Anderson TM, Hess SD, Egilmez NK, Nwogu CE, Lenox JM, Bankert RB. Comparison of human lung cancer/SCID mouse tumor xenografts and cell culture growth with patient clinical outcomes. J Cancer Res Clin Oncol 2003; 129:565-8. [PMID: 12923636 DOI: 10.1007/s00432-003-0473-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Accepted: 06/09/2003] [Indexed: 11/25/2022]
Abstract
Leukemic cell growth in SCID mice has been reported as a predictor of disease relapse. However, there is a paucity of literature regarding xenograft growth and clinical outcomes in non-small cell lung cancer (NSCLC). Seventy-nine specimens from patients with NSCLC were either subcutaneously implanted into SCID mice and/or placed in tissue culture. Retrospective chart review was correlated with stage, histology, necrosis, disease-free interval, and survival. Tumor xenografts were successfully established with 17 of 37 (46%) tumor biopsy tissues. Thirteen of 59 (22%) specimens grew in cell culture. Patients whose tumors grew in SCID mice had no difference in survival compared to those with no growth ( n=20, p=0.42). Median survival was 36 months in 13 patients whose tumors grew in cell culture compared to 39 months in 46 patients without growth. Eight of 12 (67%) patients with metastasis showed SCID/human xenograft growth, whereas nine of 25 (36%) without metastases did so ( p=0.08). Growth of tumor cells in vitro occurred in 11 of 31 (35%) adenocarcinomas, one of 25 (4%) squamous cell carcinomas, and one of three (33%) large cell carcinomas ( p=0.02). Well or moderately differentiated tumors grew in cell culture in only two of 22 (9%), whereas poorly or undifferentiated tumors grew in 11 of 32 (34%) cases ( p=0.03). We conclude that neither the ability of a tumor to engraft and grow in SCID mice nor its ability to grow in vitro in cell culture is a reliable predictor of disease outcome or survival in patients with NSCLC. The ability to propagate tumors in vitro appears to be more dependent upon the histological type of tumor and its degree of differentiation.
Collapse
MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma, Bronchiolo-Alveolar/mortality
- Adenocarcinoma, Bronchiolo-Alveolar/pathology
- Adult
- Aged
- Aged, 80 and over
- Animals
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Cell Line, Tumor
- Disease-Free Survival
- Female
- Humans
- Injections, Subcutaneous
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Medical Records
- Mice
- Mice, SCID
- Middle Aged
- Neoplasm Staging
- Neoplasm Transplantation
- Prognosis
- Retrospective Studies
- Survival Analysis
Collapse
Affiliation(s)
- T M Anderson
- Division of Thoracic Surgery, Roswell Park Cancer Institute, A-249 Carlton Building, Buffalo, NY 14263, USA.
| | | | | | | | | | | |
Collapse
|
7
|
Anderson TM, Nwogu CE, Loree TR, Cheng CC, Hughes JM, Nava HR. Iatrogenic esophagobronchial fistula arising in irradiated Barrett's esophagus. Int J Gastrointest Cancer 2003; 30:161-3. [PMID: 12540028 DOI: 10.1385/ijgc:30:3:161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 47-yr-old male underwent a right upper lobectomy for stage IIB bronchoalveolar carcinoma followed by 4600 Gy of irradiation. One year later a fistula formed from an ulcerated region of Barrett's esophagus into the left main bronchus. Bronchotomy repair with onlay patch intercostal muscle flap and esophageal repair with serratus anterior muscle flap plus postoperative esophageal stent placement for stricture resulted in good functional results.
Collapse
Affiliation(s)
- T M Anderson
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
| | | | | | | | | | | |
Collapse
|
8
|
Anderson TM, McMahon JJ, Nwogu CE, Pombo MW, Urschel JD, Driscoll DL, Lele SB. Pulmonary resection in metastatic uterine and cervical malignancies. Gynecol Oncol 2001; 83:472-6. [PMID: 11733957 DOI: 10.1006/gyno.2001.6427] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although thoracotomy for removal of pulmonary metastasis is well documented in a wide variety of solid tumors, data are sparse regarding management of patients with gynecologic malignancies metastatic to the lung. METHODS We retrospectively reviewed the Roswell Park Cancer Institute experience between 1982 and 1999. Of 82 eligible patients with gynecologic tumors metastatic and confined to the lung, 25 underwent pulmonary resection. RESULTS There were 60 uterine and 22 cervix cancer patients with pulmonary metastases. Among patients with uterine cancer primaries undergoing pulmonary resection (n = 19) median survival was 26 months. Uterine cancer patients who underwent surgical resection for leiomyosarcomas (n = 11) had a median survival of 25 months compared to 46 months in patients with adenocarcinoma (n = 6, P = 0.02). Median survival in cervix cancer patients undergoing resection for pulmonary metastases (n = 6) was 36 months. CONCLUSIONS Pulmonary resection may provide a survival advantage for selected patients with uterine and cervical malignancies with metastases isolated to the lung.
Collapse
Affiliation(s)
- T M Anderson
- Department of Surgical Oncology, Roswell Park Cancer Institute and SUNY at Buffalo, 14263, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Lung metastases have been found in 25-30% of all patients with cancer at autopsy. Those patients satisfying criteria for surgical resection represent a much smaller subgroup. Given the potentially curative nature of pulmonary metastasectomy in the absence of disseminated disease, it has become widely accepted as an important treatment option for a variety of malignancies with metastasis to the lungs. A standardized approach remains unfounded however, given limited numbers of patients, various histologic subtypes and few published studies utilizing randomized prospective methodology.Ultimately, the development of metastasis represents a major determinant of survival for patients with cancer. Pulmonary metastasectomy is an important treatment modality for patients with metastatic pulmonary disease. The indications for pulmonary metastasectomy and the surgeon's role in pulmonary metastatic disease continue to evolve. Future prospective studies and the compilation of comparable data yielding prognostic factors for specific histologies will better define indications for resection.
Collapse
Affiliation(s)
- R S Davidson
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | | | | | | |
Collapse
|
10
|
Anderson TM, Ray CW, Nwogu CE, Bottiggi AJ, Lenox JM, Driscoll DL, Urschel JD. Pericardial catheter sclerosis versus surgical procedures for pericardial effusions in cancer patients. J Cardiovasc Surg (Torino) 2001; 42:415-9. [PMID: 11398043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Approximately 21% of patients with advanced malignancies have cardiac or pericardial involvement with tumor. Controversy exists regarding the optimal approach to the pericardial space when hemodynamic compromise due to effusions occurs. METHODS A six-year retrospective review of 59 cancer patients with pericardial effusions. RESULTS Thirty-six patients had subxiphoid pericardial window (SXPW) alone (Group A), 5 had pericardial catheter drainage (PCD) followed by a SXPW (Group B), 10 had PCD with sclerosis (Group C), 5 had PCD alone (Group D), 2 had PCD with pericardial-pleural window (Group E), and one had pericardial-peritoneal window (Group F). The method of procedure, complications, number of hospital and ICU days, cytological or pathologic evidence of malignancy, solid versus hematological tumors, and survival were analyzed. The median survival for those patients in group C was one month compared to 4 months for Group A and 6 months for Group B. Essentially, results were similar regardless of method performed with the exception that professional and hospital charges averaged $4830 for SXPW compared to $1625 for PCD. CONCLUSIONS Pericardial catheter drainage and sclerosis provides a viable option for the treatment of pericardial effusions in selected cancer patients at markedly reduced cost and patient discomfort.
Collapse
Affiliation(s)
- T M Anderson
- Department of Thoracic Surgical Oncology,State University of New York & Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Two cases of acute submucosal esophageal hemorrhage are reported. This condition is uncommon and presents an urgent diagnostic dilemma. Its presentation, diagnosis, and management are reviewed. The underlying pathology and causative factors are researched and clarified. Conservative management is safe and effective.
Collapse
Affiliation(s)
- C E Nwogu
- Division of Cardiothoracic Surgery, University of Massachusetts Medical Center, Worcester 01655, USA
| | | |
Collapse
|
12
|
Ebel A, Nwogu CE, Lumba-Guanlao E. Ulnar motor nerve conduction velocity: comparison of two measurement techniques. Arch Phys Med Rehabil 1972; 53:34-7. [PMID: 5007658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|