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Garg H, Bhandari M, Dursun F, Liss MA, Kaushik D, Svatek RS, Mansour AM. A comparative analysis of radical cystectomy with perioperative chemotherapy, chemoradiation therapy, or systemic therapy in patients with clinically advanced node-positive bladder cancer (cN2/N3). Front Oncol 2024; 13:1157880. [PMID: 38273851 PMCID: PMC10808589 DOI: 10.3389/fonc.2023.1157880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The management of non-metastatic clinically advanced lymph nodal (cN2/N3) bladder cancer (Stage IIIB) could involve radical cystectomy, chemoradiation, or systemic therapy alone. However, a definitive comparison between these approaches is lacking. This study aims to compare the outcomes of patients undergoing radical cystectomy with pelvic lymph node dissection (RC-PLND), chemoradiation therapy (CRT) or systemic therapy (including immunotherapy) (ST) only in patients with stage IIIB bladder cancer. Materials and methods A retrospective analysis of the National Cancer Database for patients with stage IIIB urothelial bladder cancer was done from 2004-2019. Patients were classified as Group A: Those who received RC-PLND with perioperative chemotherapy, Group B: Those who received CRT, and Group C: Those who received only ST alone. The primary outcome was overall survival (OS). Inverse probability weighting (IPW)-adjusted Kaplan Meier curves were utilized to compare overall survival (OS) and cox multivariate regression analysis was used to identify predictors for OS. Results Overall, 2,575 patients were identified. They were classified into Group A (n=1,278), Group B (n=317) and Group C (n=980). Compared to Group B, patients in Group A were younger (SMD=19.6%), had lower comorbidities (SMD=18.2%), had higher income (SMD=31.5%), had private insurance (SMD= 26.7%), were treated at academic centres (SMD=29.3%) and had higher percentage of N2 disease (SMD=31.1%). Using IPW-adjusted survival analysis, compared to Group C, the median OS was significantly higher in Group A (20.7 vs 14.2 months, p<0.001) and Group B (19.7 vs 14.2 months, p<0.001) but similar between Group A and Group B (20.9 vs 19.7 months, p=0.74). Both surgery (HR=0.72 (0.65-0.80), p<0.001) and CRT (0.70 (0.59-0.82), p<0.001) appeared to be independent predictors for OS on cox-regression analysis. The major limitations include bias due to retrospective analysis and non-assessment of cancer-specific survival. Conclusion In stage IIIB bladder cancer with advanced lymph nodal disease, both RC and CRT offer equivalent survival benefits and are superior to systemic therapy alone.
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Affiliation(s)
- Harshit Garg
- Department of Urology, University of Texas Health, San Antonio, TX, United States
| | - Mukund Bhandari
- Department of Population Health Science, University of Texas Health, San Antonio, TX, United States
| | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, United States
| | - Michael A. Liss
- Department of Urology, University of Texas Health, San Antonio, TX, United States
- Department of Urology, University of Texas Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, United States
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, United States
- Department of Urology, University of Texas Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, United States
| | - Robert S. Svatek
- Department of Urology, University of Texas Health, San Antonio, TX, United States
- Department of Urology, University of Texas Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, United States
| | - Ahmed M. Mansour
- Department of Urology, University of Texas Health, San Antonio, TX, United States
- Department of Urology, University of Texas Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, United States
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Lønbro S, Gam S, Hermann AP, Hansen CR, Johansen J. Accelerated loss of lean body mass in head and neck cancer patients during cisplatin-based chemoradiation. Acta Oncol 2023; 62:1403-1411. [PMID: 37589161 DOI: 10.1080/0284186x.2023.2245558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND This study investigated changes in body weight, lean body mass (LBM), fat mass (FM), muscle strength and functional performance during radiation treatment in head and neck cancer (HNSCC) patients. Secondly, it investigated the impact of cisplatin-based chemoradiation (CCRT) on LBM loss compared with radiation alone. METHODS 48 patients (all tumor sites) received either 6 weeks of radiation alone (n = 16) with 66-68 Gy in 33-34 Fx, 5-6 Fx/week or CCRT, adding weekly cisplatin or carboplatin (n = 32). LBM and FM was evaluated using Dual-energy X-ray Absorptiometry bi-weekly from pre- to two weeks post-treatment. Maximal muscle strength (knee extension, leg - and chest press) and functional performance (stair climb, chair rise, and arm curl) were assessed pre- and post-treatment. RESULTS Body weight and LBM had declined significantly already week 2 into treatment and declined significantly further through week 4 and 6 before leveling off after week 6. Bi-weekly, from treatment start to week 2, 2-4, and 4-6, LBM declined 1.2 ± 0.4 kg (p = .002; 95% CI: 0.4;2.0), 2.0 ± 0.4 kg (p < .0001; 1.2;2.8) and 1.4 ± 0.4 kg (p = .001; 0.6;2.2). With a two-week delay, FM declined significantly from week 2-8. All measures of muscle strength declined significantly from pre- to post-treatment. Functional performance was unchanged. LBM loss from pre- to post-treatment was significantly associated with impaired muscle strength (R2 = 0.3-0.5). CCRT patients lost 3.1 ± 0.8 kg of LBM (p = .0001; 1.5;4.7) more from pre- to post-treatment compared with patients receiving radiation alone. Analyses adjusting for nimorazole, tumor stage, baseline BMI, mean radiation dose to constrictor muscles and oral cavity confirmed this. CONCLUSION Accelerated and substantial LBM loss was already initiated within the first two weeks of treatment - before the onset of radiation-induced mucositis. LBM loss was associated with muscle strength impairment. Patients receiving CCRT experienced significantly larger LBM loss than patients receiving radiation alone. Registered on clinincaltrials.gov (Identifier: NCT05890859).
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Affiliation(s)
- Simon Lønbro
- Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark
| | - Søren Gam
- Department of Diabetes and Endocrinology, University of Southern Denmark, Esbjerg, Denmark
| | - Anne Pernille Hermann
- Department of Endocrinology, University Hospital of Southern Denmark, Odense, Denmark
| | - Christian Rønn Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Ho YC, Lai YC, Lin HY, Ko MH, Wang SH, Yang SJ, Chou TW, Hung LC, Huang CC, Chang TH, Lin JB, Lin JC. Cardiac Dose Predicts the Response to Concurrent Chemoradiotherapy in Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:4580. [PMID: 37760549 PMCID: PMC10526131 DOI: 10.3390/cancers15184580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Definitive concurrent chemoradiation (CCRT) is the standard treatment for cervical esophageal cancer and non-surgical candidates. Initial treatment response affects survival; however, few validated markers are available for prediction. This study evaluated the clinical variables and chemoradiation parameters associated with treatment response. Between May 2010 and April 2016, 86 completed CCRT patients' clinical, dosimetric, and laboratory data at baseline and during treatment were collected. Cox regression analysis assessed the risk factors for overall survival (OS). A receiver operating characteristic curve with Youden's index was chosen to obtain the optimal cut-off value of each parameter. Treatment response was defined per Response Evaluation Criteria in Solid Tumors v.1.1 at the first post-CCRT computed tomography scan. Responders had complete and partial responses; non-responders had stable and progressive diseases. Logistic regression (LR) was used to evaluate the variables associated with responders. The Cox regression model confirmed the presence of responders (n = 50) vs. non-responders (n = 36) with a significant difference in OS. In multivariate LR, cardiac dose-volume received ≥10 Gy; the baseline hemoglobin level, highest neutrophil to lymphocyte ratio during CCRT, and cumulative cisplatin dose were significantly associated with the responders. The initial clinical treatment response significantly determines disease outcome. Cardiac irradiation may affect the treatment response.
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Affiliation(s)
- Yu-Chieh Ho
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Yuan-Chun Lai
- Division of Medical Physics, Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.L.); (M.-H.K.)
- Department of Medical Imaging Radiological Science, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
| | - Hsuan-Yu Lin
- Division of Haematology/Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Ming-Hui Ko
- Division of Medical Physics, Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.L.); (M.-H.K.)
| | - Sheng-Hung Wang
- Department of Radiation Oncology, Lukang Christian Hospital, Changhua Christian Medical Foundation, Lukang 505, Taiwan;
| | - Shan-Jun Yang
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Tsai-Wei Chou
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Li-Chung Hung
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Chia-Chun Huang
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Tung-Hao Chang
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
- Department of Medical Imaging Radiological Science, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Science and Technology, Hsinchu 300, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua 500, Taiwan; (Y.-C.H.); (S.-J.Y.); (T.-W.C.); (L.-C.H.); (C.-C.H.); (T.-H.C.); (J.-C.L.)
- Research Department, Division of Translation Research, Changhua Christian Hospital, Changhua 500, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
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Aboud O, Liu Y, Dahabiyeh L, Abuaisheh A, Li F, Aboubechara JP, Riess J, Bloch O, Hodeify R, Tagkopoulos I, Fiehn O. Profile Characterization of Biogenic Amines in Glioblastoma Patients Undergoing Standard-of-Care Treatment. Biomedicines 2023; 11:2261. [PMID: 37626757 PMCID: PMC10452138 DOI: 10.3390/biomedicines11082261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Biogenic amines play important roles throughout cellular metabolism. This study explores a role of biogenic amines in glioblastoma pathogenesis. Here, we characterize the plasma levels of biogenic amines in glioblastoma patients undergoing standard-of-care treatment. METHODS We examined 138 plasma samples from 36 patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma at multiple stages of treatment. Untargeted gas chromatography-time of flight mass spectrometry (GC-TOF MS) was used to measure metabolite levels. Machine learning approaches were then used to develop a predictive tool based on these datasets. RESULTS Surgery was associated with increased levels of 12 metabolites and decreased levels of 11 metabolites. Chemoradiation was associated with increased levels of three metabolites and decreased levels of three other metabolites. Ensemble learning models, specifically random forest (RF) and AdaBoost (AB), accurately classified treatment phases with high accuracy (RF: 0.81 ± 0.04, AB: 0.78 ± 0.05). The metabolites sorbitol and N-methylisoleucine were identified as important predictive features and confirmed via SHAP. CONCLUSION To our knowledge, this is the first study to describe plasma biogenic amine signatures throughout the treatment of patients with glioblastoma. A larger study is needed to confirm these results with hopes of developing a diagnostic algorithm.
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Affiliation(s)
- Orwa Aboud
- Department of Neurology, University of California, Davis, Sacramento, CA 95817, USA
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Yin Liu
- Department of Neurology, University of California, Davis, Sacramento, CA 95817, USA
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Department of Ophthalmology, University of California, Davis, Sacramento, CA 95817, USA
| | - Lina Dahabiyeh
- West Coast Metabolomics Center, University of California Davis, Davis, CA 95616, USA
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Ahmad Abuaisheh
- School of Medicine, Al Balqa Applied University, Al-Salt 19117, Jordan
| | - Fangzhou Li
- Department of Computer Science, University of California, Davis, Sacramento, CA 95616, USA
- Genome Center, University of California, Davis, Sacramento, CA 95616, USA
- USDA/NSF AI Institute for Next Generation Food Systems (AIFS), Davis, CA 95616, USA
| | | | - Jonathan Riess
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, Sacramento, CA 95817, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | - Rawad Hodeify
- Department of Biotechnology, School of Arts and Sciences, American University of Ras Al Khaimah, Ras Al-Khaimah 10021, United Arab Emirates
| | - Ilias Tagkopoulos
- Department of Computer Science, University of California, Davis, Sacramento, CA 95616, USA
- Genome Center, University of California, Davis, Sacramento, CA 95616, USA
- USDA/NSF AI Institute for Next Generation Food Systems (AIFS), Davis, CA 95616, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis, Davis, CA 95616, USA
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Nanda R, Katke A, Thejaswini B, Giri GV, Pawar Y, Manjula MV, Babu G. Ten years survival results of randomized study comparing weekly vs. triweekly cisplatin with concurrent radiation in locally advanced carcinoma cervix. Rep Pract Oncol Radiother 2023; 28:322-331. [PMID: 37795405 PMCID: PMC10547408 DOI: 10.5603/rpor.a2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background The current standard of treatment for locally advanced cervical cancer is concurrent chemo-radiation with improved overall survival (OS) by 6% with manageable toxicities. The cisplatin 40 mg/m2 given weekly is the widely practiced regimen for 4-6 cycles concurrently with irradiation. Materials and methods Two hundred and twelve patients with histologically proven squamous cell carcinoma of cervix with stages IIB to IIIB were enrolled between 2007-2011. External beam radiation dose of 45 Gy in 25 fractions was delivered over 5 weeks. Brachytherapy was delivered by manual afterloading cesium-137 (Cs137) low dose brachytherapy (LDR) using modified Fletcher suit intracavitary applicators to a total dose of 30 Gy to Point A or interstitial template to dose of 21 Gy/3 fractions with remote afterloading iridium-192 (Ir192) high dose brachytherapy (HDR). Patients were randomized to arm A receiving 40 mg/m2 of concurrent cisplatin weekly and arm B receiving 100 mg/m2 of concurrent cisplatin triweekly. Results One hundred and nine patients were randomized to weekly cisplatin and one hundred and three patients to triweekly cisplatin at the end of recruitment. At ten years, the OS was higher in the weekly arm (79.8%) compared to triweekly arm (70.9%). Disease free survival (DFS) was almost equal (76.1% and 73.8%) in the weekly and three-weekly arms. There is definite significance in overall DFS with patients receiving the cumulative cisplatin doses of more than 250 mg (p = 0.028). The patients with more than 45 years of age had better overall survival (OS) (79%) with statistical significance 31 (p = 0.020). Conclusion Both cisplatin based triweekly and weekly concurrent chemotherapy are equally effective in terms of OS and DFS.
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Affiliation(s)
- R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Yashwant Pawar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - M V Manjula
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Govind Babu
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Rhome R, Wright J, De Souza Lawrence L, Stearns V, Wolff A, Zellars R. Concurrent chemotherapy with partial breast irradiation in triple negative breast cancer patients may improve disease control compared with sequential therapy. Front Oncol 2023; 13:1146754. [PMID: 37503312 PMCID: PMC10370352 DOI: 10.3389/fonc.2023.1146754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/06/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose To report outcomes on a subset of patients with triple negative breast cancer (TNBC) treated on prospective trials with post-lumpectomy partial breast irradiation and concurrent chemotherapy (PBICC) and compare them to a retrospectively assessed similar cohort treated with whole breast irradiation after adjuvant chemotherapy (WBIaC). Methods and materials Women with T1-2, N0-1 invasive breast cancer with ≥ 2mm lumpectomy margins were offered therapy on one of two PBICC trials. PBI consisted of 40.5 Gy in 15 daily 2.7 Gy fractions delivered concurrently with the first 2 cycles of adjuvant chemotherapy. The comparison cohort received WBI to a median dose of 60.7 Gy, (including boost, range 42.5 - 66 Gy), after completion of non-concurrent, adjuvant chemotherapy. We evaluated disease-free survival (DFS), and local/loco-regional/distant recurrence-free survival (RFS). We compared survival rates using Kaplan-Meier curves and log-rank test of statistical significance. Results Nineteen patients with TNBC were treated with PBICC on prospective protocol, and 49 received WBIaC. At a median follow-up of 35.5 months (range 4.8-71.9), we observed no deaths in the PBICC cohort and 2 deaths in the WBIaC cohort (one from disease recurrence). With a median time of 23.4 (range 4.8 to 47) months, there were 7 recurrences (1 nodal, 4 local, 4 distant), all in the WBIaC group. At 5 years, there was a trend towards increased local RFS (100% vs. 85.4%, p=0.17) and loco-regional RFS (100% vs. 83.5, p=0.13) favoring the PBICC cohort. There was no significant difference in distant RFS between the two groups (100% vs. 94.4%, p=0.36). Five-year DFS was 100% with PBICC vs.78.9% (95% CI: 63.2 to 94.6%, p=0.08) with WBIaC. Conclusion This study suggests that PBICC may offer similar and possibly better outcomes in patients with TNBC compared to a retrospective cohort treated with WBIaC. This observation is hypothesis-generating for prospective trials.
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Affiliation(s)
- Ryan Rhome
- Department of Radiation Oncology, Indiana University Hospital, Indianapolis, IN, United States
| | - Jean Wright
- Department of Radiation Oncology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | | | - Vered Stearns
- Department of Oncology, Division of Women’s Malignancies, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Antonio Wolff
- Department of Oncology, Division of Women’s Malignancies, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Richard Zellars
- Department of Radiation Oncology, Indiana University Hospital, Indianapolis, IN, United States
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Chen CS, Huang EY. Comparison of Oncologic Outcomes between Radical Hysterectomy and Primary Concurrent Chemoradiotherapy in Women with Bulky IB and IIA Cervical Cancer under Risk Stratification. Cancers (Basel) 2023; 15:cancers15113034. [PMID: 37296994 DOI: 10.3390/cancers15113034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To stratify patients according to tumor marker and histology and compare the survival outcome between radical hysterectomy (RH) and primary concurrent chemoradiotherapy (CCRT) in bulky IB and IIA cervical cancer. METHODS A total of 442 patients with cervical cancer were enrolled in the Chang Gung Research Database from January 2002 to December 2017. Patients with squamous cell carcinoma (SCC) and carcinoembryonic antigen (CEA) ≥10 ng/mL, adenocarcinoma (AC), or adenosquamous carcinoma (ASC) were stratified into the high-risk (HR) group. The others were classified into the low-risk (LR) group. We compared oncology outcomes between RH and CCRT in each group. RESULTS In the LR group, 5-year overall survival (OS) and recurrence-free survival (RFS) were 85.9% vs. 85.4% (p = 0.315) and 83.6% vs. 82.5% (p = 0.558) in women treated with RH (n = 99) vs. CCRT (n = 179), respectively. In the HR group, the 5-year OS and RFS were 83.2% vs. 73.3% (p = 0.164) and 75.2% vs. 59.6% (p < 0.036) in patients treated with RH (n = 128) vs. CCRT (n = 36), respectively. Regarding recurrence, locoregional recurrence (LRR) (8.1% vs. 8.6%, p = 0.812) and distant metastases (DM) (17.8% vs. 21%, p = 0.609) were similar between RH and CCRT in the LR group. However, lower LRR (11.6% vs. 26.3%, p = 0.023) but equivalent DM (17.8% vs. 21%, p = 0.609) were found for women undergoing RH compared with CCRT in the HR group. CONCLUSIONS There were similar survival and recurrence rates between both treatment modalities in low-risk patients. Meanwhile, primary surgery with or without adjuvant radiation provides better RFS and local control in women with high-risk features. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Chung-Shih Chen
- Departments of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan
| | - Eng-Yen Huang
- Departments of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City 804, Taiwan
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Bera RN, Tandon S, Singh AK, Boojar FMA, Jaiswal G, Borse S, Pal US, Sharma NK. Management and outcome of locally advanced oral squamous cell carcinoma. Natl J Maxillofac Surg 2023; 14:185-189. [PMID: 37661995 PMCID: PMC10474551 DOI: 10.4103/njms.njms_125_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/30/2022] [Accepted: 04/13/2023] [Indexed: 09/05/2023] Open
Abstract
Management of locally advanced OSCC is multimodal. No single therapy has been proved to be efficacious. However there is a trend towards surgical intervention in operable disease. In this review we appraise the various therapies used for the management of locally advanced OSCC. We review the literature with regards to the various treatment options for locally advanced OSCC. We categorically divided the manuscript into resectable, unresectable and technically unresectable disease. Surgery is the ideal treatment modality for resectable disease. For unresectable disease concurrent chemoradiation appears to improve survival compared to radiotherapy alone. Induction therapy might downstage tumors in the unresectable category. Targeted and Immunotherapy is reserved for recurrent, metastatic or platinum refractory OSCC. Management of locally advanced OSCC is multimodal with surgery playing the primary role. In the event where the tumor is in operable concurrent chemoradiotherapy is regarded as the best treatment modality. Induction chemotherapy currently cannot be recommended for resectable or even unresectable oral squamous cell carcinomas. However for technically unresectable disease it might play a role in improving respectability but it depends on the response of the tumor. Targeted therapy and immunotherapy is currently used for recurrent, metastatic and/or platinum refractory Head and Neck cancers. Currently it is not recommended for initial management of locally advanced disease.
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Affiliation(s)
- Rathindra N. Bera
- Department of Oral and Maxillofacial Surgery, Dental Institute Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sapna Tandon
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Akhilesh K. Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Gaurav Jaiswal
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Shraddha Borse
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Uma S. Pal
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences Kings George Medical University, Lucknow, Uttar Pradesh, India
| | - Naresh K. Sharma
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Aboud O, Liu YA, Fiehn O, Brydges C, Fragoso R, Lee HS, Riess J, Hodeify R, Bloch O. Application of Machine Learning to Metabolomic Profile Characterization in Glioblastoma Patients Undergoing Concurrent Chemoradiation. Metabolites 2023; 13:299. [PMID: 36837918 PMCID: PMC9961856 DOI: 10.3390/metabo13020299] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
We here characterize changes in metabolite patterns in glioblastoma patients undergoing surgery and concurrent chemoradiation using machine learning (ML) algorithms to characterize metabolic changes during different stages of the treatment protocol. We examined 105 plasma specimens (before surgery, 2 days after surgical resection, before starting concurrent chemoradiation, and immediately after chemoradiation) from 36 patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma. Untargeted GC-TOF mass spectrometry-based metabolomics was used given its superiority in identifying and quantitating small metabolites; this yielded 157 structurally identified metabolites. Using Multinomial Logistic Regression (MLR) and GradientBoostingClassifier (GB Classifier), ML models classified specimens based on metabolic changes. The classification performance of these models was evaluated using performance metrics and area under the curve (AUC) scores. Comparing post-radiation to pre-radiation showed increased levels of 15 metabolites: glycine, serine, threonine, oxoproline, 6-deoxyglucose, gluconic acid, glycerol-alpha-phosphate, ethanolamine, propyleneglycol, triethanolamine, xylitol, succinic acid, arachidonic acid, linoleic acid, and fumaric acid. After chemoradiation, a significant decrease was detected in 3-aminopiperidine 2,6-dione. An MLR classification of the treatment phases was performed with 78% accuracy and 75% precision (AUC = 0.89). The alternative GB Classifier algorithm achieved 75% accuracy and 77% precision (AUC = 0.91). Finally, we investigated specific patterns for metabolite changes in highly correlated metabolites. We identified metabolites with characteristic changing patterns between pre-surgery and post-surgery and post-radiation samples. To the best of our knowledge, this is the first study to describe blood metabolic signatures using ML algorithms during different treatment phases in patients with glioblastoma. A larger study is needed to validate the results and the potential application of this algorithm for the characterization of treatment responses.
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Affiliation(s)
- Orwa Aboud
- Department of Neurology, University of California, Davis, Sacramento, CA 95817, USA
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Yin Allison Liu
- Department of Neurology, University of California, Davis, Sacramento, CA 95817, USA
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Department of Ophthalmology, University of California, Davis, Sacramento, CA 95817, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis, Davis, CA 95817, USA
| | - Christopher Brydges
- West Coast Metabolomics Center, University of California Davis, Davis, CA 95817, USA
| | - Ruben Fragoso
- Department of Radiation Oncology, University of California, Davis, Sacramento, CA 95817, USA
| | - Han Sung Lee
- Department of Pathology, University of California, Davis, Sacramento, CA 95817, USA
| | - Jonathan Riess
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, Sacramento, CA 95817, USA
| | - Rawad Hodeify
- Department of Biotechnology, School of Arts and Sciences, American University of Ras Al Khaimah, Ras Al Khaimah 72603, United Arab Emirates
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95817, USA
- Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
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Yun JM, Chung MK, Baek CH, Son YI, Ahn MJ, Oh D, Kim KW, So YK. Prognostic Significance of the Post-Treatment Neutrophil-to-Lymphocyte Ratio in Pharyngeal Cancers Treated with Concurrent Chemoradiotherapy. Cancers (Basel) 2023; 15. [PMID: 36831590 DOI: 10.3390/cancers15041248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Even though the pre-treatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are well-established prognosticators in various cancers including head and neck cancers, there have been relatively few studies on the clinical significance of the post-treatment values. This study aimed to investigate the changes in NLR and PLR after concurrent chemoradiotherapy (CCRT) and to evaluate their prognostic significance in pharyngeal cancers. METHODS This study was retrospectively conducted on 461 consecutive patients with primary pharyngeal cancer who had received definitive CCRT. Blood test results before and after CCRT were obtained, and the pre- and post-treatment NLR and PLR were calculated. Patient prognosis was evaluated based on overall survival (OS) and relapse-free survival (RFS). RESULTS After CCRT, the NLR increased from 2.01 (interquartile range (IQR), 1.53-2.62) to 2.69 (IQR, 1.93-3.81), and the PLR increased from 118.84 (IQR, 92.61-151.63) to 193.19 (IQR, 146.28-262.46). Along with high pre-treatment NLR and high pre-treatment PLR, high post-treatment NLR was also significantly associated with worse OS and RFS (p = 0.013 and p = 0.026). In addition, patients with a high ΔNLR (i.e., the difference between pre- and post-treatment NLRs) had significantly worse OS and RFS (p = 0.013 and p = 0.026). However, only a high pre-treatment NLR (hazard ratio (HR), 2.19; 95% confidence interval (CI), 1.17-4.08; p = 0.014), age (HR, 2.16; 95% CI, 1.14-4.08; p = 0.018), and stage IV (HR, 2.11; 95% CI, 1.15-3.89; p = 0.017) were independent prognostic factors for OS in the multivariate analysis. CONCLUSIONS In patients with pharyngeal cancers, following CCRT, the NLR and PLR increased significantly from pre-treatment values. Like the pre-treatment NLR and PLR, a high post-treatment NLR and a significant increase in NLR were also associated with poor prognosis. Further prospective studies are required to prove the independent significance of the post-treatment NLR and PLR.
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Katke A, Nanda R, Thejaswini B, Pasha T, Giri GV, Babu G, Pawar Y. Weekly vs. tri-weekly cisplatin based chemoradiation in carcinoma cervix: a prospective randomized study of toxicity and compliance. Rep Pract Oncol Radiother 2021; 26:948-954. [PMID: 34992867 PMCID: PMC8726454 DOI: 10.5603/rpor.a2021.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Addition of chemotherapy to radiation has improved 5-year survival by 6%. However, the optimal dose and schedule of concurrent cisplatin is not well defined, though widely accepted practice is the weekly schedule of 40 mg/m2 for 5 weeks. Repeated admissions for weekly cisplatin drain the limited resources in high volume centres. We intended to study the compliance and toxicity of two cisplatin schedules in our patients diagnosed with carcinoma cervix. MATERIALS AND METHODS Between 2007-2011, 212 patients, histologically proven squamous cell carcinoma with stages IIB to IIIB were randomized into two arms. All patients were planned for external beam radiotherapy 45 Gy/25 frs over 5 weeks followed by Intracavitary or Interstitial brachytherapy to a total BED dose of 75-85 Gy. Single agent cisplatin given concomitantly, was scheduled weekly (40 mg/m2/cycle, 5 cycles) in an arm A and three weekly (100 mg/m2/cycle, 2 cycles) in an arm B. Toxicity and compliance were evaluated weekly according to the RTOG guidelines. Analysis of the compiled data was done using SSPS version 20. RESULTS Of the evaluable 212, 109 patients received weekly cisplatin chemotherapy and 103 patients received three weekly cisplatin. The most common acute toxicity observed was grade I-II leucopoenia. The upper and lower gastrointestinal reactions were high in three weekly arms, which was statistically significant (57% and 42.7%, p < 0.05). Proctitis was observed in 10% of patients in both of the arms and only two patients had Gr1 Cystitis after 6 months of treatment. CONCLUSIONS Tri-weekly cisplatin based concurrent chemoradiation can be adopted in high volume centres with manageable haematological and gastrointestinal acute toxicities.
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Affiliation(s)
- Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Tanveer Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Govind Babu
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Yashwant Pawar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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12
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Su CW, Lee JC, Chang YF, Su NW, Lee PH, Dai KY, Tai HC, Leu YS, Chen YJ. Delta-volume radiomics of induction chemotherapy to predict outcome of subsequent chemoradiotherapy for locally advanced hypopharyngeal cancer. Tumori 2021; 108:450-460. [PMID: 34423708 DOI: 10.1177/03008916211039018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) is recommended for larynx-preserving treatment of locally advanced hypopharyngeal cancer (LAHC). However, the conventional evaluation of response is not robust enough to predict the outcome of subsequent treatments. This study aimed to develop an imaging biomarker using changes in radiomic features in invasive tumor front (ITF) by IC to predict treatment outcome of subsequent CCRT in LAHC. METHODS From 2006 to 2018, 59 computed tomography (CT) scan images before and after IC in patients with LAHC were used to contour the gross tumor volumes (GTVs). A total of 48 delta-volume radiomics features were acquired from the absolute spatial difference of GTVs (delta-GTV) before and after IC, conceptually representing a consistent portion of ITF. Least absolute shrinkage and selection operator regression (LASSO) was used to select features for establishing the model generating radiomic score (R score). RESULTS A model including 5 radiomic features from delta-GTV to predict better progression-free survival (PFS) of patients receiving subsequent CCRT was established. The R score was validated with all datasets (area under the curve 0.77). Low R score (<-0.16) was associated with improved PFS (p < 0.05). CONCLUSIONS The established radiomic model for ITF from radiomic features of delta-GTV after IC might be a potential imaging biomarker for predicting clinical outcome of subsequent CCRT in LAHC.
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Affiliation(s)
- Che-Wei Su
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei
| | - Jehn-Chuan Lee
- Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei
| | - Yi-Fang Chang
- Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei
| | - Nai-Wen Su
- Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei
| | - Pei-Hsuan Lee
- Department of International Business, National Chengchi University, Taipei
| | - Kun-Yao Dai
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei
| | - Hung-Chi Tai
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei
| | - Yi-Shing Leu
- Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei.,Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei.,Department of Medical Research, China Medical University Hospital, Taichung
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13
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Ahmed HZ, Vijayakumar S, Duggar WN, Allbright R. MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States. Cureus 2021; 13:e15495. [PMID: 34113529 PMCID: PMC8186450 DOI: 10.7759/cureus.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting. The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.
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Affiliation(s)
- Hiba Z Ahmed
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Robert Allbright
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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14
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Hua L, Chen S, Wei M, Shen Y, Long J, Lin Z, Meng Y, Guo C, Huang H, Tu X, Yao M. Predictive Value of ERCC1 mRNA Level from Receiver-Operator Characteristic and Pretreatment EBV-DNA Virus Load in Stage II Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy with Concurrent Cisplatin. Cancer Biother Radiopharm 2021; 37:2-10. [PMID: 33764811 DOI: 10.1089/cbr.2020.4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The molecular mechanisms underlying chemoresistance are still poorly understood in nasopharyngeal cancer; the protein expression of ERCC1 in DNA repair genes has been reported related to resistance platinum and predicting treatment outcomes in various malignant carcinomas, but the benefit for predicting outcomes with optimal cutoff value of ERCC1mRNA is controversial. The level of plasma Epstein-Barr virus (EBV) DNA is positively correlated with clinical stages of nasopharyngeal carcinoma (NPC). The predictive value of ERCC1mRNA from receiver-operator characteristic (ROC) and EBV-DNA level for stratified treatment with stage II NPC is exactly unclear. This study aims to assess the predictive value of combined EBV-DNA and ERCC1 in stage II nasopharyngeal cancer (NPC) patients treated with intensity-modulated radiotherapy (IMRT) with concurrent cisplatin, and provide guidance for future stratified treatment. Methods: A total of 86 stage II NPC patients who received IMRT and concurrent cisplatin-based chemotherapy with or without cisplatin-based adjuvant chemotherapy had measurements of ERCC1 mRNA, and pretreatment EBV-DNA levels were analyzed by real-time PCR (RT-PCR). Associations of ERCC1 mRNA and pretreatment EBV-DNA levels with clinical characteristics and survivals were evaluated. Results: Cutoff value of ERCC1 mRNA obtained from ROC curve was used, and there were significant differences in progression-free survival (PFS) and overall survival (OS) and overall response rate (ORR) between high expression group and low expression group (p = 0.021 and 0.030 and 0.000, respectively). Patients with pretreatment EBV-DNA <2000 copies/mL had significantly better PFS and ORR (p = 0.024 and 0.043, respectively) and a marginally significant impact on OS (p = 0.062) than those with pretreatment EBV-DNA ≥2000 copies/mL. Patients were divided into three groups by combination of ERCC1 mRNA and EBV-DNA level: ERCC1 mRNA low expression/pre-EBV-DNA <2000 copies/mL, ERCC1 mRNA low expression/pre-EBV-DNA ≥2000 copies/mL, and ERCC1 mRNA high expression/pre-EBV-DNA ≥2000 copies/mL. There were significant differences in ORR among the three groups (p = 0.005). The median follow-up was 62 months (range 22-84) with a follow-up rate of 90.70%. In these groups by combination of ERCC1 mRNA and EBV-DNA level, 1, 3, 5-year OS were 100%, 100%, 100%; 100%, 94.1%, 90.9%; and 100%, 85%, 72.9%, respectively (p = 0.038); 1, 3, 5-year PFS were 100%, 100%, 100%; 97.1%, 91.2%, 84.8%; and 95%, 85%, 71.4%, respectively (p = 0.028). Multivariate analysis showed that combination of ERCC1 mRNA and EBV-DNA levels remained independent prognostic factor but not ERCC1 mRNA and EBV-DNA alone. Conclusions: Combined ERCC1 mRNA and pre-EBV-DNA is a better prognostic biomarker in stage II NPC patients treated with concurrent chemoradiation. Patients with ERCC1 mRNA high expression/pre-EBV-DNA ≥2000 copies/mL may benefit from more aggressive treatment.
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Affiliation(s)
- Li Hua
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Shaojun Chen
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Mengzhuan Wei
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Yongqi Shen
- Department of Oncology, The Liuzhou Railway Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jianxin Long
- Department of Oncology, Qinzhou Hospital of Traditional Chinese Medicine, Qinzhou, China
| | - Zhan Lin
- Department of Oncology, The Yulin First People's Hospital, Yulin, China
| | - Yiliang Meng
- Department of Oncology, The Baishe People's Hospital, Baishe, China
| | - Chengxian Guo
- Clinical Pharmacology Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Haixin Huang
- Department of Oncology, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Xiaoning Tu
- Department of Head and Neck Surgery, the Forth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Min Yao
- Department of Radiation Onclogy, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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15
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Ott OJ, Gani C, Lindner LH, Schmidt M, Lamprecht U, Abdel-Rahman S, Hinke A, Weissmann T, Hartmann A, Issels RD, Zips D, Belka C, Grützmann R, Fietkau R. Neoadjuvant Chemoradiation Combined with Regional Hyperthermia in Locally Advanced or Recurrent Rectal Cancer. Cancers (Basel) 2021; 13:1279. [PMID: 33805731 DOI: 10.3390/cancers13061279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The HyRec trial was initially designed to optimize and standardize the treatment of locally recurrent rectal cancer (LRRC). An escalated neoadjuvant treatment schedule, consisting of curative radiotherapy, concurrent chemotherapy with 5-Fluorouracil and Oxaliplatin, and additional regional hyperthermia, was evaluated with the intention to increase the rate of curative resections. Primary endpoints were the feasibility rate defined by the number of therapy-limiting toxicity or treatment withdrawal, and the pathologically confirmed complete remission (pCR) rate. Between 2012 and 2018, 111 patients with Union for International Cancer Control (UICC) stage IIB-IV or any locally recurrent rectal cancer were included. The intensified neoadjuvant and multimodality treatment schedule was feasible and led to comparable early toxicity rates as described by other trials that used the similar chemoradiation protocol. The presented treatment regimen resulted in a very high pCR rate and appears as a promising option for patients with LRRC. Abstract Background: To prospectively analyze feasibility and pathological complete response (pCR) rates of neoadjuvant chemoradiotherapy combined with regional hyperthermia (RHT) in patients with locally advanced (LARC) or recurrent (LRRC) rectal cancer. Methods: between 2012 and 2018, 111 patients with UICC stage IIB-IV or any locally recurrent rectal cancer were included (HyRec-Trial, ClinicalTrials.gov Identifier: NCT01716949). Patients received radiotherapy with concurrent 5-Fluororuracil (5-FU)/Capecitabine and Oxaliplatin, and RHT. Stage 1 feasibility analysis evaluated dose-limiting toxicities (DLT) after 19 patients, stage 2 after 59 evaluable patients. Analysis of the pCR rate was based on histopathological reports. Results: the feasibility rates for stages 1 and 2 were 90% (17/19) and 73% (43/59), respectively. In the intention-to-treat population the pCR rate was 19% (20/105; 90% confidence interval (CI) 13.0–26.5). In the per-protocol-analysis, complete tumor regression was seen in 28% (18/64) and 38% (3/8) of the patients with LARC and LRRC, respectively. Complete resection rates (R0) among patients with LARC and LRRC who received surgery were 99% (78/84) and 67% (8/12). Conclusions: the intensified neoadjuvant and multimodality treatment schedule was feasible and led to comparable early toxicity rates as described by other trials that used the similar chemoradiation protocol. The presented treatment regimen resulted in a very high pCR rate and appears as a promising option for patients with LRRC.
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16
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Dreyfuss AD, Barsky AR, Wileyto EP, Eads JR, Kucharczuk JC, Williams NN, Karasic TB, Metz JM, Ben-Josef E, Plastaras JP, Wojcieszynski AP. The efficacy and safety of definitive concurrent chemoradiotherapy for non-operable esophageal cancer. Cancer Med 2021; 10:1275-1288. [PMID: 33474812 PMCID: PMC7926027 DOI: 10.1002/cam4.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To report outcomes and toxicity in patients who received definitive concurrent chemoradiation (DCCRT) for non‐operable esophageal cancer (EC) in the modern era, and to identify markers of overall and disease‐free survival (OS/DFS). Methods We conducted a retrospective cohort study of patients with unresectable EC who received DCCRT at our institution between 1/2008 and 1/2019. Descriptive statistics were used to report disease‐control outcomes and CTCAE v4.0–5.0 toxicities. Univariable and multivariable Cox regression, and stepwise regression were used to identify associations with survival. Results At a median follow‐up of 19.5 months, 130 patients with adenocarcinoma (AC) (62%) or squamous cell carcinoma (SCC) (38%) were evaluable (Stage II‐III: 92%). Patients received carboplatin/paclitaxel (75%) or fluorouracil‐based (25%) concurrent chemotherapy. Median total RT dose was 50.4 Gy (range, 44.7–71.4 Gy) delivered in 28 fractions (24–35). Locoregional and distant recurrence occurred in 30% and 35% of AC, and 24% and 33% of SCC, respectively. Median OS and DFS were 22.9 and 10.7 months in AC, and 25.7 and 20.2 months in SCC, respectively. On stepwise regression, tumor stage, feeding tube during DCCRT, and change in primary tumor PET/CT SUVmax were significantly associated with OS and DFS. Most severe toxicities were acute grade 4 hematologic cytopenia (6%) and radiation dermatitis (1%). Most common acute grade 3 toxicities were hematologic cytopenia (35%), dysphagia (23%), and anorexia (19%). Conclusions Treatment of non‐operable EC with DCCRT has acceptable toxicity and can provide multi‐year disease control for some patients, even in AC. Continued follow‐up and investigation in large studies would be useful.
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Affiliation(s)
- Alexandra D Dreyfuss
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew R Barsky
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R Eads
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John C Kucharczuk
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas B Karasic
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James M Metz
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrzej P Wojcieszynski
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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Nanda R, Katke A, Suneetha N, Thejaswini B, Pasha T, Jagannath KP, Giri GV, Babu KG. A prospective randomized study comparing concurrent chemoradiation with weekly and 3 weekly cisplatin in locally advanced oropharyngeal carcinoma. South Asian J Cancer 2020; 8:178-182. [PMID: 31489293 PMCID: PMC6699241 DOI: 10.4103/sajc.sajc_270_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: The chemotherapy schedules with cytotoxic dose or weekly regimes are still challenging, weighing the benefits versus toxicities. This prospective randomized study is an attempt to assess the efficacy of two schedules of cisplatin in management of locally advanced HNSCC. Objectives: The objectives of this study was to evaluate tolerance, tumour response and toxicities of concurrent chemoradiation with cisplatin in weekly and three weekly regimes. Methods: Locally advanced oropharyngeal squamous cell carcinoma patients fit for concurrent chemoradiation with cisplatin 40 mg/m2 (weekly) and 100 mg/m2 (3 weekly) were randomized to Arm A and B concurrently with radiotherapy of 70Gy/35frs/7 weeks. Statistical Analysis: Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between the groups. The statistical software SPSS 15.0 was used. Results: Between December 2010 and January 2013, 60 patients were enrolled. The median cycles of cisplatin in Arm-A was 5 and 2 in Arm-B. The complete response of 80.9% vs 75% and partial response of 14.3% vs 12.5% was observed in both arms respectively. There was no statistical difference in acute radiation and hematological toxicities between the two groups. With median follow up of 28 months, the 2 and 5 years overall survival was 55% and 58%; 41.6% and 32.3% in arms A and B respectively. Conclusion: In our study of locally advanced oropharyngeal carcinoma treated with radical radiotherapy comparing concurrent chemotherapy with cisplatin weekly vs 3 weekly had no significant difference in overall response, complete response and acute toxicities.
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Affiliation(s)
- R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - N Suneetha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Tanvir Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K P Jagannath
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Gadducci A, Cosio S. Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer: Review of the Literature and Perspectives of Clinical Research. Anticancer Res 2020; 40:4819-4828. [PMID: 32878770 DOI: 10.21873/anticanres.14485] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
Concurrent cisplatin-based chemotherapy and radiotherapy (CCRT) plus brachytherapy is standard treatment for locally advanced cervical cancer. Platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy has been proposed as an alternative approach, especially for patients with stage Ib2-IIb disease. This review analyzes the most commonly used combination regimens in this clinical setting and the randomized trials comparing chemo-surgery versus definitive radiotherapy or CCRT. The combination of paclitaxel plus ifosfamide plus cisplatin (TIP regimen) obtained the highest rates of optimal pathological response, associated with elevated hematological toxicity. In a recent phase II study, a dose-dense regimen consisting of weekly paclitaxel plus carboplatin for 9 cycles has achieved optimal pathological response rates similar to those of TIP with better toxicity profile. Further studies are strongly warranted to better define the optimal regimen for the patients selected to receive NACT followed by radical surgery.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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19
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Huang MY, Lee HH, Huang CW, Huang CM, Ma CJ, Yin TC, Tsai HL, Chai CY, Chen YT, Wang JY. ERCC overexpression associated with a poor response of cT4b colorectal cancer with FOLFOX-based neoadjuvant concurrent chemoradiation. Oncol Lett 2020; 20:212. [PMID: 32963618 PMCID: PMC7491057 DOI: 10.3892/ol.2020.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) of the clinical tumor stage T4b (cT4b) refers to advanced tumors with direct invasion of adjacent structures and the tumors are considered unresectable. Despite advancements in aggressive surgery and combination chemotherapy, the prognosis of cT4b CRC remains poor. Optimizing the therapeutic sequence administered to patients with cT4b CRC to improve clinical outcomes is crucial. In the present study, patients with unresectable cT4b and nodal stage N1-2 CRC were investigated at a single institution. A total of 20 consecutive patients were treated with pre-operative concurrent chemoradiation by using 5-fluorouracil/leucovorin/oxaliplatin (FOLFOX) since February 2015 and were regularly followed up until March 2020. Due to their poor response to concurrent chemoradiation (CCRT) with FOLFOX, the chemotherapy regimen was changed to irinotecan plus 5-fluorouracil/leucovorin (FOLFIRI) as the second-line neoadjuvant treatment. Genetic alterations, such as microsatellite instability (MSI), were documented, and the expression levels of excision repair cross-complementing group 1 (ERCC1) and ERCC2 were examined. Of the 20 patients, the tumors of 14 patients (70%) became resectable after FOLFIRI administration. The median duration between the last date of radiotherapy and surgery was 32.7 weeks (range, 10.1–59.3 weeks). Of note, 4 of the 14 patients with resectable tumors (28.6%) achieved a pathologic complete response. The median overall survival and progression-free survival were 27.5 months (range, 12–39 months) and 27.5 months (range, 8–39 months), respectively. The cancerous specimens of all of the patients (100%) exhibited ERCC2 overexpression and 18 specimens (90%) had ERCC1 overexpression. Only one tumor (5%) exhibited high MSI. The present study indicated that ERCC overexpression associated with the poor response of FOLFOX-based CCRT and FOLFIRI after FOLFOX-based CCRT failure may have a potential role in conversion to resectable tumors by neoadjuvant treatment in cT4b CRC. However, a further prospective study with more patients is required to improve the precision of the conclusions.
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Affiliation(s)
- Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Division of Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan, R.O.C.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Hsin-Hua Lee
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Division of Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan, R.O.C
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
| | - Tzu-Chieh Yin
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Jaw-Yuan Wang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.,Clinical Pharmacogenomics and Pharmacoproteinomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan, R.O.C.,Cohort Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
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20
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Pathak S, Soni TP, Sharma LM, Patni N, Gupta AK. A Randomized Controlled Trial to Evaluate the Role and Efficacy of Oral Glutamine in the Treatment of Chemo-radiotherapy-induced Oral Mucositis and Dysphagia in Patients with Oropharynx and Larynx Carcinoma. Cureus 2019; 11:e4855. [PMID: 31410338 PMCID: PMC6684294 DOI: 10.7759/cureus.4855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the role and efficacy of oral glutamine in the treatment of chemo-radiotherapy-induced oral mucositis and dysphagia in patients with carcinoma of the oropharynx and larynx. The primary objective of this study was to compare the incidence and severity of oral mucositis and dysphagia between the glutamine group (oral glutamine, along with concurrent chemo-radiotherapy) and the control group (concurrent chemo-radiotherapy alone, no glutamine). Secondary objectives were to compare the time to onset of oral mucositis and dysphagia, the incidence of treatment breaks (more than three consecutive radiation fractions missed), and significant weight loss (more than 3 kilograms of weight loss from the baseline) between the two groups. METHOD A total of 60 patients with locally advanced carcinoma of the oropharynx and larynx (Stage III - IV) who were receiving concurrent chemo-radiotherapy were randomised to the glutamine group (study arm, n = 30) and the non-glutamine group (control arm, n = 30). All patients were treated by radiotherapy to a total dose of 70 Gy in 35 fractions, along with concurrent weekly injections of cisplatin (40 mg/m2) chemotherapy. Patients in the study arm received 10 gm of oral glutamine two hours before radiotherapy (five days a week during the seven-week course of radiotherapy). In the control arm, glutamine was not given to patients during the chemo-radiotherapy treatment. All patients were assessed for oral mucositis, dysphagia, weight loss, and compliance/gap in the treatment (greater than three consecutive days of radiation missed) until the completion of chemo-radiotherapy. Grading of oral mucositis and dysphagia was done as per the National Cancer Institute, Common Terminology Criteria for Adverse Events version 4.03. RESULTS Out of 60 patients, 56 patients (93.33%) completed the full course of chemo-radiotherapy treatment. Twenty-seven patients (96.43%) in the control arm developed Grade III oral mucositis compared to only 12 patients (42.83%) in the glutamine arm (p < 0.001). Twenty-six patients (93%) in the control arm developed Grade III dysphagia compared to only 11 patients (39%) in the glutamine arm (p < 0.001). Glutamine significantly decreased the incidence and severity of mucositis and dysphagia. Glutamine delayed the onset of mucositis and dysphagia. As severe dysphagia was more prevalent in the control arm, feeding by Ryle's tube was required in 17 patients (56.67%) in the control arm versus only in eight patients (26.67%) in the glutamine arm (p = 0.03). Significant weight loss during the treatment was seen in all patients of the control arm (100% patients) compared to only 71% of the patients in the glutamine arm (p = 0.004). In the control arm, 46.67% patients had treatment interruption (gap) compared to 16.67% in the glutamine arm (p = 0.025). Sixteen patients (53%) from the control arm required admission (inpatient care) in the hospital to manage the treatment-toxicity (mucositis and dysphagia) compared to seven patients (23%) from the glutamine arm (p = 0.03). CONCLUSION Glutamine significantly decreased the incidence and severity of chemo-radiotherapy-induced oral mucositis and dysphagia. It delayed the onset of oral mucositis and dysphagia, improved the compliance to the chemo-radiotherapy treatment, and reduced the requirement for hospitalization for the management of treatment-induced toxicities in patients with locally advanced carcinoma of the oropharynx and larynx.
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Affiliation(s)
- Shuchita Pathak
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Tej P Soni
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Lalit M Sharma
- Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Nidhi Patni
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Anil K Gupta
- Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
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21
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Abstract
Primary sino-nasal neuroendocrine carcinomas (PSNNECs) are rare, with a wide spectrum of histological differentiation. Advanced tumors may invade the surrounding structures, such as the skull base, orbit, or brain. Here, we present a rare case of PSNNEC and its management by concurrent chemoradiation (CCRT) followed by adjuvant chemotherapy with the radiological resolution of the tumor mass.
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Affiliation(s)
- Shaqul Qamar Wani
- Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ishtiyaq A Dar
- Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Talib Khan
- Anesthesiology, Sher I Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Mohammad M Lone
- Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, IND
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22
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Qie S, Li Y, Shi HY, Yuan L, Zhang X. S-1 plus cisplatin with concurrent radiotherapy for stage III non-small cell lung cancer: A meta-analysis (PRISMA) of randomized control trials. Medicine (Baltimore) 2018; 97:e13441. [PMID: 30557998 PMCID: PMC6320030 DOI: 10.1097/md.0000000000013441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The present study aims to assess the efficacy and safety of S-1 plus cisplatin as concurrent chemoradiation (experimental group [EG]) compared with standard concurrent chemoradiation regimens (control group[CG]) in patients with local advanced non-small cell lung cancer. METHODS The Cochrane library, pubmed, and Ovid (elsevier) were retrieved. The included randomized controlled trials (RCT) were evaluated, and the statistical analysis was performed using RevMan 5.3 software. Cochrane handbook was applied to evaluate the methodological quality. Statistical significance was considered as P <.05. RESULTS There were 5 randomized control trials identified eligible for the meta-analysis. Meta-analysis of the pooled date suggested that overall survival (OS) (HR, 0.81; 95% CI, 0.58-1.13; P = .21, heterogeneity P = 1.00, I = 0%), progressives free survival (PFS) (HR, 0.82; 95% CI, 0.62-1.09; P = .18, heterogeneity P = .83, I = 0%) and 1,2,3-year OS (1-year OS: RR 1.03; 95% CI: 0.92-1.15, p = 0.59), (2-year OS: RR 1.14; 95% CI: 0.98-1.34, P = .09), (3 -year OS: RR 1.14; 95% CI: 0.90-1.44, P = .29) were not significantly different. The combination of S-1 and cisplatin had lower grade 3 or 4 leukocytopenia, neutropenia, (RR = 0.54, 95% CI: 0.38-0.75, P = .0003; RR = 0.23,95% CI: 0.14-0.36, P <.00001;, respectively). The rates of nausea, diarrhea, thrombocytopenia, pneumonitis, anorexia, anemia, febrile neutropenia were much the same in the 2 groups (RR = 1.35, 95% CI: 0.68-2.68, P = .38; RR = 1.85, 95% CI: 0.61-5.60, P = .28; RR = 1.67, 95% CI: 0.88-3.17, P = .12; RR = 1.19, 95% CI: 0.44-3.21, P = .73; RR = 1.35, 95% CI: 0.68-2.68, P = .38; RR = 0.86, 95% CI:0.55-1.34, P = .50; RR = 0.63, 95% CI:0.35-1.14, P = .13;, respectively). CONCLUSIONS This meta-analysis of 5 randomized control trails demonstrates that EG results similar OS, PFS, and 1,2,3-year OS, compared with CG, with lower risk of leukocytopenia, neutropenia.
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23
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Giambattista J, McVicar N, Hamilton S, Martin M, Maas B, Ho C, Wu J, Tran E, Hay J, Berthelet E. Magnetic Resonance Imaging Volumetry of Primary Nasopharyngeal Cancer in Patients Treated with Induction Gemcitabine and Cisplatin Followed by Concurrent Cisplatin and Volumetric Modulated Arc Therapy. Cureus 2018; 10:e3296. [PMID: 30443466 PMCID: PMC6235650 DOI: 10.7759/cureus.3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction The addition of induction chemotherapy (IC) to the standard concurrent chemoradiotherapy (CCRT) is under consideration in locally advanced nasopharyngeal carcinoma (LANPC). To-date, no studies have reported primary gross tumour volume (GTVp) changes using gemcitabine and cisplatin as the IC phase in LANPC. We investigated the timing and magnitude of GTVp response throughout sequential gemcitabine and cisplatin IC and CCRT for LANPC. Toxicity and tumour control probability (TCP) analyses are also presented Methods Ten patients with LANPC underwent sequential IC and CCRT between 2011 and 2015. All patients had magnetic resonance imaging (MRI) at three time points: before IC (MRI0), after IC (MRI1), and three months after CCRT (MRI3). Five of the 10 patients had an additional MRI four to five weeks into CCRT (MRI2). GTVp contours were delineated retrospectively using contrast-enhanced MRIs, and each GTVp underwent secondary review by a neuroradiologist. Acute toxicities were graded retrospectively via chart review based on the National Cancer Institute Common Terminology for Adverse Events version 4.0 (NCI CTCAE v4.0). Results Mean GTVp reduction between MRI0 - MRI1 was from 68 cc to 47 cc and from 47 cc to 9 cc between MRI1 - MRI3. In patients with MRI2, the mean GTVp reduction between MRI1 - MRI2 was from 57 cc to 32 cc. Tumour control probability estimates increased by 0.11 after IC. Patients tolerated the treatment well with one Grade IV toxicity event. Conclusion The observed GTVp response and improved tumor control probability support further investigation into the use of IC in LANPC.
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Affiliation(s)
- Joshua Giambattista
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Nevin McVicar
- Medical Physics, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Sarah Hamilton
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Montgomery Martin
- Radiology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Benjamin Maas
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Cheryl Ho
- Medical Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Jonn Wu
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Eric Tran
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - John Hay
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Eric Berthelet
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
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24
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Ahmad I, Chufal KS, Bashir I, Bhatt CP, Bajpai R, Sharma L, Rathour S. Early Clinical Outcomes, Patterns of Failure, and Acute Haematologic Toxicity of Image-Guided Volumetric Modulated Arc Therapy (IG-VMAT) in the Definitive Treatment of Locally Advanced Carcinoma Cervix. Clin Med Insights Oncol 2018; 12:1179554918783990. [PMID: 30093800 PMCID: PMC6081749 DOI: 10.1177/1179554918783990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/22/2018] [Indexed: 11/21/2022]
Abstract
Purpose: To evaluate clinical outcomes and failure patterns in patients with locally
advanced cervical cancer (LACC) treated definitively using image-guided
volumetric-modulated arc therapy (IG-VMAT). Methods and materials: This retrospective review included 18 consecutively treated patients with
LACC. Treatment consisted of IG-VMAT and concurrent chemotherapy followed by
intracavitary radiotherapy. The primary end points were overall survival
(OS) and disease-free survival (DFS). Acute haematologic toxicity was
evaluated using Radiation Therapy Oncology Group (RTOG) criteria. Results: A total of 16 patients were either stage IIB or IIIB and the median follow-up
was 30.5 months (interquartile range: 13-36.25 months). The 2-year DFS was
63.3% (95% confidence interval [CI]: 52.8%-72.4%) and 2-year OS was 72.2%
(95% CI: 62.1%-80.5%). There were 7 treatment failures, predominantly
in-field. Acute haematologic toxicity was low. Conclusions: IG-VMAT is associated with favourable outcomes for patients with LACC.
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Affiliation(s)
- Irfan Ahmad
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Kundan Singh Chufal
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute & Research Centre, Rohini, New Delhi, India
| | - Irfan Bashir
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Chandi Prasad Bhatt
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Ram Bajpai
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lalit Sharma
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
| | - Sandeep Rathour
- Department of Radiotherapy, Batra Hospital & Medical Research Centre, New Delhi, India
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25
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Kanakamedala MR, Giri SPG, Hamilton RD, Bhanat E, Vijayakumar S. Outcomes utilizing intensity-modulated radiotherapy in oropharyngeal cancers: Tonsils versus base of tongue. Head Neck 2018; 40:1034-1039. [PMID: 29385294 PMCID: PMC5947155 DOI: 10.1002/hed.25077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 10/03/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to present the outcomes of oropharyngeal cancers treated with intensity-modulated radiotherapy (IMRT) especially the differences between tonsillar and base of tongue (BOT) primaries. METHODS Retrospective analysis of 124 patients with biopsy proven squamous cell carcinomas of the oropharynx, treated with IMRT. RESULTS Human papillomavirus (HPV) association correlated with improvement in survivals in both tonsillar and BOT primaries. At the 2-year median follow-up, the cumulative incidences of locoregional recurrences were 8% in both the tonsil and BOT groups (P = .76) but the distant metastases were 8% in the tonsil group versus 26% in the BOT group (P = .009). Thirty percent of tonsil primaries has ≥N2c neck disease as compared to 54% of BOT. Incidence of distant metastases increases with advanced nodal classification, especially >N2c. CONCLUSION Even though the locoregional controls are excellent with IMRT and chemotherapy, these patients continue to fail distantly, particularly significant for the BOT group and for nodal stage >N2c.
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Affiliation(s)
| | - Shankar P. G. Giri
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Robert D. Hamilton
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Eldrin Bhanat
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Srinivasan Vijayakumar
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
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26
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Jin T, Zhang Q, Jiang F, Qin WF, Jin QF, Cao CN, Piao YF, Feng XL, Luo W, Chen XZ. Neoadjuvant chemotherapy with different dose regimens of docetaxel, cisplatin and fluorouracil (TPF) for locoregionally advanced nasopharyngeal carcinoma: a retrospective study. Oncotarget 2017; 8:100764-100772. [PMID: 29246020 PMCID: PMC5725062 DOI: 10.18632/oncotarget.21992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Compare high- vs. low-dose TPF neoadjuvant chemotherapy with chemoradiotherapy in Chinese patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and Methods Retrospective analysis of 210 stage III/IV NPC patients treated between April 1, 2012 and April 1, 2014; 138 received three cycles of high-dose TPF (H-TPF) every 3 weeks at Zhejiang Cancer Hospital and 72, three cycles of low-dose TPF (L-TPF) every 3 weeks at Sun Yat-Sen University Cancer Center. H-TPF was docetaxel (75 mg/m2; 1 h infusion), cisplatin (75 mg/m2; 0.5-3 h), then 5-fluorouracil (600 mg/m2/day; 4 days). L-TPF was docetaxel (60 mg/m2), cisplatin (65 mg/m2), then 5-fluorouracil (550 mg/m2/day; 5 days). All patients received chemoradiotherapy. Results During neoadjuvant chemotherapy, treatment delays were more frequent for H-TPF than L-TPF (33.3% vs. 19.4%; P = 0.034). During chemoradiotherapy, grade III-IV anemia, thrombocytopenia and neutropenia were more common for H-TPF than L-TPF (P < 0.001, P < 0.001, P = 0.048). Fewer patients in the H-TPF group finished two cycles of concurrent chemotherapy (81.2% vs. 100%, P < 0.001). Three-year PFS (84.5% vs. 80.6%, P = 0.484) and OS (91.1% vs. 93.5%, P = 0.542) were not significantly different between H-TPF and L-TPF. Conclusions L-TPF neoadjuvant chemotherapy has substantially better tolerance and compliance rates and similar treatment efficacy to H-TPF neoadjuvant chemotherapy in locoregionally-advanced NPC.
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Affiliation(s)
- Ting Jin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qun Zhang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Feng Jiang
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei-Feng Qin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qi-Feng Jin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Cai-Neng Cao
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yong-Feng Piao
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xing-Lai Feng
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei Luo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
| | - Xiao-Zhong Chen
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
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Schernberg A, Moureau-Zabotto L, Rivin Del Campo E, Escande A, Ducreux M, Nguyen F, Goere D, Chargari C, Deutsch E. Leukocytosis and neutrophilia predict outcome in locally advanced esophageal cancer treated with definitive chemoradiation. Oncotarget 2017; 8:11579-11588. [PMID: 28086222 PMCID: PMC5355287 DOI: 10.18632/oncotarget.14584] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/26/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To investigate the prognostic value of leukocyte and neutrophil count as biomarkers in patients with locally advanced esophageal squamous cell carcinoma (SCC) undergoing exclusive chemoradiation. Results A total of 126 patients were identified. Respectively, 33% and 35% displayed baseline leukocytosis and neutrophilia. Estimated 3-year OS and PFS from chemoradiation completion were 31% and 25%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS, and LRC (p < 0.01). In multivariate analysis, leukocytosis remained an independent risk factor associated with poorer OS, PFS and LRC (p < 0.05), independently from tumor stage and length, with higher prognostic value for OS compared with patients’ performance status (PS). Materials and Methods Bi-institutional clinical records from consecutive non-operable patients treated between 2003 and 2015 with definitive chemoradiation for locally advanced esophageal carcinoma were reviewed. Leukocytosis and neutrophilia were defined as a leukocyte or neutrophil count over 10 G/L and 7 G/L, respectively. These parameters were studied for their potential correlation with overall survival (OS), progression free survival (PFS), locoregional control (LRC) and distant metastases control (DMC). Conclusions Leukocytosis and neutrophilia were independent prognostic factors of poor OS, PFS, and LRC in this bi-institutional series of locally advanced esophageal SCC treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters might be clinically relevant biomarkers to be considered for further clinical investigations.
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Affiliation(s)
- Antoine Schernberg
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | - Alexandre Escande
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michel Ducreux
- Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France.,Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - France Nguyen
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Diane Goere
- Department of Surgery, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Cyrus Chargari
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France.,French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France.,Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Eric Deutsch
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.,Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France
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28
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Ou X, Xu T, He X, Ying H, Hu C. Who benefited most from higher cumulative dose of cisplatin among patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiation therapy? A retrospective study of 527 cases. J Cancer 2017; 8:2836-2845. [PMID: 28928873 PMCID: PMC5604216 DOI: 10.7150/jca.19725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose: Our previous study demonstrated the benefit of cumulative dose of cisplatin during the whole treatment on locally advanced nasopharyngeal carcinoma (NPC) treated with various chemotherapy strategies. The purpose of this study is to identify the subgroup of locally advanced NPC who benefits from higher dose of cisplatin, and to clarify whether cumulative dose of cisplatin during the whole treatment brings survival benefit to those treated with concurrent chemoradiotherapy (CCRT). Materials and methods: This retrospective study enrolled 527 patients with locally advanced NPC treated with intensity-modulated radiation therapy (IMRT) and chemotherapy in our institution from 2009 to 2010. The median cumulative dose of cisplatin of 300mg/m2 was chose to be the cutoff value of low and high dose subgroups. Survival curves were estimated using the Kaplan-Meier method. Univariate analysis was conducted using the log-rank test. Multivariate analyses (MVA) were performed using Cox proportional hazards regression model. Results: With a median follow-up of 54.5 (1-76.7) months, high-dose subgroup had a significant higher distant metastasis-free survival (DMFS) (82.0% vs. 76.5%, p=0.029) and overall survival (OS) (84.1% vs. 74.0%, p=0.028). Cumulative dose of cisplatin were demonstrated an independent prognostic factors for DMFS (HR=0.524, 95% CI 0.340-0.806) and OS (HR=0.577, 95% CI 0.373-0.893) for the entire cohort upon MVA. As for T1-2N2-3, high-dose subgroup had a trend of better DMFS (85.7% vs. 76.3%, p=0.069) and a significant improvement in OS (87.8% vs. 76.3%, p=0.041). Similarly, in the subgroup of T3-4N2-3, higher dose of cisplatin was associated with higher OS (80.3% vs. 52.3%, p=0.032). Cumulative dose of cisplatin was an independent prognostic factor for DMFS (HR=0.483, 95%CI 0.292-0.798) and OS (HR=0.429, 95%CI 0.258-0.715) for patients with T1-4N2-3 disease upon MVA. However, the benefit of higher dose of cisplatin was not observed in the subgroup of T3-4N0-1. For patients receiving CCRT (n=278), those treated with higher dose of cisplatin had a significantly higher DMFS (87.7% vs. 75.4%, p=0.004). The benefit mainly derived from T3-4N2-3 patients treated with CCRT (5y DMFS: 87.9% vs. 58.2%, p=0.034). Cumulative dose of cisplatin was associated with a lower risk of distant metastasis (HR=0.427, 95% CI 0.228-0.801) for patients treated with CCRT upon MVA. Conclusions: Our study identified that patients with N2-3 disease were those benefited from higher cumulative dose. The benefit of higher cumulative dose maintained in those treated with CCRT. The intensity of chemotherapy may be tailored based on various stage subgroups in locally advanced NPC.
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Affiliation(s)
- Xiaomin Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
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29
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Lin SM, Ku HY, Chang TC, Liu TW, Hong JH. The prognostic impact of overall treatment time on disease outcome in uterine cervical cancer patients treated primarily with concomitant chemoradiotherapy: a nationwide Taiwanese cohort study. Oncotarget 2017; 8:85203-85213. [PMID: 29156713 PMCID: PMC5689603 DOI: 10.18632/oncotarget.19617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/06/2017] [Indexed: 11/25/2022] Open
Abstract
The importance of the overall treatment time (OTT) has a paradoxical status in the current era of concomitant chemoradiotherapy. The main objective of this nationwide study was to evaluate the correlation between overall treatment duration and clinical outcome in cervical cancer patients treated primarily with curative concurrent chemoradiotherapy (CCRT). In this population-based cohort study, 2,594 patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA uterine cervical cancer were studied. Univariate and multivariate analyses of prognostic factors were analyzed using Cox’s proportional hazards models. The median irradiation duration was 59 days. Significant prognostic factors related to poor cancer-specific survival (CSS) and overall survival (OS) included old age, non-squamous cell cancer type, high-grade histology, increased tumor size, advanced FIGO stage, and prolonged OTT. After multivariate analysis, prolonged treatment time remained as a significant factor for poor CSS (hazard ratio, HR = 1.33; p < 0.001) and OS (HR = 1.15; p = 0.05). Further subgroup analysis showed that the 5-year OS rates after a treatment time of ≤ 56 days compared with > 56 days in patients with FIGO stages I-IIB and III-IVA were 70% and 65% (p = 0.002) compared with 43% and 42% (p = 0.67), respectively. Inconclusion, completion of CCRT within 8 weeks is recommended, particularly for patients with FIGO stage I-IIB disease.
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Affiliation(s)
- Shih-Min Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Ying Ku
- National Health Research Institute, Miaoli, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsang-Wu Liu
- National Health Research Institute, Miaoli, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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30
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Pushpa Naga CH, Janaki MG, Arul Ponni TR, Rajeev AG, Kirthi Koushik AS, Mohan Kumar S. Accelerated Radiation Therapy Using Weekend Boost with Concurrent Cisplatin in Head and Neck Squamous Cell Cancers: An Indian Institutional Experience. J Med Imaging Radiat Sci 2017; 48:307-315. [PMID: 31047415 DOI: 10.1016/j.jmir.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility and efficacy of an accelerated radiotherapy schedule using weekend boost in terms of tumor response, compliance, and acute toxicities for head and neck squamous cell carcinoma, and to report long-term clinical outcomes. MATERIALS AND METHODS Twenty-six patients with stages III-IV head and neck squamous cell carcinoma receiving radical chemoradiotherapy were accrued prospectively into the study. External beam radiation therapy to a total dose of 66-70 Gy in 33-35 fractions, 1.8-2.0 Gy per fraction along with concurrent weekly cisplatin was planned. Radiation regimen included delivery of six fractions per week, with boost field delivered as the sixth fraction on the weekend. The compliance, tumor response, and toxicities were recorded. Survival curves were estimated using the Kaplan-Meier method. RESULTS Twenty-one of 26 patients (81%) completed treatment as planned and five patients died during the course of treatment. Sixteen patients (62%) completed treatment in less than 44 days and, at the end of 3 months' follow-up, 18 patients (69%) showed complete response and two patients (8%) showed partial response. The 2- and 5-year actuarial disease-free survival were 90% and 65%, respectively, and 2- and 5-year actuarial overall survival were 60% and 38%, respectively. CONCLUSION Accelerated fractionation using weekend boost, along with concurrent weekly concurrent cisplatin, is an effective and promising approach with favorable impact on initial tumor response, comparable results, and acceptable toxicities.
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Affiliation(s)
- C H Pushpa Naga
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
| | - M G Janaki
- Department of Radiation Oncology, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - T R Arul Ponni
- Department of Radiation Oncology, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - A G Rajeev
- Department of Radiation Oncology, Radiant Cancer Hospital, Mysooru, Karnataka, India
| | - A S Kirthi Koushik
- Department of Radiation Oncology, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - S Mohan Kumar
- Department of Radiation Oncology, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
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31
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Stokes WA, Amini A, Jones BL, McDermott JD, Raben D, Ghosh D, Goddard JA, Bowles DW, Karam SD. Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis. Head Neck 2017; 39:1113-1121. [PMID: 28301079 DOI: 10.1002/hed.24739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113-1121, 2017.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Prasongvej P, Nanthakomon T, Jaisin K, Chanthasenanont A, Lertvutivivat S, Tanprasertkul C, Bhamarapravatana K, Suwannarurk K. Quality of Life in Cervical Cancer Survivors and Healthy Women: Thai Urban Population Study. Asian Pac J Cancer Prev 2017; 18:385-389. [PMID: 28345784 PMCID: PMC5454732 DOI: 10.22034/apjcp.2017.18.2.385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: To determine a baseline quality of life (QoL) in cervical cancer survivors compared to that of healthy subjects in the tertiary Thammasat University Hospital, Thailand. Materials and Methods: The investigation was conducted at the outpatient gynecological department of Thammasat University Hospital between January and June 2016. A total of 192 women were entered into the study (97 cervical cancer survivors; 37 after radical hysterectomy (RH), 43 with concurrent chemoradiation (CRT), and 17 featuring both RH and CRT; and 95 control subjects from the same outpatient department with no history of malignancy). Participant QoL was assessed using a Thai version of the EORTC-QLQ-C30 (European Organization for Research Treatment of Cancer Quality-of-Life) and a general survey for the assessment of sociodemographic data was also conducted. Results: There were significant differences in physical, role, emotional and social functions between cervical cancer survivor and control groups. Global health, fatigue, pain, appetite loss, and financial difficulties also demonstrated statistically significant variation. Cervical cancer survivors treated by RH had higher scores for emotional and social function and global health than the control group. Moreover, they had less appetite loss, fatigue and financial difficulties. However, patients treated with CRT experienced more pain than the control group. All cervical cancer survivors had lower physical function scores than the control group. Conclusion: Quality of life in cervical cancer survivors is better than in healthy peers in some domains. Cervical cancer survivors treated with RH may have a better QoL than healthy peers. Early detection for early stage cervical cancer remains most important because treatment in early stages does not cause lowering of the QoL.
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Affiliation(s)
- Pichita Prasongvej
- Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Thailand.
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33
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Tinhofer I, Stenzinger A, Eder T, Konschak R, Niehr F, Endris V, Distel L, Hautmann MG, Mandic R, Stromberger C, Weichert W, Budach V. Targeted next-generation sequencing identifies molecular subgroups in squamous cell carcinoma of the head and neck with distinct outcome after concurrent chemoradiation. Ann Oncol 2016; 27:2262-2268. [PMID: 27681865 DOI: 10.1093/annonc/mdw426] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Based on epidemiological (HPV status, smoking habits) and clinical risk factors (T/N stage), three subgroups of patients suffering from locally advanced oropharyngeal carcinoma with significantly different outcome after concurrent chemoradiation (cCRTX) can be distinguished. Mutational profiling by targeted next-generation sequencing (NGS) might further improve risk stratification. PATIENTS AND METHODS Patients with stage IV squamous cell carcinoma of the oropharynx and hypopharynx who had been enrolled in a randomized phase III trial (ARO-0401) comparing two regimens of cCRTX and from whom archival tumor specimens were available were included. The HPV status was determined by p16 immunostaining and detection of HPV DNA. Targeted NGS covering 45 genes frequently altered in squamous cell carcinoma of the head and neck (SCCHN) was applied for detection of non-synonymous somatic and germline mutations. Interference of mutational profiles with cCRTX efficacy was determined. RESULTS The prognostic value of the 'Ang' risk model could be confirmed in the total biomarker study cohort (N = 175) as well as the patient subgroup for which mutational profiles could be established (N = 97). Mutations in genes involved in phosphoinositide 3-kinase (PI3K), receptor tyrosine kinase (RTK), and p53 signaling pathways were significantly enriched in the low- (N = 7), intermediate- (N = 20), and high-risk group (N = 70), respectively. Mutations in TP53 identified a subgroup of high-risk patients with dismal outcome after cCRTX. No prognostic relevance was observed for mutations in PI3K and RTK signaling pathways in the low- and intermediate-risk groups, respectively. Mutated NOTCH1 and two functional KDR germline variants (rs2305948, rs1870377) were associated with improved outcome in all risk groups. All genetic markers (TP53, NOTCH1, KDR) remained independent prognosticators of OS in the multivariate model. CONCLUSION A potential of targeted NGS for risk classification of SCCHN cases beyond HPV status and clinical factors was demonstrated.
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Affiliation(s)
- I Tinhofer
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin .,German Cancer Research Center (DKFZ), Heidelberg, and German Cancer Consortium (DKTK) Partner Site Berlin
| | - A Stenzinger
- Institute of Pathology, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany.,Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - T Eder
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin.,German Cancer Research Center (DKFZ), Heidelberg, and German Cancer Consortium (DKTK) Partner Site Berlin
| | - R Konschak
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin.,German Cancer Research Center (DKFZ), Heidelberg, and German Cancer Consortium (DKTK) Partner Site Berlin
| | - F Niehr
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin.,German Cancer Research Center (DKFZ), Heidelberg, and German Cancer Consortium (DKTK) Partner Site Berlin
| | - V Endris
- Institute of Pathology, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany
| | - L Distel
- Department of Radiation Oncology, University Hospitals Erlangen-Nürnberg, Erlangen
| | - M G Hautmann
- Department of Radiotherapy, University Hospital Regensburg
| | - R Mandic
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Giessen-Marburg, Marburg
| | - C Stromberger
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin
| | - W Weichert
- Institute of Pathology, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany.,Institute of Pathology, Technical University Munich (TUM), Munich.,German Cancer Research Center (DKFZ), Heidelberg, and German Cancer Consortium (DKTK) partner site Munich, Germany
| | - V Budach
- Department of Radiooncology and Radiotherapy, Charite University Hospital, Berlin
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34
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Sonoda K, Yahata H, Ichinoe A, Okugawa K, Kaneki E, Kawano Y, Kenjo H, Ohgami T, Yagi H, Ohga S, Asai K, Nakamura K, Honda H, Kato K. Retrospective Analysis of Concurrent Chemoradiation with Triweekly Cisplatin plus 5-Fluorouracil Versus Weekly Cisplatin in Cervical Cancer. Anticancer Res 2015; 35:3447-3454. [PMID: 26026109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Concurrent chemoradiation (CCRT) is the standard treatment for locally advanced cervical cancer. The purpose of the study was to compare the outcomes of triweekly cisplatin plus 5-fluorouracil and weekly cisplatin regimens. PATIENTS AND METHODS We retrospectively reviewed data from 91 patients with stage IB1-IVA cervical cancer. RESULTS Out of 91 patients, 48 received triweekly CCRT and 43 received weekly CCRT. For triweekly CCRT, patients received a median of two chemotherapy cycles and median total doses of cisplatin and 5-fluorouracil were 210 mg/body and 8,525 mg/body, respectively. For weekly CCRT, patients received a median of five chemotherapy cycles and the median total dose of cisplatin was 252 mg/body. No statistically significant differences in overall survival or progression-free survival were noted between the two groups. CONCLUSION Both triweekly CCRT and weekly CCRT appear to have similar efficacy for cervical cancer patients, but the toxicities were better tolerable in weekly CCRT.
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Affiliation(s)
- Kenzo Sonoda
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akimasa Ichinoe
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kaoru Okugawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eisuke Kaneki
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiaki Kawano
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Kenjo
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuhiro Ohgami
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Yagi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Saiji Ohga
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kaori Asai
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Vrankar M, Zwitter M, Bavcar T, Milic A, Kovac V. Induction gemcitabine in standard dose or prolonged low-dose with cisplatin followed by concurrent radiochemotherapy in locally advanced non-small cell lung cancer: a randomized phase II clinical trial. Radiol Oncol 2014; 48:369-80. [PMID: 25435850 PMCID: PMC4230557 DOI: 10.2478/raon-2014-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/18/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The optimal combination of chemotherapy with radiation therapy for treatment locally advanced non-small cell lung cancer (NSCLC) remains an open issue. This randomized phase II study compared gemcitabine in two different schedules and cisplatin - as induction chemotherapy, followed by radiation therapy concurrent with cisplatin and etoposid. PATIENTS AND METHODS Eligible patients had microscopically confirmed inoperable non-metastatic non-small cell lung cancer; fulfilled the standard criteria for platin-based chemotherapy; and signed informed consent. Patients were treated with 3 cycles of induction chemotherapy with gemcitabine and cisplatin. Two different aplications of gemcitabine were compared: patients in arm A received gemcitabine at 1250 mg/m(2) in a standard half hour i.v. infusion on days 1 and 8; patients in arm B received gemcitabine at 250 mg/m(2) in prolonged 6-hours i.v. infusion on days 1 and 8. In both arms, cisplatin 75 mg/m(2) on day 2 was administered. All patients continued treatment with radiation therapy with 60-66 Gy concurrent with cisplatin 50 mg/m(2) on days 1, 8, 29 and 36 and etoposid 50 mg/m(2) on days 1-5 and 29-33. The primary endpoint was response rate (RR) after induction chemotherapy; secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). RESULTS From September 2005 to November 2010, 106 patients were recruited to this study. No statistically signifficant differences were found in RR after induction chemotherapy between the two arms (48.1% and 57.4%, p = 0.34). Toxicity profile was comparable and mild with grade 3/4 neutropenia as primary toxicity in both arms. One patient in arm B suffered from acute peripheral ischemia grade 4 and an amputation of lower limb was needed. With a median follow-up of 69.3 months, progression-free survival and median survival in arm A were 15.7 and 24.8 months compared to 18.9 and 28.6 months in arm B. The figures for 1- and 3-year overall survival were 73.1% and 30.8% in arm A, and 81.5 % and 44.4% in arm B, respectively. CONCLUSIONS Among the two cisplatin-based doublets of induction chemotherapy for inoperable NSCLC, both schedules of gemcitabine have a comparable toxicity profile. Figures for RR, PFS and OS are among the best reported in current literature. While there is a trend towards better efficacy of the treament with prolonged infusion of gemcitabine, the difference between the two arms did not reach statistical significance.
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Affiliation(s)
| | - Matjaz Zwitter
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, Slovenia
| | - Tanja Bavcar
- Clinical Radiology Institute, University Medical Centre Ljubljana, Slovenia
| | - Ana Milic
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Viljem Kovac
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Hsieh CH, Shueng PW, Wang LY, Liao LJ, Lin YC, Kuo YS, Lo WC, Tseng CF, Tien HJ, Chou HL, Hsieh YP, Wu LJ, Chen YJ. Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients. Onco Targets Ther 2014; 7:405-14. [PMID: 24648744 PMCID: PMC3956740 DOI: 10.2147/ott.s59998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The outcome of postoperative high- and intermediate-risk oral cavity cancer (OCC) patients receiving helical tomotherapy (HT) remains limited. Materials and methods Between November 2006 and November 2012, 53 postoperative high- and intermediate-risk OCC patients treated with HT were enrolled. Results The 4-year locoregional, local, and regional control rates were 66%, 76.4%, and 94.3%, respectively. The 4-year locoregional control rates of oral tongue and buccal mucosa cancer were 88.3% and 37.1%, respectively (P=0.012). Eleven (20.8%) patients experienced locoregional failure. In-field failure occurred in six of 53 (11.3%) in the primary area and three of 53 (5.7%) in the regional lymph-node area. No marginal failure was noted. Two of 53 (3.8%) experienced out-of-field failure. The rates of grade 3 dermatitis, mucositis, and dysphagia were 11%, 34%, and 13%, respectively. No grade 3 xerostomia was noted. Grade 2 xerostomia was 33% at month 6 and declined to 0 at month 48. A rate of 56% of grade 2 trismus at month 6 was noted, and declined to around 30% after 2 years. No grade 3 trismus was noted after 2 years. Conclusion HT as a postoperative modality provided satisfying results, especially for xerostomia and trismus, and was impressive in high- and intermediate-risk OCC patients receiving postoperative HT.
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Affiliation(s)
- Chen-Hsi Hsieh
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan ; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan ; Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Oriental Institute of Technology, Taipei, Taiwan
| | - Yu-Chin Lin
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Oriental Institute of Technology, Taipei, Taiwan
| | - Ying-Shiung Kuo
- Department of Dentistry and Oral Surgery, Oriental Institute of Technology, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Oriental Institute of Technology, Taipei, Taiwan
| | - Chien-Fu Tseng
- Department of Dentistry and Oral Surgery, Oriental Institute of Technology, Taipei, Taiwan
| | - Hui-Ju Tien
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, Oriental Institute of Technology, Taipei, Taiwan ; Department of Nursing, Oriental Institute of Technology, Taipei, Taiwan
| | - Yen-Ping Hsieh
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Le-Jung Wu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan ; Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan
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Abstract
Data supporting use of concurrent chemoradiation in locally advanced lung cancers comes from clinical trials from developed countries. Applicability and outcomes of such schedules in developing countries is not widely reported. There are various challenges in delivering chemoradiation in locally advanced non small cell lung cancer in developing countries which is highlighted by an audit of patients treated with chemoradiation in our center. This article deals with the challenges in the context of a developing country. We conclude that sequential chemoradiotherapy is better tolerated than concurrent chemoradiation in Indian patients with locally advanced non-small cell lung cancers. Patients with stage IIIa, normal weight or overweight, and adequate baseline pulmonary function should be offered concurrent chemoradiation.
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Affiliation(s)
- Sushma Agrawal
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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38
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Hsu HW, Wall NR, Hsueh CT, Kim S, Ferris RL, Chen CS, Mirshahidi S. Combination antiangiogenic therapy and radiation in head and neck cancers. Oral Oncol 2013; 50:19-26. [PMID: 24269532 DOI: 10.1016/j.oraloncology.2013.10.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/24/2013] [Accepted: 10/02/2013] [Indexed: 02/02/2023]
Abstract
Tumor angiogenesis is a hallmark of advanced cancers and promotes invasion and metastasis. Over 90% of head and neck squamous cell carcinomas (HNSCC) express angiogenic factors such as vascular endothelial growth factor (VEGF). Several preclinical studies support the prognostic implications of angiogenic markers for HNSCC and currently this is an attractive treatment target in solid tumors. Since radiotherapy is one of the most commonly used treatments for HNSCC, it is imperative to identify the interactions between antiangiogenic therapy and radiotherapy, and to develop combination therapy to improve clinical outcome. The mechanisms between antiangiogenic agents and ionizing radiation are complicated and involve many interactions between the vasculature, tumor stroma and tumor cells. The proliferation and metastasis of tumor cells rely on angiogenesis/blood vessel formation. Rapid growing tumors will cause hypoxia, which up-regulates tumor cell survival factors, such as hypoxia-inducing factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF), giving rise to more tumor proliferation, angiogenesis and increased radioresistance. Thus, agents that target tumor vasculature and new tumor vessel formation can modulate the tumor microenvironment to improve tumor blood flow and oxygenation, leading to enhanced radiosensitivity. In this review, we discuss the mechanisms of how antiangiogenic therapies improve tumor response to radiation and data that support this combination strategy as a promising method for the treatment of HNSCC in the future.
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Affiliation(s)
- Heng-Wei Hsu
- Department of Pharmacology, Loma Linda University, Loma Linda, CA, USA; Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA; LLU Cancer Center Biospecimen Laboratory, Loma Linda University, Loma Linda, CA, USA
| | - Nathan R Wall
- Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA; Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - Chung-Tsen Hsueh
- Division of Oncology & Hematology, Loma Linda University, Loma Linda, CA, USA
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chien-Shing Chen
- Department of Medicine, Loma Linda University, Loma Linda, CA, USA; LLU Cancer Center Biospecimen Laboratory, Loma Linda University, Loma Linda, CA, USA; Division of Oncology & Hematology, Loma Linda University, Loma Linda, CA, USA
| | - Saied Mirshahidi
- Department of Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA; LLU Cancer Center Biospecimen Laboratory, Loma Linda University, Loma Linda, CA, USA.
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Yoo EJ, Shin HS, Kim SU, Joo DJ, Park JY, Choi GH, Kim DY, Ahn SH, Seong J, Koh MJ, Han KH, Chon CY. Orthotopic liver transplantation after the combined use of locoregional therapy and sorafenib for advanced hepatocellular carcinoma. Onco Targets Ther 2013; 6:755-9. [PMID: 23836988 PMCID: PMC3699313 DOI: 10.2147/ott.s45602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We herein report a patient with advanced hepatitis B virus-related hepatocellular carcinoma (HCC) beyond the Milan criteria. He underwent orthotopic liver transplantation after successful HCC downstaging that satisfied the University of California, San Francisco criteria, using concurrent chemoradiation therapy with a combination of repeated hepatic arterial infusion chemotherapy (HAIC) and sorafenib. A 52-year-old male was diagnosed with advanced hepatitis B virus-related HCC beyond the Milan criteria. He underwent concurrent chemoradiation therapy (50 Gy with 20 fractions over 5 weeks with HAIC using 5-fluorouracil at a dose of 500 mg/day, which was administered during the first and fifth weeks of radiation therapy) as an initial treatment modality. This was followed by the combined use of HAIC using 5-fluorouracil (500 mg/m2 for 5 hours on days 1–3) and cisplatin (60 mg/m2 for 2 hours on day 2) every 4 weeks (twelve cycles) and sorafenib (from the third to the twelfth cycle of HAIC) to treat the remaining HCC. Because a remarkable decrease in the tumor burden that satisfied the University of California, San Francisco criteria was observed after these combination treatments, the patient underwent orthotopic liver transplantation with curative aim and survived for 11 months without evidence of HCC recurrence.
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Affiliation(s)
- Eun Jin Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Abstract
PURPOSE The aim of this study was to evaluate long-term oncologic outcomes after concurrent chemoradiation treatment for anal cancer. MATERIALS AND METHODS Between January 1979 and December 2008, the records of 50 consecutive patients with anal cancer and who were treated by chemoradiation or radiation only with a curative intent were retrospectively reviewed. The oncologic outcomes and the risk factors for recurrence were analyzed. RESULTS Of the 50 patients, 49 underwent concurrent chemoradiation and one underwent radiation only. After these definitive treatments, 43 (86.0%) achieved a clinical complete response. During the median follow-up of 60 months (range: 2-202 months), the 5-year overall survival, disease-free survival, and locoregional recurrence-free survival were 84.2%, 72.7%, and 69.9%, respectively. Multivariate analysis revealed that the performance status (p=0.031) and a clinical complete response (p=0.039) were the independent predictors for overall survival; lymph node involvement (p=0.031) was the only independent predictor for disease-free survival. CONCLUSION The performance status and a clinical complete response may be reliable predictors of survival after chemoradiation for anal cancer. The addition of irradiation to the inguinal area may not be significantly associated with the outcomes.
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Affiliation(s)
- Hun Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Jung Wook Huh
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Sang Woo Lim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, Korea
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Hida N, Okamoto H, Misumi Y, Sato A, Ishii M, Kashizaki F, Shimokawa T, Shimizu T, Watanabe K. A phase I trial of concurrent chemoradiotherapy with non-split administration of docetaxel and cisplatin for dry stage III non-small-cell lung cancer (JCOG9901DI). Cancer Chemother Pharmacol 2012; 69:1625-31. [PMID: 22565592 PMCID: PMC3362714 DOI: 10.1007/s00280-012-1871-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 04/19/2012] [Indexed: 12/03/2022]
Abstract
PURPOSE This study aimed to establish the maximum tolerated dose of concurrent chemoradiotherapy (cCRT) with conventional administration of the docetaxel (D) plus cisplatin (P) (conv-DP) regimen. METHODS Patients (aged ≤70 years) with unresectable dry stage III non-small-cell lung cancer (NSCLC) and having performance status 0 or 1 and adequate organ function were eligible. They received radiotherapy (60 Gy in 30 fractions) once daily starting on day 2. Concurrent P (day 1; 60 mg/m(2) at Levels 1-3, 80 mg/m(2) at Level 4) and D (day 1; 30 mg/m(2) at Level 1, 40 mg/m(2) at Level 2, 50 mg/m(2) at Levels 3-4) were administered every 4 weeks for 2-4 courses. RESULTS Eighteen patients were enrolled (stage IIIA/IIIB, 5/13 patients). Three cases of dose-limiting toxicity were observed in this study, although another 3 cases were added at Levels 2 and 3. Radiotherapy was completed in 15 patients. Seventeen patients received more than 2 courses of chemotherapy. Neither Grade 3/4 esophagitis nor severe hematological events were observed at Levels 1-4. However, dose escalation to Level 5 (P [80 mg/m(2)], D [60 mg/m(2)]) was stopped because the Level 5 dose was the recommended dose (RD) of chemotherapy alone for stage IIIB/IV NSCLC in Japan. Therefore, the RD was determined as D50/P80 mg/m(2) in this cCRT. The objective response rate was 89%, and the median survival time was 23.6 months. CONCLUSIONS cCRT with non-split DP was a tolerable and effective regimen, and RD was 50/80 mg/m(2) every 4 weeks.
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Affiliation(s)
- Naoya Hida
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-Ku, Yokohama, Kanagawa, 240-8555, Japan.
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Kiura K, Ueoka H, Segawa Y, Tabata M, Kamei H, Takigawa N, Hiraki S, Watanabe Y, Bessho A, Eguchi K, Okimoto N, Harita S, Takemoto M, Hiraki Y, Harada M, Tanimoto M. Phase I/II study of docetaxel and cisplatin with concurrent thoracic radiation therapy for locally advanced non-small-cell lung cancer. Br J Cancer 2003; 89:795-802. [PMID: 12942107 PMCID: PMC2394466 DOI: 10.1038/sj.bjc.6601217] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recent studies have suggested the superiority of concomitant over sequential administration of chemotherapy and radiotherapy. Docetaxel and cisplatin have demonstrated efficacy in advanced non-small-cell lung cancer (NSCLC). This study evaluated the safety, toxicity, and antitumour activity of docetaxel/cisplatin with concurrent thoracic radiotherapy for patients with locally advanced NSCLC. Patients with locally advanced NSCLC (stage IIIA or IIIB), good performance status, age <or=75 years, and adequate organ function were eligible. Both docetaxel and cisplatin were given on days 1, 8, 29, and 36. Doses of docetaxel/cisplatin (mg m(-2)) in the phase I study portion were escalated as follows: 20/30, 25/30, 30/30, 30/35, 30/40, 35/40, 40/40, and 45/40. Beginning on day 1 of chemotherapy, thoracic radiotherapy was given at a total dose of 60 Gy with 2 Gy per fraction over 6 weeks. In the phase I portion, the maximum tolerated doses (MTD) among 33 patients were docetaxel 45 mg m(-2) and cisplatin 40 mg m(-2). The major dose-limiting toxicity (DLT) was radiation oesophagitis. The recommended doses (RDs) for the phase II study were docetaxel 40 mg m(-2) and cisplatin 40 mg m(-2). A total of 42 patients were entered in the phase II portion. Common toxicities were leukopenia, granulocytopenia, anaemia, and radiation oesophagitis, with frequencies of grade >or=3 toxicities of 71, 60, 24, and 19%, respectively. Toxicity was significant, but manageable according to the dose and schedule modifications. Dose intensities of docetaxel and cisplatin were 86 and 87%, respectively. Radiotherapy was completed without a delay in 67% of 42 patients. The overall response rate was 79% (95% confidence interval (CI), 66-91%). The median survival time was 23.4+ months with an overall survival rate of 76% at 1 year and 54% at 2 years. In conclusion, chemotherapy with cisplatin plus docetaxel given on days 1, 8, 29, and 36 and concurrent thoracic radiotherapy is efficacious and tolerated in patients with locally advanced NSCLC and should be evaluated in a phase III study.
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Affiliation(s)
- K Kiura
- Second Department of Internal Medicine, Okayama University Medical School, Okayama, Japan.
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