1
|
Nepal P, Zafar MH, Liu LC, Xu Z, Abdulhai MA, Perez-Tamayo AM, Chaudhry V, Mellgren AF, Gantt GA. Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival. Dis Colon Rectum 2024; 67:773-781. [PMID: 38411981 DOI: 10.1097/dcr.0000000000003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Socioeconomic inequities have implications for access to health care and may be associated with disparities in treatment and survival. OBJECTIVE To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous-cell carcinoma. DESIGN This is a retrospective study using a nationwide data set. SETTINGS The patients were selected from the National Cancer Database and enrolled from 2004 to 2016. PATIENTS We identified patients with stage I to III squamous-cell carcinoma of the anus who were treated with chemoradiation therapy. MAIN OUTCOMES MEASURES Socioeconomic factors, including race, insurance status, median household income, and percentage of the population with no high school degrees, were included. The association of these factors with treatment delay and overall survival was investigated. RESULTS A total of 24,143 patients who underwent treatment for grade I to III squamous-cell carcinoma of the anus were identified. The median age was 60 years, and 70% of patients were women. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, patients with a higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late-treatment group had worse overall survival compared to the early treatment group (98 vs 125 months; p < 0.001). LIMITATIONS No detailed information is available about the chemoradiotherapy regimen, completion of treatment, recurrence, disease-free survival, and individual-level socioeconomic condition and risk factors. CONCLUSION Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract . DESIGUALDADES SOCIOECONMICAS EN CASOS DE CNCER ANAL EFECTOS EN EL RETRASO DEL TRATAMIENTO Y LA SOBREVIDA ANTECEDENTES:Las desigualdades socio-económicas tienen implicaciones en el acceso a la atención médica y pueden estar asociadas con disparidades en el tratamiento y la sobrevida.OBJETIVO:Indagar el impacto de las desigualdades socio-económicas sobre el tiempo de retraso en el tratamiento y la sobrevida en casos de carcinoma a células escamosas del ano (CCEA).DISEÑO:Estudio retrospectivo utilizando un conjunto de datos a nivel nacional.AJUSTES:Todos aquellos pacientes inscritos entre 2004 a 2016 y que fueron seleccionados de la Base Nacional de Datos sobre el Cáncer.PACIENTES:Identificamos pacientes con CCEA en estadíos I-III y que fueron tratados con radio-quimioterápia.PRINCIPALES MEDIDAS DE RESULTADOS:Se incluyeron factores socio-económicos tales como la raza, el tipo de seguro de salud, el ingreso familiar medio y el porcentaje de personas sin bachillerato de secundaria (SBS). Se investigó la asociación entre estos factores con el retraso en iniciar el tratamiento y la sobrevida global.RESULTADOS:Se identificaron un total de 24.143 pacientes que recibieron tratamiento para CCEA estadíos I-III. La mediana de edad fue de 60 años donde 70% eran de sexo femenino. La mediana del tiempo transcurrido desde el diagnóstico hasta el inicio del tratamiento fue de 33 días. Los pacientes residentes en zonas de código postal con ingresos medios más bajos, con un mayor porcentaje de individuos SBS y los pacientes con otro tipo de seguro gubernamental de salud, seguidos del seguro tipo Medicaid iniciaron el tratamiento solamente después de 60 días al diagnóstico inicial de CCEA. El análisis de Kaplan-Meier de la sobrevida mostró que el grupo de tratamiento tardío tuvo una peor supervivencia general comparada con el grupo de tratamiento precoz o temprano (98 frente a 125 meses; p <0,001).LIMITACIONES:No se dispone de información detallada sobre el tipo de radio-quimioterapia utilizada, ni sobre la finalización del tratamiento o la recurrencia, tampoco acerca de la sobrevida libre de enfermedad ni sobre las condiciones socio-económicas o aquellos factores de riesgo a nivel individual.CONCLUSIÓN:Los pacientes de comunidades con ingresos medios más bajos, con un nivel de educación limitado e inscritos en un seguro público tardaron mucho más tiempo en recibir el tratamiento prescrito. El nivel socio-económico más bajo también se asoció con una sobrevida global más baja. Los presentes resultados justifican mayor análisis y medidas mas importantes para mejorar el acceso a la atención en salud y poder afrontar esta disparidad. (Traducción-Dr. Xavier Delgadillo ).
Collapse
Affiliation(s)
- Pramod Nepal
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Muhammad H Zafar
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Li C Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ziqiao Xu
- University of Illinois Cancer Center, Chicago, Illinois
| | - Mohamad A Abdulhai
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| | | | - Vivek Chaudhry
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Anders F Mellgren
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Gerald A Gantt
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
2
|
Chin RI, Otegbeye EE, Kang KH, Chang SH, McHenry S, Roy A, Chapman WC, Henke LE, Badiyan SN, Pedersen K, Tan BR, Glasgow SC, Mutch MG, Samson PP, Kim H. Cost-effectiveness of Total Neoadjuvant Therapy With Short-Course Radiotherapy for Resectable Locally Advanced Rectal Cancer. JAMA Netw Open 2022; 5:e2146312. [PMID: 35103791 PMCID: PMC8808328 DOI: 10.1001/jamanetworkopen.2021.46312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Short-course radiotherapy and total neoadjuvant therapy (SCRT-TNT) followed by total mesorectal excision (TME) has emerged as a new treatment paradigm for patients with locally advanced rectal adenocarcinoma. However, the economic implication of this treatment strategy has not been compared with that of conventional long-course chemoradiotherapy (LCCRT) followed by TME with adjuvant chemotherapy. OBJECTIVE To perform a cost-effectiveness analysis of SCRT-TNT vs LCCRT in conjunction with TME for patients with locally advanced rectal cancer. DESIGN, SETTING, AND PARTICIPANTS A decision analytical model with a 5-year time horizon was constructed for patients with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma treated with SCRT-TNT or LCCRT. Markov modeling was used to model disease progression and patient survival after treatment in 3-month cycles. Data on probabilities and utilities were extracted from the literature. Costs were evaluated from the Medicare payer's perspective in 2020 US dollars. Sensitivity analyses were performed for key variables. Data were collected from October 3, 2020, to January 20, 2021, and analyzed from November 15, 2020, to April 25, 2021. EXPOSURES Two treatment strategies, SCRT-TNT vs LCCRT with adjuvant chemotherapy, were compared. MAIN OUTCOMES AND MEASURES Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Both costs and QALYs were discounted at 3% annually. Willingness-to-pay threshold was set at $50 000/QALY. RESULTS During the 5-year horizon, the total cost was $41 355 and QALYs were 2.21 for SCRT-TNT; for LCCRT, the total cost was $54 827 and QALYs were 2.12, resulting in a negative incremental cost-effectiveness ratio (-$141 256.77). The net monetary benefit was $69 300 for SCRT-TNT and $51 060 for LCCRT. Sensitivity analyses using willingness to pay at $100 000/QALY and $150 000/QALY demonstrated the same conclusion. CONCLUSIONS AND RELEVANCE These findings suggest that SCRT-TNT followed by TME incurs lower cost and improved QALYs compared with conventional LCCRT followed by TME and adjuvant chemotherapy. These data offer further rationale to support SCRT-TNT as a novel cost-saving treatment paradigm in the management of locally advanced rectal cancer.
Collapse
Affiliation(s)
- Re-I Chin
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ebunoluwa E. Otegbeye
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kylie H. Kang
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Su-Hsin Chang
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Scott McHenry
- Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - William C. Chapman
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lauren E. Henke
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shahed N. Badiyan
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Katrina Pedersen
- Division of Hematology and Oncology, Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Benjamin R. Tan
- Division of Hematology and Oncology, Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Sean C. Glasgow
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Matthew G. Mutch
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Pamela P. Samson
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
3
|
Wang J, Xu Y, Rao X, Zhang R, Tang J, Zhang D, Jie X, Zhu K, Wang X, Xu Y, Zhang S, Dong X, Zhang T, Yang K, Xu S, Meng R, Wu G. BRD4-IRF1 axis regulates chemoradiotherapy-induced PD-L1 expression and immune evasion in non-small cell lung cancer. Clin Transl Med 2022; 12:e718. [PMID: 35083874 PMCID: PMC8792480 DOI: 10.1002/ctm2.718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemoradiotherapy-induced PD-L1 upregulation leads to therapeutic resistance and treatment failure. The PD-1/PD-L1 blocking antibodies sensitize cancers to chemoradiotherapy by blocking extracellular PD-1 and PD-L1 binding without affecting the oncogenic function of intracellular PD-L1. Reversing the chemoradiation-induced PD-L1 expression could provide a new strategy to achieve a greater anti-tumour effect of chemoradiotherapy. Here, we aimed to identify candidate small molecular inhibitors that might boost the anti-tumour immunity of chemoradiotherapy by decreasing treatment-induced PD-L1 expression in non-small cell lung cancer (NSCLC). METHODS A drug array was used to recognize compounds that can suppress the cisplatin-induced and radiation-induced PD-L1 expression in NSCLC via the flow cytometry-based assay. We examined whether and how targeting bromodomain containing 4 (BRD4) inhibits chemoradiation-induced PD-L1 expression and evaluated the effect of BRD4 inhibition and chemoradiation combination in vivo. RESULTS BRD4 inhibitors JQ1 and ARV-771 were identified as the most promising drugs both in the cisplatin and radiation screening projects in two NSCLC cell lines. Targeting BRD4 was supposed to block chemoradiotherapy inducible PD-L1 expression by disrupting the recruitment of BRD4-IRF1 complex to PD-L1 promoter. A positive correlation between BRD4 and PD-L1 expression was observed in human NSCLC tissues. Moreover, BRD4 inhibition synergized with chemoradiotherapy and PD-1 blockade to show a robust anti-tumour immunity dependent on CD8+ T cell through limiting chemoradiation-induced tumour cell surface PD-L1 upregulation in vivo. Notably, the BRD4-targeted combinatory treatments did not show increased toxicities. CONCLUSION The data showed that BRD4-targeted therapy synergized with chemoradiotherapy and anti-PD-1 antibody by boosting anti-tumour immunity in NSCLC.
Collapse
Affiliation(s)
- Jian Wang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Yingzhuo Xu
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Xinrui Rao
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Ruiguang Zhang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Jing Tang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Dan Zhang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Xiaohua Jie
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Kuikui Zhu
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Xu Wang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Yunhong Xu
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Sheng Zhang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Xiaorong Dong
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Tao Zhang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Kunyu Yang
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Shuangbing Xu
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Rui Meng
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| | - Gang Wu
- Cancer Center, Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhan430022China
| |
Collapse
|
4
|
Willemsen ACH, Kok A, Baijens LWJ, de Boer JP, de Bree R, Devriese LA, Driessen CML, van Herpen CML, Hoebers FJP, Kaanders JHAM, Karsten RT, van Kuijk SMJ, Lalisang RI, Navran A, Pereboom SR, Schols AMWJ, Terhaard CHJ, Hoeben A. Development and external validation of a prediction model for tube feeding dependency for at least four weeks during chemoradiotherapy for head and neck cancer. Clin Nutr 2021; 41:177-185. [PMID: 34883306 DOI: 10.1016/j.clnu.2021.11.019] [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: 08/17/2021] [Revised: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Patients who receive chemoradiotherapy or bioradiotherapy (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates interfering with oral intake, causing tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds 4 weeks. We aimed to develop and externally validate a prediction model to identify patients who need TF ≥ 4 weeks and would benefit from prophylactic gastrostomy insertion. METHODS A retrospective multicenter cohort study was performed in four tertiary head and neck cancer centers in the Netherlands. The prediction model was developed using data from University Medical Center Utrecht and the Netherlands Cancer Institute and externally validated using data from Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF dependency ≥4 weeks initiated during CRT/BRT or within 30 days after CRT/BRT completion. Potential predictors were extracted from electronic health records and radiotherapy dose-volume parameters were calculated. RESULTS The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed predictive value for pretreatment weight change, texture modified diet at baseline, ECOG performance status, tumor site, N classification, mean radiation dose to the contralateral parotid gland and oral cavity. The area under the receiver operating characteristics curve for this model was 0.73 and after external validation 0.62. Positive and negative predictive value for a risk of 90% or higher for TF dependency ≥4 weeks were 81.8% and 42.3% respectively. CONCLUSIONS We developed and externally validated a prediction model to estimate TF-dependency ≥4 weeks in LAHNSCC patients treated with CRT/BRT. This model can be used to guide personalized decision-making on prophylactic gastrostomy insertion in clinical practice.
Collapse
Affiliation(s)
- Anna C H Willemsen
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, the Netherlands
| | - Annemieke Kok
- Department of Dietetics, University Medical Center Utrecht, the Netherlands.
| | - Laura W J Baijens
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Otorhinolaryngology, Head & Neck Surgery, Maastricht University Medical Center, the Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Chantal M L Driessen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J P Hoebers
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rebecca T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, the Netherlands
| | - Roy I Lalisang
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands
| | - Arash Navran
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Susanne R Pereboom
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Ann Hoeben
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands
| |
Collapse
|
5
|
Zhang S, Guo J, Zhang H, Li H, Hassan MOO, Zhang L. Metastasis pattern and prognosis in men with esophageal cancer patients: A SEER-based study. Medicine (Baltimore) 2021; 100:e26496. [PMID: 34160464 PMCID: PMC8238299 DOI: 10.1097/md.0000000000026496] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023] Open
Abstract
Esophageal cancer (EC) is relatively common; at the time of diagnosis, 50% of cases present with distant metastases, and most patients are men. This study aimed to examine and compare the clinicopathological characteristics and metastatic patterns of male EC (MEC) and female EC (FEC). In addition, risk factors associated with MEC prognosis were evaluated.The present study population was extracted from the Surveillance Epidemiology and End Results database. MEC characteristics and factors associated with prognosis were evaluated using descriptive analysis, the Kaplan-Meier method, and the Cox regression model.A total of 12,558 MEC cases were included; among them, 3454 cases had distant organ metastases. Overall, 27.5% of the entire cohort were patients with distant organ metastases. Compared with patients with non-metastatic MEC, patients with metastatic MEC were more likely to be aged ≤60 years, of Black and White race, have a primary lesion in the overlapping esophagus segments, and have a diagnosis of adenocarcinoma of poorly differentiated and undifferentiated grade that was treated with radiotherapy and chemotherapy rather than surgery; moreover, they were also more likely to be married and insured. In addition, patients with MEC were more likely to be aged ≤60 years, White race, and diagnosed with a primary lesion in the lower third of the esophagus and overlapping esophagus segments, and treated without chemotherapy, compared with those with FEC. Patients in the former group were also more likely than those in the latter group to be unmarried and have bone metastasis only and lung metastasis only. Liver, lung, and bone metastases separately, and simultaneous liver and lung metastases were associated with poor survival in MEC patients.Metastatic MEC is associated with clinicopathological characteristics and metastatic patterns different from those associated with non-metastatic MEC and metastatic FEC. Metastatic MEC and FEC patients may have similar prognoses. Distant organ metastasis may be associated with poor prognosis in patients with MEC and FEC.
Collapse
Affiliation(s)
- Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Hongyan Zhang
- Department of Physiology and Neurobiology, Mudanjiang Medical University, Mudanjiang, China
| | - Huawei Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Mohamed Osman Omar Hassan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
- Department of Cardiothoracic Surgery, Qena University Hospitals, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| |
Collapse
|
6
|
Mishra S, Ahmad F, Singh S, Singh RK, Das KJM, Kumar S. Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus. Cancer Rep (Hoboken) 2021; 4:e1332. [PMID: 33369258 PMCID: PMC8222558 DOI: 10.1002/cnr2.1332] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patterns of failure following definitive CRT (dCRT) are different as compared to neoadjuvant chemoradiotherapy (NACRT) with increased locoregional failures documented with dCRT. AIM To document failure patterns in patients with esophageal carcinoma treated with neoadjuvant and definitive intent radiation strategies. METHODS Subjects were 123 patients treated with two chemoradiotherapy strategies. Group 1 (n = 99) underwent dose escalated definitive chemoradiotherapy (dCRT), Group 2 (n = 24) received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Cumulative incidence of locoregional failure (LRF), local failure (LF), regional lymph node failure (RLNF), and distant metastasis (DM) were computed; differences between the groups was evaluated using log rank test. Univariable and multivariable predictors of failure were identified using Cox regression analysis. RESULTS Cumulative LRF: 64% in Group 1 vs 35% in Group 2 (P = .050). Cumulative LF: 59% in Group 1 vs 12% in Group 2 (P = .000). Cumulative RLNF: 30% in Group 1 vs 24% in Group 2 (P = .592). Most common RLNF: mediastinum for both groups (6% vs 12.5%, respectively). Distant metastasis: 40.4% Group 1 vs 17% Group 2 (P = .129), predominantly lung (Group 1, 5%), and nonregional nodes (Group 2, 8.3%). Univariate analysis identified age ≤50, absence of concurrent chemotherapy, dose ≤50 Gy, and incomplete radiotherapy to predict higher odds of LRF and DM for Group 1; absence of comorbidities predicted for lower odds of LRF for Group 2. Age ≤50 predicted for higher odds of RNLR for Group 1, while absence of comorbidities predicted for lower odds of RNLR in Group 2. Multivariate analysis identified age ≤50, incomplete radiotherapy, and absence of concurrent chemotherapy to predict higher odds of LRF for Group 1. Age ≤50, absence of concurrent chemotherapy predicted higher odds of DM for Group 1. Absence of comorbidity predicted lower odds of LRF in Group 2. CONCLUSION LRF is common in both groups, with LF being predominant in dCRT as opposed to RNLF in NACRT. Age ≤50, absence of concurrent chemotherapy is a predictor of LRF and DM in dCRT.
Collapse
Affiliation(s)
- Shagun Mishra
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Farhan Ahmad
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Shalini Singh
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Rajneesh K. Singh
- Department of GastrosurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Koilpillai J. Maria Das
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Shaleen Kumar
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| |
Collapse
|
7
|
Pan X, Liao M, Ma H, Jiang X, Huang H, Wei M, Li Q. Chemoradiotherapy and Increased Prescription Dose in Esophageal Squamous Cell Cancer: A Retrospective Study. Biomed Res Int 2021; 2021:3834040. [PMID: 33628778 PMCID: PMC7884139 DOI: 10.1155/2021/3834040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/21/2020] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Abstract
To analyze the outcomes and adverse events of patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiation with modified radiotherapy volume and increased radiation dose. This was a retrospective analysis of patients with ESCC treated with definitive chemoradiotherapy at the Sun Yat-sen University Cancer Center (02/2015 to 02/2017). The dose to the planning gross tumor volume (PGTV) and planning clinical tumor volume (PTV1) was 66-68 Gy (2.0-2.2 Gy/fraction). The dose to the planning regional lymph node drainage area volume (PTV2) was 46 Gy (2.0 Gy/fraction). Treatment response, adverse events, progression-free survival (PFS), overall survival (OS), and locoregional failure-free survival (LRFFS) were analyzed. Twenty-six patients were included. The median follow-up was 31 (range, 4.3-51.3) months. Sixteen (61.5%) patients had a complete response, and four (15.4%) achieved a partial response. The objective response rate was 76.9%, and the disease control rate was 80.8%. The median PFS and OS were not achieved. The 4-year PFS was 63.9%, and the 4-year OS was 71.0%. Grade 1-2 and 3-4 radiation-related esophagitis was observed in 15 (57.7%) and one (4.5%) patients, respectively. Grade 1-2 and 3-4 radiation-related pneumonitis was observed in 12 (46.2%) and one (4.5%) patients, respectively. No patients developed radiation-related heart or skin damage. The modified target volume definition and increased dose of definitive radiotherapy combined with chemotherapy in patients with ESCC had low toxicity and might improve survival, but additional trials are necessary to prove the superiority of this strategy.
Collapse
Affiliation(s)
- Xiaofen Pan
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Mingchu Liao
- Department of Medical Oncology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Hongmei Ma
- Department of Medical Oncology, The First People's Hospital of Chengdu, Chengdu, China
| | - Xiaobing Jiang
- Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hanwen Huang
- Department of Oncology, Yunfu People's Hospital of Guangdong, Yunfu, China
| | - Min Wei
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Qun Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
8
|
Toor H, Savla P, Podkovik S, Patchana T, Ghanchi H, Kashyap S, Tashjian V, Miulli D. Timing of Chemoradiation in Newly Diagnosed Glioblastoma: Comparative Analysis Between County and Managed Care Health Care Models. World Neurosurg 2021; 149:e1038-e1042. [PMID: 33476782 DOI: 10.1016/j.wneu.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/22/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and temozolomide. Despite an established treatment protocol, there exists heterogeneity in outcomes due to patients not receiving all treatments. We analyzed patients in different health care models to investigate this heterogeneity. METHODS A retrospective analysis was performed at 2 hospitals in San Bernardino County, California, for patients with newly diagnosed GBM from 2004 to 2019. Patients younger than 18 years of age, with history of low-grade glioma, who had undergone prior treatment, and those lost to follow-up were excluded. RESULTS A total of 57 patients were included in our study. Chemotherapy was started at 41 ± 30 and 77 ± 68 days in the health maintenance organization (HMO) and county model, respectively (P = 0.050); radiation therapy was started at 46 ± 34 and 85 ± 76 days in the HMO and county models, respectively (P = 0.036). In individuals who underwent both chemotherapy and radiation therapy (XRT), the difference in time to XRT was no longer significant (P = 0.060). Recurrence time was 309 ± 263 and 212 ± 180 days in the HMO and county groups, respectively (P = 0.379). The time to death was 412 ± 285 and 343 ± 304 days for HMO and county models, respectively (P = 0.334). CONCLUSIONS Our study demonstrates a statistically significant difference in time to adjuvant therapies between patients within a county hospital and a managed health care organization. This information has the potential to inform future policies and care coordination for patients within the county model.
Collapse
Affiliation(s)
- Harjyot Toor
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Paras Savla
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA.
| | - Stacey Podkovik
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Tye Patchana
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Hammad Ghanchi
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Samir Kashyap
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Vartan Tashjian
- Department of Neurological Surgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Dan Miulli
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| |
Collapse
|
9
|
Knoth J, Pötter R, Jürgenliemk-Schulz IM, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Wiebe E, Rai B, Cooper R, van der Steen-Banasik E, van Limbergen E, Pieters BR, Sundset M, Tan LT, Nout RA, Tanderup K, Kirisits C, Nesvacil N, Lindegaard JC, Schmid MP. Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging - An analysis from the EMBRACE study. Gynecol Oncol 2020; 159:136-141. [PMID: 32798000 DOI: 10.1016/j.ygyno.2020.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/05/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. METHODS Patients from the prospective observational multi-centre study "EMBRACE" were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. RESULTS Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. CONCLUSIONS MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation.
Collapse
Affiliation(s)
- J Knoth
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - R Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | | | - C Haie-Meder
- Department of Radiotherapy, Gustave-Roussy, France
| | - L Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | - A Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - U Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, India
| | - B Segedin
- Department of Oncology, Institute of Oncology Ljubljana, Slovenia
| | - K Bruheim
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Norway
| | - E Wiebe
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - B Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Cooper
- Leeds Cancer Centre, St James's University Hospital, United Kingdom
| | | | - E van Limbergen
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - M Sundset
- Clinic of Oncology and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - L T Tan
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - R A Nout
- Department of Radiation Oncology, Erasmus MC, Erasmus University Rotterdam, The Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| | - C Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - N Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - J C Lindegaard
- Department of Oncology, Aarhus University Hospital, Denmark
| | - M P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria.
| |
Collapse
|
10
|
Wirsching HG, Roelcke U, Weller J, Hundsberger T, Hottinger AF, von Moos R, Caparrotti F, Conen K, Remonda L, Roth P, Ochsenbein A, Tabatabai G, Weller M. MRI and 18FET-PET Predict Survival Benefit from Bevacizumab Plus Radiotherapy in Patients with Isocitrate Dehydrogenase Wild-type Glioblastoma: Results from the Randomized ARTE Trial. Clin Cancer Res 2020; 27:179-188. [PMID: 32967939 DOI: 10.1158/1078-0432.ccr-20-2096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/09/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore a prognostic or predictive role of MRI and O-(2-18F-fluoroethyl)-L-tyrosine (18FET) PET parameters for outcome in the randomized multicenter trial ARTE that compared bevacizumab plus radiotherapy with radiotherpay alone in elderly patients with glioblastoma. PATIENTS AND METHODS Patients with isocitrate dehydrogenase wild-type glioblastoma ages 65 years or older were included in this post hoc analysis. Tumor volumetric and apparent diffusion coefficient (ADC) analyses of serial MRI scans from 67 patients and serial 18FET-PET tumor-to-brain intensity ratios (TBRs) from 31 patients were analyzed blinded for treatment arm and outcome. Multivariate Cox regression analysis was done to account for established prognostic factors and treatment arm. RESULTS Overall survival benefit from bevacizumab plus radiotherapy compared with radiotherapy alone was observed for larger pretreatment MRI contrast-enhancing tumor [HR per cm3 0.94; 95% confidence interval (CI), 0.89-0.99] and for higher ADC (HR 0.18; CI, 0.05-0.66). Higher 18FET-TBR on pretreatment PET scans was associated with inferior overall survival in both arms. Response assessed by standard MRI-based Response Assessment in Neuro-Oncology criteria was associated with overall survival in the bevacizumab plus radiotherapy arm by trend only (P = 0.09). High 18FET-TBR of noncontrast-enhancing tumor portions during bevacizumab therapy was associated with inferior overall survival on multivariate analysis (HR 5.97; CI, 1.16-30.8). CONCLUSIONS Large pretreatment contrast-enhancing tumor mass and higher ADCs identify patients who may experience a survival benefit from bevacizumab plus radiotherapy. Persistent 18FET-PET signal of no longer contrast-enhancing tumor after concomitant bevacizumab plus radiotherapy suggests pseudoresponse and predicts poor outcome.
Collapse
Affiliation(s)
- Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Ulrich Roelcke
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Jonathan Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Thomas Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andreas F Hottinger
- Departments of Clinical Neurosciences and Medical Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - Roger von Moos
- Department of Medical Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Katrin Conen
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Patrick Roth
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adrian Ochsenbein
- Department of Medical Oncology, Inselspital, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Ghazaleh Tabatabai
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Gao X, Goffredo P, Kahl AR, Charlton ME, Weigel RJ, Hassan I. Chemoradiation versus local excision in treatment of stage I anal squamous cell carcinoma: A population-based analysis. Eur J Surg Oncol 2020; 46:1663-1667. [PMID: 32199768 PMCID: PMC7434694 DOI: 10.1016/j.ejso.2020.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Chemoradiation therapy (CRT) is the standard treatment for anal squamous cell carcinoma (ASCC) but can have significant treatment related toxicities. Recent studies have demonstrated the effectiveness of local excision (LE) for stage I ASCC with comparable oncologic outcomes to CRT. We aimed to evaluate this finding in a large population-based database. METHODS Patients diagnosed with stage I (T1N0M0) ASCC were identified from the Surveillance, Epidemiology, and End Results database, 2004-2015. Treatment approach was categorized as CRT or LE. Factors associated with treatment approach and cause-specific survival (CSS) were analyzed for the entire cohort and after stratification by tumor size (≤1 cm and 1-2 cm). RESULTS Among 883 patients, 56% had ASCCs 1-2 cm in size and 77% received CRT. Mean age was 60 years, 65% were female, and 90% were White. Factors independently associated with receiving CRT were, being female, higher tumor grade, and tumor size 1-2 cm. Unadjusted 5-year CSS for CRT was 96% while for LE it was 98% (p = 0.048). After adjusting for available confounders, treatment approach was not associated with worse CSS, however being Black (HR = 8.7) and uninsured (HR = 13.7) were independently associated with worse prognosis. After stratification by tumor size, there was still no significant difference in 5-year CSS by treatment approach. CONCLUSIONS LE was performed in a significant proportion of patients but was not independently associated with worse CSS compared to CRT. In appropriately selected patients with well differentiated ASCCs ≤1 cm, LE could be an acceptable management option but studies measuring outcomes such as local recurrence are needed.
Collapse
Affiliation(s)
- Xiang Gao
- Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Paolo Goffredo
- Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Amanda R Kahl
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Dr., Iowa City, IA, 52242, USA.
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N Riverside Dr., Iowa City, IA, 52242, USA.
| | - Ronald J Weigel
- Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Imran Hassan
- Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| |
Collapse
|
12
|
Amin S, Baine MJ, Meza JL, Lin C. Association of Immunotherapy With Survival Among Patients With Brain Metastases Whose Cancer Was Managed With Definitive Surgery of the Primary Tumor. JAMA Netw Open 2020; 3:e2015444. [PMID: 32902650 PMCID: PMC7489857 DOI: 10.1001/jamanetworkopen.2020.15444] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Immunotherapy has shown significant control of intracranial metastases in patients with melanoma. However, the association of immunotherapy combined with other cancer treatments and overall survival (OS) of patients with brain metastases, regardless of primary tumor site, is unknown. OBJECTIVE To explore the association of immunotherapy with OS in patients with cancer and brain metastases who received definitive surgery of the primary site. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study included 3112 adult patients in the National Cancer Database from 2010 to 2016 with non-small cell lung cancer, breast cancer, melanoma, colorectal cancer, or kidney cancer and brain metastases at the time of diagnosis and who received definitive surgery of the primary site. Data analysis was conducted from March to April 2020. EXPOSURES Treatment groups were stratified as follows: (1) any treatment with or without immunotherapy, (2) chemotherapy with or without immunotherapy, (3) radiotherapy (RT) with or without immunotherapy, and (4) chemoradiation with or without immunotherapy. MAIN OUTCOMES AND MEASURES The association of immunotherapy with OS was assessed with Cox proportional hazards regression, adjusted for age at diagnosis, race, sex, place of living, income, education, treatment facility type, primary tumor type, and year of diagnosis. RESULTS Of 3112 patients, 1436 (46.14%) were men, 2714 (87.72%) were White individuals, 257 (8.31%) were Black individuals, and 123 (3.98%) belonged to other racial and ethnic groups. The median (range) age at diagnosis was 61 (19-90) years. Overall, 183 (5.88%) received immunotherapy, 318 (10.22%) received chemotherapy alone, 788 (25.32%) received RT alone, and 1393 (44.76%) received chemoradiation alone; 22 (6.47%) received chemotherapy plus immunotherapy, 72 (8.37%) received RT plus immunotherapy, and 76 (5.17%) received chemoradiation plus immunotherapy. In the multivariable analysis, patients who received immunotherapy had significantly improved OS compared with no immunotherapy (hazard ratio, 0.62; 95% CI, 0.51-0.76; P < .001). Treatment with RT plus immunotherapy was associated with significantly improved OS compared with RT alone (hazard ratio, 0.59; 95% CI, 0.42-0.84; P = .003). Chemotherapy plus immunotherapy or chemoradiation plus immunotherapy were not associated with improved OS in the multivariable analysis. CONCLUSIONS AND RELEVANCE In this study, the addition of immunotherapy to RT was associated with improved OS compared with radiotherapy alone in patients with brain metastases who received definitive surgery of the primary tumor site.
Collapse
Affiliation(s)
- Saber Amin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha
| | - Michael J. Baine
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha
| | - Jane L. Meza
- College of Public Health, Department of Biostatistics, University of Nebraska Medical Center, Omaha
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha
| |
Collapse
|
13
|
Yusuf D, Walton RN, Hurry M, Farrer C, Bebb DG, Cheung WY. Population-based Treatment Patterns and Outcomes for Stage III Non-Small Cell Lung Cancer Patients: A Real-world Evidence Study. Am J Clin Oncol 2020; 43:615-620. [PMID: 32889830 DOI: 10.1097/coc.0000000000000716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most patients with stage III non-small cell lung cancer (NSCLC) develop metastases and succumb to their cancer. Approaches to the treatment of stage III disease can be highly variable. Understanding current treatment patterns can inform the optimal integration of emerging therapies. In this study, we describe contemporary treatment patterns and outcomes for a population-based cohort of stage III NSCLC patients from a large Canadian province. METHODS On the basis of the provincial cancer registry, all adult patients diagnosed with stage III NSCLC from April 1, 2010 to March 31, 2015 were identified. Analyses of these patients' existing electronic medical records and administrative claims data were conducted to describe patient characteristics, treatment patterns, and survival outcomes. RESULTS In total, we screened 6438 patients diagnosed with NSCLC, of whom 1151 (17.9%) had stage III disease. Among them, 61.2% were stage IIIA, 36.4% were stage IIIB, and 2.4% were unspecified. Median age at diagnosis was 70 (22 to 94) years and 50.2% were men. In this cohort, a significant proportion of patients received only palliative radiotherapy (35.6%), palliative chemotherapy (8.8%), or best supportive care (24.8%) as initial treatment. Conversely, relatively few underwent concurrent chemoradiotherapy (11.7%) or trimodality therapy (1.7%). Surgery±adjuvant treatments were performed in 14.8% of stage III patients. Median overall survival was 13.2 months (95% confidence interval [CI], 12.2-14.0) among stage III patients. Patients who received initial curative treatment had statistically significant better survival compared with those who received noncurative treatment (P<0.001); median overall survival 29.8 months (95% CI, 22.3-34.6) and 8.9 months (95% CI, 7.6-11.6), respectively. CONCLUSIONS In a population-based setting that includes community, regional, and tertiary cancer centers, use of concurrent chemoradiotherapy and trimodality therapy in stage III NSCLC was low despite evidence supporting the potential benefits of these strategies.
Collapse
Affiliation(s)
| | - Ryan N Walton
- AstraZeneca Canada Inc., Missiissauga, ON and BC Cancer, Vancouver, BC, Canada
| | - Manjusha Hurry
- AstraZeneca Canada Inc., Missiissauga, ON and BC Cancer, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
14
|
Maeda Y, Takeuchi H, Matsuda S, Okamura A, Fukuda K, Miyasho T, Nakamura R, Suda K, Wada N, Kawakubo H, Kitagawa Y. Clinical significance of preoperative serum concentrations of interleukin-6 as a prognostic marker in patients with esophageal cancer. Esophagus 2020; 17:279-288. [PMID: 31845119 DOI: 10.1007/s10388-019-00708-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the clinical outcome of esophageal cancer has recently improved, the relapse rate remains high for all disease stages. At present, there is no diagnostic method to predict the long-term outcome for esophageal cancer. In this study, we evaluated serum preoperative proinflammatory cytokine levels and investigated the correlation between preoperative interleukin-6 (IL-6) and IL-8 levels and survival of patients with esophageal cancer. METHODS Between 2008 and 2015, we evaluated preoperative serum cytokine levels in 122 patients who underwent esophagectomy for esophageal cancer. Serum IL-6 and IL-8 levels were measured by enzyme-linked immunosorbent assays. We investigated the relationship between serum cytokine levels and the response to chemotherapy and survival. RESULTS The preoperative IL-6 levels were significantly associated with shorter recurrence-free survival (RFS, p = 0.001) and overall survival (OS, p = 0.001) after esophagectomy. Higher IL-8 levels were significantly associated with RFS (p = 0.018). In the multivariate analysis, age, preoperative chemotherapy, lymph node metastasis, serum C-reactive protein (CRP) levels and serum IL-6 levels (hazard ratio (HR), 2.888; p = 0.049) were significantly independent prognostic factors of RFS. Additionally, age, pathological stage, and serum IL-6 levels (HR, 3.247; p = 0.027) were shown to be significantly independent prognostic factors of OS. Serum IL-6 levels were significantly higher in the non-responder group (pathological response pGrade0 and pGrade1) after neoadjuvant therapy. CONCLUSIONS High preoperative serum IL-6 levels are associated with a poor response to chemotherapy or chemoradiotherapy and poor prognosis after esophagectomy. Preoperative serum IL-6 levels may be a useful independent prognostic marker for esophageal cancer patients.
Collapse
Affiliation(s)
- Yusuke Maeda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, School of Medicine, Hamamatsu University, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Satoru Matsuda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Akihiko Okamura
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Taku Miyasho
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodaimidorimachi, Ebetsu-shi, Hokkaido, 069-8501, Japan
| | - Rieko Nakamura
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Suda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
15
|
Ratosa I, Orazem M, Scoccimarro E, Steinacher M, Dominici L, Aquilano M, Cerbai C, Desideri I, Ribnikar D, Marinko T, Livi L, Meattini I. Cyclin-Dependent Kinase 4/6 Inhibitors Combined With Radiotherapy for Patients With Metastatic Breast Cancer. Clin Breast Cancer 2020; 20:495-502. [PMID: 32622736 DOI: 10.1016/j.clbc.2020.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) represent the standard treatment for hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer. Data about the balance between efficacy and toxicity of combined palliative radiotherapy (RT) and CDK4/6 inhibition are lacking. PATIENTS AND METHODS We undertook a review of 46 patients with metastatic breast cancer on systemic treatment with CDK4/6i who underwent 62 metastases-directed RT. Clinical, laboratory, and RT treatment planning data were collected. Statistical analyses included Student t test, paired sample t test, and logistic regression modeling. RESULTS Thirty patients (65.2%) received palbociclib, 15 (32.6%) received ribociclib, and one patient received abemaciclib (2.2%). Median total prescribed RT dose was 20 Gy (range, 8-63 Gy). Sites of RT were bone (n = 50; 80.7%), visceral (n = 7; 11.3%), or brain metastases (n = 3; 4.8%), as well as primary tumor of the breast (n = 2; 3.2%). Overall, the rates of grade 3 or higher adverse events (AEs) were 6.5%, 4.3%, 15.2%, and 23.9% before the start of RT, during RT, 2 and 6 weeks after RT completion, respectively. We found no correlation between dose distribution to organs at risk and the development of AEs. The local control rates for the entire cohort were 98% at 6 months and 90% at 12 months. Overall, pain relief (complete or partial) was experienced by 80% (24/30) of patients who initially reported pain at the treated metastatic site. CONCLUSION We observed a modest increase in the rates of grade 3 or higher AEs after combined RT and CDK4/6i, with maintained efficacy of concomitant RT.
Collapse
Affiliation(s)
- Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
| | - Miha Orazem
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Erika Scoccimarro
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mateja Steinacher
- Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Luca Dominici
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Michele Aquilano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domen Ribnikar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Tanja Marinko
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence, Florence, Italy; Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| |
Collapse
|
16
|
Lopez A, Harada K, Chen HC, Bhutani MS, Weston B, Lee JH, Maru DM, Chin FW, Rogers JE, Thomas I, Amlashi FG, Blum-Murphy MA, Rice DC, Zhao M, Hofstetter WL, Nguyen Q, Ajani JA. Taxane-based or platinum-based combination chemotherapy given concurrently with radiation followed by surgery resulting in high cure rates in esophageal cancer patients. Medicine (Baltimore) 2020; 99:e19295. [PMID: 32118743 PMCID: PMC7478597 DOI: 10.1097/md.0000000000019295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Preoperative chemoradiotherapy (CRT) is one standard option for localized esophageal or gastroesophageal junction (GEJ) cancer patients but an optimal concurrent chemotherapy combination is not established. METHODS 412 patients with resectable (cT1N1M0 or cT2-4N0-3M0) esophageal or GEJ cancer treated at the MDACC between October 2002 and June 2016 were analyzed. Exposures: CRT with DF or FOX followed by surgery (trimodality; TMT). Main outcomes and measures: Primary endpoints were overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox analyses were performed. RESULTS Of the 412 patients analyzed, 264 (64%) received DF and 148 (36%) FOX. The median age was 60 years, and 95% had adenocarcinoma. The clinical complete response, positron-emission tomography response, and pathologic complete response rates were 73%, 73%, and 30%, respectively. Median follow-up was 60.4 months. Median OS for the entire cohort was 81.6 months (95% confidence interval [CI], 56.3-122.0); 81.6 months (95% CI, 55.9-not estimable) for the DF group and 67.7 months (95% CI, 41.6-not estimable) for the FOX group (P = .24). The median DFS was 45.6 months (95% CI, 33.1-61.7) for the entire cohort; 49.5 months (95% CI, 38.6-70.3) for DF and 33.0 months (95% CI, 18.1-70.4; P = .38) for FOX. Higher tumor location (unfavorable) and clinical complete response (favorable) were prognostic for both OS and DFS in the multivariate analysis. CONCLUSION At our high-volume center, the outcome of 412 TMT esophageal cancer patients was excellent. Taxane-based chemotherapy produces nonsignificant favorable trend.
Collapse
Affiliation(s)
- Anthony Lopez
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | | | - Jane E. Rogers
- Department of Pharmacy Clinical Programs Gastroenterology
| | - Irene Thomas
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fatemeh G. Amlashi
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mariela A. Blum-Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David C. Rice
- Department of Thoracic and Cardiovascular Surgery Surgical Oncology
| | - Meina Zhao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Quynh Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
17
|
Jones DA, Mistry P, Dalby M, Fulton-Lieuw T, Kong AH, Dunn J, Mehanna HM, Gray AM. Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial. Eur J Cancer 2020; 124:178-185. [PMID: 31794928 PMCID: PMC6947474 DOI: 10.1016/j.ejca.2019.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The De-ESCALaTE HPV trial confirmed the dominance of cisplatin over cetuximab for tumour control in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Here, we present the analysis of health-related quality of life (HRQoL), resource use, and health care costs in the trial, as well as complete 2-year survival and recurrence. MATERIALS AND METHODS Resource use and HRQoL data were collected at intervals from the baseline to 24 months post treatment (PT). Health care costs were estimated using UK-based unit costs. Missing data were imputed. Differences in mean EQ-5D-5L utility index and adjusted cumulative quality-adjusted life years (QALYs) were compared using the Wilcoxon signed-rank test and linear regression, respectively. Mean resource usage and costs were compared through two-sample t-tests. RESULTS 334 patients were randomised to cisplatin (n = 166) or cetuximab (n = 168). Two-year overall survival (97·5% vs 90·0%, HR: 3.268 [95% CI 1·451 to 7·359], p = 0·0251) and recurrence rates (6·4% vs 16·0%, HR: 2·67 [1·38 to 5·15]; p = 0·0024) favoured cisplatin. No significant differences in EQ-5D-5L utility scores were detected at any time point. At 24 months PT, mean difference was 0·107 QALYs in favour of cisplatin (95% CI: 0·186 to 0·029, p = 0·007) driven by the mortality difference. Health care costs were similar across all categories except the procurement cost and delivery of the systemic agent, with cetuximab significantly more expensive than cisplatin (£7779 [P < 0.001]). Consequently, total costs at 24 months PT averaged £13517 (SE: £345) per patient for cisplatin and £21064 (SE: £400) for cetuximab (mean difference £7547 [95% CI: £6512 to £8582]). CONCLUSIONS Cisplatin chemoradiotherapy provided more QALYs and was less costly than cetuximab bioradiotherapy, remaining standard of care for nonsurgical treatment of HPV-positive OPSCC.
Collapse
Affiliation(s)
- David A Jones
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Matthew Dalby
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tessa Fulton-Lieuw
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony H Kong
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hisham M Mehanna
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| |
Collapse
|
18
|
de Vos-Geelen J, Geurts SME, van Putten M, Valkenburg-van Iersel LBJ, Grabsch HI, Haj Mohammad N, Hoebers FJP, Hoge CV, Jeene PM, de Jong EJM, van Laarhoven HWM, Rozema T, Slingerland M, Tjan-Heijnen VCG, Nieuwenhuijzen GAP, Lemmens VEPP. Trends in treatment and overall survival among patients with proximal esophageal cancer. World J Gastroenterol 2019; 25:6835-6846. [PMID: 31885424 PMCID: PMC6931002 DOI: 10.3748/wjg.v25.i47.6835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/04/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.
AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.
METHODS In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.
RESULTS In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P < 0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P < 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26).
CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.
Collapse
Affiliation(s)
- Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Sandra ME Geurts
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Margreet van Putten
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
| | - Liselot BJ Valkenburg-van Iersel
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Heike I Grabsch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James”s, University of Leeds, Leeds LS9 7TF, United Kingdom
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht 3584 CX, Netherlands
| | - Frank JP Hoebers
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6229 ET, Netherlands
| | - Chantal V Hoge
- Department of Internal Medicine, Division of Gastroenterology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Paul M Jeene
- Department of Radiotherapy, Radiotherapiegroep, Deventer 7416 SE, Netherlands
| | - Evelien JM de Jong
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Tom Rozema
- Department of Radiotherapy, Insituut Verbeeten, Tilburg 5042 SB, Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Vivianne CG Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | | | - Valery EPP Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
| |
Collapse
|
19
|
Almaazmi H, Taylor JP, Stem M, Yu D, Lo BD, Safar B, Efron JE. Anal Squamous Cell Carcinoma: Radiation Therapy Alone Must Be Avoided. J Surg Res 2019; 247:530-540. [PMID: 31648811 DOI: 10.1016/j.jss.2019.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/11/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anal squamous cell carcinoma (ASCC) is the most common histological subtype of anal cancer. Rates have been observed to increase in recent years. Combined chemoradiotherapy (CCRT) is currently the gold standard of treatment. The aim of this study is to assess ASCC prevalence, treatment trends, and overall survival (OS) in the United States. METHODS Patients diagnosed with stage I-IV ASCC were identified from the National Cancer Database from 2004 to 2015. The primary outcome was 5-year OS, which was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS 34,613 cases were included (stage I: 21.45%; II: 41.00%; III: 31.62%; IV: 5.94%), with an increasing trend in prevalence. CCRT was the most used treatment. Multimodal treatment, combining surgery with CCRT, offered the best OS rates for stage I, II, and IV cancers (I: 84.87%; II: 75.12%; IV: 33.08%), comparable with survival of stage III patients treated with CCRT (III: 61.14%). Radiation alone had the worse OS rates, and on adjusted analysis, radiation treatment alone had the greatest risk of mortality (I: hazard ratio, 2.01; 95% confidence interval, 1.14-3.54; P = 0.016; II: 2.05, 1.44-2.93, P < 0.001; IV: 1.99, 0.99-4.02, P = 0.054). CONCLUSIONS ASCC has increased in prevalence, notably in stage III and IV disease. Although CCRT is the most commonly used treatment type for all stages of ASCC, multimodal treatment offers better OS in stages I, II, and IV. Treatment with radiation alone offers the worst OS no matter the stage and should no longer be used as a solitary treatment modality.
Collapse
Affiliation(s)
- Hamda Almaazmi
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James P Taylor
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miloslawa Stem
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Yu
- Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Brian D Lo
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E Efron
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
20
|
Zhang B, Li MM, Chen WH, Zhao JF, Chen WQ, Dong YH, Gong X, Chen QY, Zhang L, Mo XK, Luo XN, Tian J, Zhang SX. Association of Chemoradiotherapy Regimens and Survival Among Patients With Nasopharyngeal Carcinoma: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1913619. [PMID: 31626318 PMCID: PMC6813597 DOI: 10.1001/jamanetworkopen.2019.13619] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The role of induction chemotherapy (IC) or adjuvant chemotherapy (AC) in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC) remains controversial. OBJECTIVES To update meta-analyses on the association of survival outcomes with IC and AC regimens in patients with locoregionally advanced NPC and assess whether the current evidence is conclusive by a trial sequential analysis (TSA) approach. DATA SOURCES PubMed, Embase, and Web of Science were searched for articles published from inception until June 1, 2019. STUDY SELECTION Randomized clinical trials that assessed the efficacy of radiotherapy with or without chemotherapy among previously untreated patients and patients with nondistant metastatic NPC. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 investigators from each trial independently and synthesized by the 2 investigators. All trial results were combined and analyzed by a fixed- or random-effects model. MAIN OUTCOMES AND MEASURES Overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS). RESULTS A total of 8036 patients (median age, 46.5 years; 5872 [73.1%] male) from 28 randomized clinical trials were included in the analysis. Pooled analyses revealed that concurrent chemoradiotherapy (CCRT) was significantly associated with improved OS, PFS, DMFS, and LRFS compared with radiotherapy across all subgroups. The TSA confirmed the treatment outcomes of CCRT compared with radiotherapy. The additional IC regimen was associated with an improvement in OS (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95), PFS (HR, 0.73; 95% CI, 0.64-0.84), DMFS (HR, 0.67; 95% CI, 0.59-0.78), and LRFS (HR, 0.74; 95% CI, 0.64-0.85). These findings were consistent in subgroup analyses of multicenter trials with sample sizes greater than 250, years of survival rate of 5 or greater, median follow-up longer than 5 years, or low risk of bias. However, the additional AC regimen was not associated with a survival benefit in OS (HR, 0.98; 95% CI, 0.78-1.23), PFS (HR, 0.86; 95% CI, 0.70-1.07), DMFS (HR, 0.84; 95% CI, 0.64-1.10), or LRFS (HR, 0.80, 95% CI, 0.59-1.09). The TSA provided sound evidence on the additional benefit of IC but not AC. CONCLUSIONS AND RELEVANCE These data suggest a significant association of survival outcomes with CCRT in patients with locoregionally advanced NPC. The addition of IC instead of AC could achieve survival benefits. The potential therapeutic gain of AC should be explored in the future.
Collapse
Affiliation(s)
- Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Min Min Li
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wen Hui Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jian Fu Zhao
- Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wei Qi Chen
- Big Data Decision Institute, Jinan University, Guangzhou, Guangdong, China
| | - Yu Hao Dong
- Department of Catheterization Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qiu Ying Chen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiao Kai Mo
- Department of Head and Neck Cancer, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Ning Luo
- Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Shui Xing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| |
Collapse
|
21
|
Buti S, Bersanelli M, Viansone A, Leonetti A, Masini C, Ratta R, Procopio G, Maines F, Iacovelli R, Ciccarese C, Vitale MG, De Giorgi U, Mucciarini C, Maruzzo M, Prati G, Lattanzi E, Ciammella P, Bruni A, Andreani S, D'Abbiero N. Treatment Outcome of metastatic lesions from renal cell carcinoma underGoing Extra-cranial stereotactic body radioTHERapy: The together retrospective study. Cancer Treat Res Commun 2019; 22:100161. [PMID: 31677494 DOI: 10.1016/j.ctarc.2019.100161] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 05/26/2019] [Revised: 08/24/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES stereotactic body radiation therapy (SBRT) use has increased overtime for the management of metastatic renal cell carcinoma (mRCC) patients, with a likely good control of irradiated lesions. We planned a retrospective multicenter Italian study, with the aim of investigating the outcome of treatment with SBRT for non-brain secondary lesions in mRCC patients. METHODS all consecutive metastatic non-brain lesions from mRCC that underwent SBRT at nine Italian institutions from January 2015 to June 2017 were considered. The primary endpoint of the study was the lesion-PFS, calculated from SBRT initiation to the local progression of the irradiated lesion. RESULTS 57 extracranial metastatic lesions from 48 patients with primary mRCC were treated with SBRT. At the median follow-up of 26.4 months, the median lesion-PFS was not reached (43 censored); 72.4% of lesions were progression-free at 40 months, with significantly better lesion-PFS for small metastatic lesions (<14 mm). SBRT was safe and the 1-year local disease control was 87.7%. After SBRT, 18 patients (37.5%) permanently interrupted systemic therapy. CONCLUSIONS consistently with the previous literature, our findings support the use of SBRT in selected mRCC patients.
Collapse
Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Medicine and Surgery Department, University of Parma, Parma, Italy.
| | | | | | - Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS, Reggio Emilia, Italy
| | - Raffaele Ratta
- SS Oncologia Genitourinaria Fondazione Istituto Nazionale Tumori Milano, Milano, Italy
| | - Giuseppe Procopio
- SS Oncologia Genitourinaria Fondazione Istituto Nazionale Tumori Milano, Milano, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Roberto Iacovelli
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Ciccarese
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Haematology and Respiratory Disease, University Hospital of Modena, Modena, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudia Mucciarini
- Medical Oncology Department, Ramazzini Hospital - AUSL Modena, Carpi, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
| | - Giuseppe Prati
- Day Hospital Oncology, Ospedale Civile di Guastalla, Reggio Emilia, Reggio Emilia, Italy
| | | | - Patrizia Ciammella
- Radiotherapy Unit, Clinical Cancer Centre, AUSL-IRCCS, Reggio Emilia, Italy
| | - Alessio Bruni
- Radiation Oncology Unit,University Hospital of Modena, Modena, Italy
| | | | | |
Collapse
|
22
|
Kulke MH, Benson AB, Dasari A, Huynh L, Cai B, Totev T, Roesner N, Duh MS, Neary MP, Maurer VE, Shih BE, Dagohoy CG, Chan J, Bergsland EK. Real-World Treatment Patterns and Clinical Outcomes in Advanced Gastrointestinal Neuroendocrine Tumors (GI NET): A Multicenter Retrospective Chart Review Study. Oncologist 2019; 24:1056-1065. [PMID: 30606883 PMCID: PMC6693731 DOI: 10.1634/theoncologist.2018-0519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We assessed treatment patterns and outcomes of patients with advanced gastrointestinal (GI) neuroendocrine tumors (NET) at four large tertiary referral centers in the U.S. PATIENTS AND METHODS We performed a retrospective chart review of patients aged ≥18 years at advanced GI NET diagnosis, treated between July 2011 and December 2014. Index date was the histologically confirmed diagnosis date of locally advanced/metastatic GI NET. Data included baseline characteristics, treatment patterns, progression, death, and GI NET-related health care resource utilization from index date through last contact or death. Time-to-event analyses, including treatment discontinuation, progression, and overall survival (OS), were performed using Kaplan-Meier analysis. RESULTS We identified 273 patients; 156 (57%) had primary ileum NET, and 174 (64%) had functional NET. First-line treatments included somatostatin analog (SSA) alone (89%) or in combination (2%), liver-directed therapy (LDT; 8%), and cytotoxic chemotherapy or interferon (2%). One hundred fifty-five patients continued with second-line therapy, including SSA alone (17%) or in combination (75%, with 3% combined with peptide receptor radionuclide therapy), LDT (4%), and other treatments (3%). Median time (months) to first-line discontinuation was 154.0 for SSAs and 3.8 for cytotoxic chemotherapy. Overall median time to investigator-assessed progression following treatment initiation was 30.3 months. Median OS (months) following first-line initiation was 151.8 for all patients and 178.9 for first-line SSA. CONCLUSION Our study illustrates the common use of SSAs in both first-line and subsequent treatment of patients with GI NETs, as well as the relatively long survival durations and multiple additional treatments received by patients with this condition. Treatment pattern assessment at later times, following approval of newer treatments, is warranted. IMPLICATIONS FOR PRACTICE This study, assessing treatment patterns over a period of up to 30 years, showed that SSAs, LDT, cytotoxic chemotherapy, and interferon are common treatments for advanced GI NETs. SSAs alone or in combination with other treatments were the most frequent therapy in first and subsequent lines. Patients in this study remained on SSAs long-term, with median treatment duration of 12.8 years in first line. Treatment patterns should be assessed beyond this study's time period, given recent U.S. Food and Drug Administration approvals for additional treatments for GI NET, which will likely be incorporated in the continuum of care of patients.
Collapse
Affiliation(s)
- Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Hematology/Oncology Section, Boston University Cancer Center, Boston, Massachusetts, USA
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Arvind Dasari
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Todor Totev
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Nina Roesner
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Victoria E Maurer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Brandon E Shih
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Cecile G Dagohoy
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Jennifer Chan
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily K Bergsland
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
23
|
Dasari A, Bergsland EK, Benson AB, Cai B, Huynh L, Totev T, Shea J, Duh MS, Neary MP, Dagohoy CG, Shih BE, Maurer VE, Chan J, Kulke MH. Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings: A Multicenter Retrospective Chart Review Study. Oncologist 2019; 24:1066-1075. [PMID: 30610008 PMCID: PMC6693720 DOI: 10.1634/theoncologist.2018-0520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/14/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). SUBJECTS, MATERIALS, AND METHODS We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. RESULTS We identified 83 patients; 19 (23%) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver-directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second-line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. CONCLUSION SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. IMPLICATIONS FOR PRACTICE Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.
Collapse
Affiliation(s)
- Arvind Dasari
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Emily K Bergsland
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Todor Totev
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Jerome Shea
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Cecile G Dagohoy
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Brandon E Shih
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Victoria E Maurer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Jennifer Chan
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Section of Hematology/Oncology, Cancer Center at Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Hung MS, Wu YF, Chen YC. Efficacy of chemoradiotherapy versus radiation alone in patients with inoperable locally advanced non-small-cell lung cancer: A meta-analysis and systematic review. Medicine (Baltimore) 2019; 98:e16167. [PMID: 31277121 PMCID: PMC6635168 DOI: 10.1097/md.0000000000016167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This meta-analysis compared radiotherapy (RT) versus concurrent chemoradiotherapy (RT+CT) in treating patients with inoperable stage III non-small-cell lung cancer (NSCLC). METHODS Medline, Cochrane, EMBASE, Google Scholar databases were searched until July 28, 2015 using the following keywords non-small cell lung cancer, advanced cancer, incurable/inoperable/unresectable, chemotherapy, radiotherapy, chemoradiotherapy/chemoradiation. Randomized controlled trials (RCTs) and two-armed prospective studies that compared combined RT+CT with RT alone in patients with locally advanced (stage III) nonresectable NSCLC were eligible for inclusion. Treatment effect on overall survival, progression-free survival (PFS), and objective response rate (ORR) were evaluated. RESULTS Ultimately, 13 RCT studies were included in the systematic review and meta-analysis. The 13 studies included a total of 1936 patients with incurable/inoperable stage III NSCLC, of which 975 received RT alone and 961 received RT+CT combination therapy. The average age ranged from 54 to 77 years. At 1 and 2 years after treatment, the pooled data reveal that patients receiving CT+RT combination therapy had higher overall survival (pooled hazard ratio (HR), 0.72; 95% CI, 0.62-0.84; P < .001; 1-yr: HR, 0.67; 95% CI, 0.54-0.84; P < .001; 2-year: HR, 0.57; 95% CI, 0.45-0.73; P < .001), higher PFS (pooled HR, 0.73, 95% CI, 0.60-0.89; P = .002; 1-year: HR, 0.36; 95% CI, 0.24-0.53; P < .001; 2-year: HR, 0.38; 95% CI, 0.23-0.63; P < .001). CONCLUSION Our findings show higher efficacy for concurrent CT+RT over RT alone in treating locally-advanced, unresectable stage III NSCLC.
Collapse
Affiliation(s)
- Ming-Szu Hung
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi
| | - Yi-Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi branch
| | - Yi-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi branch
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan ROC
| |
Collapse
|
25
|
Liu X, Wu T, Zhu SY, Shi M, Su H, Wang Y, He X, Xu LM, Yuan ZY, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Zhang YJ, Zhu Y, Cao JZ, Lan SM, Wu JX, Qi SN, Yang Y, Li YX. Risk-Dependent Conditional Survival and Failure Hazard After Radiotherapy for Early-Stage Extranodal Natural Killer/T-Cell Lymphoma. JAMA Netw Open 2019; 2:e190194. [PMID: 30821826 PMCID: PMC6484659 DOI: 10.1001/jamanetworkopen.2019.0194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Prognosis of early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is usually estimated and stratified at diagnosis, but how the prognosis actually evolves over time for patients who survived after curative treatment is unknown. OBJECTIVE To assess conditional survival and failure hazard over time based on risk categories, previous survival, and treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study reviewed the clinical data of 2015 patients with early-stage NKTCL treated with radiotherapy identified from the China Lymphoma Collaborative Group multicenter database between January 1, 2000, and December 31, 2015. Patients were stratified into low-, intermediate- and high-risk groups according to a previously established prognostic model. Median follow-up was 61 months for surviving patients. Data analysis was performed from December 1, 2017, to January 30, 2018. EXPOSURES All patients received radiotherapy with or without chemotherapy. MAIN OUTCOMES AND MEASURES Conditional survival defined as the survival probability, given patients have survived for a defined time, and annual hazard rates defined as yearly event rate. RESULTS A total of 2015 patients were included in the study (mean [SD] age, 43.3 [14.6] years; 1414 [70.2%] male); 1628 patients (80.8%) received radiotherapy with chemotherapy, and 387 (19.2%) received radiotherapy without chemotherapy. The 5-year survival rates increased from 69.1% (95% CI, 66.6%-71.4%) at treatment to 85.3% (95% CI, 81.7%-88.2%) at year 3 for conditional overall survival and from 60.9% (95% CI, 58.3%-63.3%) at treatment to 84.4% (95% CI, 80.6%-87.6%) at year 3 for conditional failure-free survival. The annual hazards decreased from 13.7% (95% CI, 13.0%-14.3%) for death and 22.1% (95% CI, 21.0%-23.1%) for failure at treatment to less than 5% after 3 years (death: range, 0%-3.9% [95% CI, 3.7%-4.2%]; failure: 1.2% [95% CI, 1.0%-1.4%] to 4.2% [95% CI 3.9%-4.6%]). Intermediate-risk (11.4% [95% CI, 10.5%-12.3%]) and high-risk (21.6% [95% CI, 20.0%-23.2%]) patients had initially higher but significantly decreased death hazards after 3 years (<6%, range: 0%-5.9% [95% CI, 5.2%-6.7%]), whereas low-risk patients maintained a constantly lower death hazard of less than 5% (range, 0%-4.8%; 95% CI, 4.4%-5.3%). In high-risk patients, radiotherapy combined with non-anthracycline-based regimens were associated with higher conditional overall survival before year 3 compared with anthracycline-based regimens (hazard ratio [HR] for death, 1.49; 95% CI, 1.13-1.95; P = .004 at treatment; HR, 1.60; 95% CI, 1.07-2.39; P = .02 at 1 year; and HR, 1.77; 95% CI, 0.94-3.33; P = .07 at 2 years) or radiotherapy alone (HR, 2.42; 95% CI, 1.73-3.39; P < .001 at treatment; HR, 1.82; 95% CI, 1.05-3.17; P = .03 at 1 year; and HR, 2.69; 95% CI, 1.23-5.90; P = .01 at 2 years). CONCLUSIONS AND RELEVANCE The survival probability increased and the hazards of failure decreased in a risk-dependent manner among patients with early NKTCL after radiotherapy. These dynamic data appear to provide accurate information on disease processes and continual survival expectations and may help researchers design additional prospective clinical trials and formulate risk-adapted therapies and surveillance strategies.
Collapse
Affiliation(s)
- Xin Liu
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Tao Wu
- Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Su-Yu Zhu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, People’s Republic of China
| | - Mei Shi
- Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People’s Republic of China
| | - Hang Su
- 307 Hospital, Academy of Military Medical Science, Beijing, People’s Republic of China
| | - Ying Wang
- Chongqing Cancer Hospital & Cancer Institute, Chongqing, People’s Republic of China
| | - Xia He
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, People’s Republic of China
| | - Li-Ming Xu
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Zhi-Yong Yuan
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Li-Ling Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Bao-Lin Qu
- The General Hospital of Chinese People's Liberation Army, Beijing, People’s Republic of China
| | - Li-Ting Qian
- The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao-Rong Hou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fu-Quan Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yu-Jing Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Yuan Zhu
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Jian-Zhong Cao
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Sheng-Min Lan
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jun-Xin Wu
- Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| |
Collapse
|
26
|
Wang Y, Yu X, Zhao N, Wang J, Lin C, Izaguirre EW, Farmer M, Tian G, Somer B, Dubal N, Schwartz DL, Ballo MT, VanderWalde NA. Definitive Pelvic Radiotherapy and Survival of Patients With Newly Diagnosed Metastatic Anal Cancer. J Natl Compr Canc Netw 2019; 17:29-37. [PMID: 30659127 DOI: 10.6004/jnccn.2018.7085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Abstract
Background: Chemotherapy with or without pelvic radiotherapy (RT) is included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for metastatic anal cancer (MAC), despite limited clinical evidence for RT in this setting. In addition, increasing evidence shows that local therapies, including RT, may increase patient survival for some types of metastatic cancers. The purpose of this study was to evaluate the patterns of care and association between definitive pelvic RT and overall survival (OS) for patients with MAC. Methods: The National Cancer Database was analyzed to evaluate OS of patients with newly diagnosed MAC treated with chemotherapy with or without pelvic RT. Those who did not undergo treatment, treated with surgery, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results: From 2004 through 2015, 437 patients received chemotherapy alone and 1,020 received pelvic chemoradiotherapy (CRT). At a median follow-up of 17.3 months, CRT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio [HR], 0.70; 95% CI, 0.61-0.81; P<.001). Propensity score-matched analysis demonstrated superior median survival (21.3 vs 15.9 months) and 2-year OS rates (46% vs 34%) with CRT compared with chemotherapy alone (P<.001). Landmark analyses limited to long-term survivors of ≥1, ≥2, and ≥4 years showed improved OS with CRT in all subsets (all P<.05). CRT with therapeutic doses (≥45 Gy) was associated with longer median survival than palliative doses (<45 Gy) and chemotherapy alone (24.9 vs 10.9 vs 15.6 months, respectively; P<.001). The benefit of CRT was present among not only those with distant lymph node metastasis (HR, 0.63; P=.04) but also those with distant organ disease (HR, 0.74; P<.001). Conclusions: In this large hypothesis-generating analysis, patients with newly diagnosed MAC who received definitive pelvic RT with chemotherapy lived significantly longer than those who received chemotherapy alone. Prospective trials evaluating definitive local RT for MAC are warranted.
Collapse
|
27
|
Ghiassi-Nejad Z, Ru M, Moshier E, Chang S, Jagannath S, Dharmarajan K. Overall Survival Trends and Clinical Characteristics of Plasmacytoma in the United States: A National Cancer Database Analysis. Clin Lymphoma Myeloma Leuk 2019; 19:310-319. [PMID: 30878315 DOI: 10.1016/j.clml.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given the rarity of plasmacytoma, large-scale database analysis can provide useful information regarding the clinical presentation and patient-related factors impacting overall survival (OS). MATERIALS AND METHODS The National Cancer Data Base was queried for patients with plasmacytoma between 2004 and 2013, excluding patients with systemic disease. Plasmacytomas were classified as originating in bone (P-bone), in extramedullary tissue (P-EM), or unspecified. Survival was estimated using the Kaplan-Meier and log-rank test method. We used Cox regression to determine specific outcomes adjusting for demographic, socioeconomic, geographic, facility type, year of diagnosis, and comorbid factors. RESULTS In total, 6225 patients were identified, of which 61.5% were men. The median age at diagnosis was 64 years (range, 18-90 years), and the median follow-up was 58 months. The primary site of disease was P-bone in 4056 (65.1%) patients and P-EM in 1468 (23.6%), and the remaining 701 patients were P-unspecified. The unadjusted median survival for solitary P-bone was 89 months (95% confidence interval, 82.9-95.0 months), and for solitary P-EM was 117.3 months (95% confidence interval, 108.8 months to not reached). Factors associated with improved OS include younger age, private insurance, higher income, solitary lesion, and lower comorbidity score. Patients with P-bone disease treated at academic facilities had improved OS. Only 65% of patients with solitary plasmacytoma lesions received radiation treatment. Age greater than 75 years and increased distance to treatment facility was associated with a decreased likelihood of receiving radiation. CONCLUSIONS This is the largest study examining outcomes of patients with plasmacytoma using a large database analysis, revealing unique aspects of P-EM versus P-bone and underutilization of radiation treatment.
Collapse
Affiliation(s)
| | - Meng Ru
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sanders Chang
- Department of Radiation Oncology, Mount Sinai Hospital, New York, NY
| | - Sundar Jagannath
- Department of Hematology and Oncology, Mount Sinai Hospital, New York, NY
| | | |
Collapse
|
28
|
Rash D, Daly ME, Durbin-Johnson B, Vaughan AT, Chen AM. Treatment outcomes in HPV-negative oropharyngeal cancer: Surgery plus radiotherapy vs. definitive chemoradiotherapy. Ear Nose Throat J 2018; 97:E1-E7. [PMID: 30138518 DOI: 10.1177/014556131809700801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We performed a retrospective study to compare clinical outcomes among 51 consecutively presenting patients-38 men and 13 women, aged 46 to 74 years (median: 57)-with locally advanced human papillomavirus (HPV)-negative oropharyngeal cancer who were treated with either primary surgery followed by postoperative radiotherapy (S/RT group; n = 22) or definitive chemoradiotherapy alone (CRT group; n = 29). Within the cohort, 45 patients reported a history of tobacco use, with a median intensity of 40 pack-years. In addition, 39 patients (76%) reported moderate to heavy alcohol use. At baseline, there were no statistically significant differences between the two cohorts in sex, median age, cancer stage, intensity of smoking history, and alcohol use (p > 0.05 for all). Radiation doses ranged from 40 to 70 Gy (median: 70). Follow-up ranged from 2 to 93 months (median: 29). After treatment, we found no difference between the S/RT group and the CRT group in the incidence of locoregional recurrence (36 vs. 24%; p = 0.43) or distant metastases (14 vs. 21%; p = 0.56). Likewise, the difference in 2-year estimates of progression-free survival in the two groups was not significant (66 vs. 62%; p = 0.64), nor was the difference in 2-year overall survival (75 vs. 76%; p = 0.83). We conclude that treatment with either (1) primary surgery followed by postoperative radiotherapy or (2) CRT for locally advanced HPV-negative oropharyngeal cancer results in similar outcomes. In view of the relatively poor prognosis for patients with HPV-negative disease compared with their HPV-positive counterparts, clinical trials to investigate intensifying treatment may be warranted.
Collapse
Affiliation(s)
- Dominique Rash
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | | | | | | |
Collapse
|
29
|
Lewis CM, Ajmani GS, Kyrillos A, Chamberlain P, Wang CH, Nocon CC, Peek M, Bhayani MK. Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity. Head Neck 2018; 40:2372-2382. [PMID: 29947066 DOI: 10.1002/hed.25341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/22/2018] [Accepted: 05/07/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Definitive surgery is recommended for oral cavity squamous cell carcinoma (SCC). The purpose of this study was to present our assessment of the disparities in treatment selection for oral cavity SCC. METHODS Non-Hispanic white and non-Hispanic black patients with oral cavity SCC were identified in the National Cancer Database (NCDB). Regression models were used to estimate relative risk (RR) of receiving surgery and absolute difference between non-Hispanic white and non-Hispanic black patients. RESULTS There were 82.3% of non-Hispanic white patients who received surgery, compared to 64.2% of non-Hispanic black patients (P < .001). The non-Hispanic black patients were less likely to receive surgery than non-Hispanic white patients (RR 0.87) with an absolute difference of 10.9%. The non-Hispanic black patients were significantly more likely to not be offered surgery (RR 1.42) and to refuse recommended surgery (RR 1.38) but not have a contraindication to surgery (RR 1.17). CONCLUSION The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.
Collapse
Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gaurav S Ajmani
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Alexandra Kyrillos
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois
| | - Cheryl C Nocon
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Monica Peek
- Secton of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Mihir K Bhayani
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| |
Collapse
|
30
|
Abstract
Neoadjuvant chemoradiation (CRT) followed by surgical resection is the standard of care for resectable, locally advanced esophageal cancer. There are promising results using 41.4 Gy relative to historical controls using higher doses, but the utilization and efficacy of lower neoadjuvant radiation dosing is unclear. This study uses the National Cancer Database (NCDB) to explore patterns of care for neoadjuvant CRT dose levels and outcomes. The NCDB was queried for localized invasive esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC) receiving neoadjuvant CRT with doses from 40 to 54 Gy followed by surgical resection. Patients were divided into radiation levels: 40-41.4, 45, 50.4, and 54 Gy, respectively. Factors predicting use of 40-41.4 Gy vs. all other dose levels were compared using multivariable logistic regression. Factors affecting overall survival (OS) were compared using univariate and multivariate modeling. A total of 6,274 patients with AC (n = 5,176) or SCC (n = 1,098) receiving neoadjuvant CRT and definitive resection were identified. Hispanic race (OR 2.67 [95% CI 1.22-5.81]) and treatment at an academic center (OR 2.72 [95% CI 1.15-6.41]) predicted for use of low-dose CRT. Lower dose CRT increased from 3.9% in 2004 to 7.2% in 2013. There was no difference in OS when stratified according to radiation dose level (P = 0.48). Multivariable analysis found private/government insurance, higher education, higher median income, and treatment at an academic center were associated with improved OS. Age, male gender, Charlson-Deyo comorbidity score, stage, tumor grade, and treatment in the South were associated with worse OS. Use of lower neoadjuvant CRT dose is more common at academic centers and shows possible increasing usage. Neoadjuvant radiation dose for esophageal cancer is not associated with differences in OS in this large database.
Collapse
Affiliation(s)
- M Buckstein
- Departments of Radiation Oncology, Mount Sinai, New York, New York, USA
| | - R Rhome
- Departments of Radiation Oncology, Mount Sinai, New York, New York, USA
| | - M Ru
- Population Health Science and Policy, Icahn School of Medicine, Mount Sinai,
New York, New York, USA
| | - E Moshier
- Population Health Science and Policy, Icahn School of Medicine, Mount Sinai,
New York, New York, USA
| |
Collapse
|
31
|
Luu C, Amaral M, Klapman J, Harris C, Almhanna K, Hoffe S, Frakes J, Pimiento JM, Fontaine JP. Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation? World J Gastroenterol 2017; 23:8193-8199. [PMID: 29290655 PMCID: PMC5739925 DOI: 10.3748/wjg.v23.i46.8193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/04/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the accuracy of endoscopic ultrasound (EUS) in early esophageal cancer (EC) performed in a high-volume tertiary cancer center.
METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with cT1N0 and cT2N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student’s t test and Fisher’s exact test or χ2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy.
RESULTS Between 2000 and 2015, 139 patients with clinical stageIorIIA esophageal cancer undergoing esophagectomy were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle third of the esophagus in 11 (8%) and lower third and gastroesophageal junction in 128 (92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. Positron emission tomography (PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients (6%) in whom both EUS and PET were negative for nodal involvement.
CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.
Collapse
Affiliation(s)
- Carrie Luu
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Marisa Amaral
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Jason Klapman
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Cynthia Harris
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Khaldoun Almhanna
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Sarah Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Jessica Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| | - Jacques P Fontaine
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
| |
Collapse
|
32
|
Zhao Q, Hu G, Xiao W, Chen Y, Shen M, Tang Q, Ning X. Comparison of definitive chemoradiotherapy and radiotherapy alone in patients older than 75 years with locally advanced esophageal carcinoma: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e7920. [PMID: 28858114 PMCID: PMC5585508 DOI: 10.1097/md.0000000000007920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and acute toxicity of definitive chemoradiotherapy (CRT) and radiotherapy (RT) alone as initial treatment in patients aged 75 years and older with locally advanced esophageal squamous cell carcinoma (ESCC) who are not eligible for surgery.Between February 2009 and February 2015, 122 patients older than 75 years with locally advanced ESCC were retrospectively reviewed, in whom 52 patients allocated to the CRT group were treated with at least 2 cycles of platinum and 5-fluorouracil, 70 patients allocated to the RT group were treated with RT alone, all patients were received a total radiation dose of 54-66 Gy, with 1.8 or 2-Gy/fraction. Response rate (RR), progression-free survival (PFS), overall survival (OS), and acute toxicities were compared between the 2 different treatment groups.In the CRT group, the median PFS and OS were 15.3 and 24.6 months, while 10.6 and 19.4 months in the RT group (P = .008 and P = .018). The 1-year survival rates of the 2 groups were 78.8% versus 64.3% (P = .081), and the 2-year survival rates were 48.1% and 30.0% (P = .042), respectively. The objective RR was 55.8% in the CRT group with 18 complete response (CR) and 18.6% in the RT group with 13 CR. Acute toxicity in the CRT group was higher than in the RT group, especially the grade 3 to 4 acute toxicities.Compared with RT alone, definitive CRT in the treatment of locally advanced ESCC can prolong the survival time in elderly patients. Definitive CRT should be considered the first-treatment choice for elderly patients like the younger patients who are not eligible for surgery.
Collapse
Affiliation(s)
- Qian Zhao
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Guofang Hu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong province
| | - Wei Xiao
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Yan Chen
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, China
| | - Meng Shen
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Qiang Tang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Xu Ning
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| |
Collapse
|
33
|
Sturdza A, Hofmann S, Kranawetter M, Polterauer S, Grimm C, Krainer M, Kirisits C, Pötter R, Reinthaller A, Schwameis R. Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy. Strahlenther Onkol 2017; 193:1056-1065. [PMID: 28721510 PMCID: PMC5696499 DOI: 10.1007/s00066-017-1178-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/22/2017] [Indexed: 01/15/2023]
Abstract
Background and purpose Patients with recurrent cervical cancer (RecCC) who received definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT) as primary treatment are currently treated in our institution with palliative intent by chemotherapy (CHT) combined with bevacizumab (BEV). We aim to evaluate the risk of gastrointestinal (GI)/genitourinary (GU) fistula formation in these patients. Materials and methods Data of 35 consecutive patients with RecCC treated initially with radiochemotherapy and IGABT were collected. Known and presumed risk factors associated with fistula formation were evaluated. Fistula rate was compared between patients receiving CHT or CHT+BEV. Results Of the 35 patients, 25 received CHT and 10 patients received CHT+BEV. Clinical characteristics were comparable. Fistulae were reported in 6 patients: two fistulae (8%) in the CHT group, four (40%) in the CHT+BEV group. GU fistula occurred in the CHT+BEV group only (3/4). Of these 6 patients with fistulae, 5 (83%) had undergone previous invasive procedures after the diagnosis of RecCC and 1 patient had undergone pelvic re-irradiation; 3/6 patients had developed a local recurrence. No other risk factors for fistula formation were identified. Conclusion In patients with RecCC after definitive radiochemotherapy including IGABT, the addition of BEV to CHT may increase the risk for GU fistula formation, particularly after invasive pelvic procedures. Future clinical studies are required to identify predictors for fistula formation to subsequently improve patient selection for the addition of BEV in the RecCC setting.
Collapse
Affiliation(s)
- Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Sandra Hofmann
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Marlene Kranawetter
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Stephan Polterauer
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria.
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Christoph Grimm
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Michael Krainer
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Richard Schwameis
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| |
Collapse
|
34
|
Park HJ, Min JJ, Bom HS, Kim J, Song HC, Kwon SY. Early stimulated thyroglobulin for response prediction after recombinant human thyrotropin-aided radioiodine therapy. Ann Nucl Med 2017; 31:616-622. [PMID: 28688088 PMCID: PMC5622909 DOI: 10.1007/s12149-017-1190-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/02/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Measurement of recombinant human thyrotropin (rhTSH)-stimulated thyroglobulin (Tg) is generally recommended 72 h after the second rhTSH injection. However, due to the acute effect of I-131 on thyrocytes, Tg measured after radioiodine therapy (RIT) would not accurately reflect the thyroid tissue burden. We aimed to determine predictive values of serum Tg level measured just before rhTSH-aided RIT and to compare the results obtained just after RIT in patients with differentiated thyroid carcinoma (DTC). METHODS We evaluated 150 patients with DTC who underwent rhTSH-aided RIT (2.96-6.66 GBq) after total thyroidectomy between 2009 and 2014. Serum Tg level was measured 24 h (early Tg) and 72 (or 96) h (delayed Tg) after the second rhTSH injection. An excellent response was defined based on the latest American Thyroid Association Guidelines. Univariate and multivariate analyses were performed for early Tg, delayed Tg, and other clinical variables. RESULTS In the multivariate analysis, tumor size [odds ratio (OR) 1.716; 95% confidence interval (CI) 1.019-2.882; p = 0.042] and early Tg level (OR 2.012; 95% CI 1.384-2.925, p < 0.001) independently predicted excellent responses. The cutoff for the best early Tg level to predict a non-excellent response was 2.0 ng/mL. Delayed Tg was not a significant predictor (OR 0.992; 95% CI 0.969-1.015; p = 0.492). CONCLUSIONS Early stimulated Tg significantly predicted therapeutic response after rhTSH-aided RIT in patients with DTC. Therefore, serum Tg should be measured before RIT to predict therapeutic responses.
Collapse
Affiliation(s)
- Hee Jeong Park
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-Gun, Jeonnam, 58128, South Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-Gun, Jeonnam, 58128, South Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-Gun, Jeonnam, 58128, South Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, 61469, South Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, 61469, South Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-Gun, Jeonnam, 58128, South Korea.
| |
Collapse
|
35
|
Yu Y, Yue J, Yu J. [Value of functional magnetic resonance imaging in predicting outcomes of neoadjuvant chemoradiotherapy in rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:491-494. [PMID: 28534322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rectal cancer is one of the common cancers which poses a threat to the health of mankind. In recent years. Multi-modality treatment strategies for locally advanced rectal cancer improve the treatment efficiency. Accurate prediction of the treatment response after the neoadjuvant chemoradiotherapy (CRT) can guide more suitable treatment strategy. MERCURY study proved the prognostic value of post-CRT standard morphologic MRI(T2-weighted) assessment of tumor regression grade(TRG), and MRI assessment of circumferential resection margin can guide the definitive surgery. Compared with standard morphologic MRI (T2-weighted), functional MRI, including diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI, has shown more promising results for the prediction of therapeutic response in rectal cancer. The addition of diffusion-weighted images to T2-weighted images improves the accuracy of restaging examinations for determination of complete pathologic responders. DCE can reflect the tumor micro-vascular environment, and the change of perfusion in response to treatment. These images have the potential to improve the accuracy of therapeutic response in rectal cancer.
Collapse
Affiliation(s)
| | | | - Jinming Yu
- Department of Radiotherapy, Shandong Cancer Hospital, Medical Academy of Shandong Province, Jinan 250117, China.
| |
Collapse
|
36
|
Zhang D, Zhan T, Li M, Gu J. [Predictive value of serum carcinoembryonic antigen level in efficacy and prognosis for patients with rectal cancer following preoperative radiochemotherapy]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:519-523. [PMID: 28534328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the association of preoperative carcinoembryonic antigen (CEA) level with the efficacy of neoadjuvant radiochemotherapy and postoperative metastasis and relapse in patients with rectal cancer. METHODS Between January 2011 and January 2014, 325 patients with local advanced rectal cancer underwent preoperative radiochemotherapy and radical operation in Department of Colorectal Cancer Surgery, Beijing University Cancer Hospital, including 194 males and 131 females. According to preoperative MRI, all the patients suffered from clinical T3-4 tumors or positive lymph nodes. Their Zubrod-ECOG-WHO score was 0-1. These patients received preoperative intensity modulated radiotherapy which consisted of 50.6 Gy in 22 fractions (IMRT GTV 50.6 Gy/CTV 41.8 Gy/22 f) with capecitabine(825 mg/m2, twice per day) as radiosensitizer. According to the preoperative serum CEA level, patients were divided into high group (125 cases) and normal group (200 cases). In high group, serum CEA level decreased into normal range in 60 patients (high-normal group) after radiochemotherapy, while it was still in high level in other 65 patients (high-high group). The differences in sensitivity to radiochemotherapy and 3-year disease free survival (DFS) of these patients were both evaluated. RESULTS In high group and normal group, the complete response rates were 18.4% (23/125) and 17.5% (35/200) (χ2=0.319, P=0.660); the percentages of tumor regression grade(TRG) 0-1 patients were 68.0%(85/125) and 67.5%(135/200)(χ2=0.009, P=0.925); the T downstage rates were 63.2%(79/125) and 70.0%(140/200)(χ2=1.266, P=0.274), respectively, whose differences were all not significant. The 3-year DFS rate in high group was 62.4%, which was significantly lower than 93.5% in normal group (χ2=53.147, P=0.000). There were 65 patients in high-high group, accounting for 52% (65/125) of high group. Among these 65 patients, 44(67.7%) presented recurrence and metastasis within 3 years and the 3-year DFS was 32.3%, which was much lower than 95.0% of 60 patients in high-normal group(χ2=182.085, P=0.000). CONCLUSIONS Preoperative serum CEA level may not be used to predict tumor response of rectal cancer patients who receive preoperative radiochemotherapy. However, the prognosis of patients with high CEA level is worse. Recurrence and metastasis are more likely to occur in patients with high CEA level after radiochemotherapy.
Collapse
Affiliation(s)
| | | | | | - Jin Gu
- Department of Colorectal Cancer Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
| |
Collapse
|
37
|
Shafi RG, Al-Mansour MM, Kanfar SS, Al Hashmi H, Alsaeed A, Al-Foheidi M, Ibrahim EM. Hodgkin Lymphoma Outcome: A Retrospective Study from 3 Tertiary Centers in Saudi Arabia. Oncol Res Treat 2017; 40:288-292. [PMID: 28380488 DOI: 10.1159/000460819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) exhibits considerable clinicopathological variations in different parts of the world. This study was prompted by the limited availability of HL data in developing countries (particularly long-term outcomes). METHODS We performed a retrospective review of eligible adult HL patients treated at 3 tertiary centers in Saudi Arabia between January 1997 and December 2012. RESULTS The review included 340 patients with a median age of 26 years (range 15-82 years); 53% were male, 74% had an advanced stage, 22% had bulky disease, and 70% had low-to-intermediate risk according to the International Prognostic Score. Nodular sclerosis was the most common histological subtype (59%). Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) was offered to 92% and radiotherapy to 43%. Initial therapy outcomes were complete response, partial response, and progressive disease in 91%, 5%, and 2% of patients, respectively. At a median follow-up of 39 months, the actuarial freedom from treatment failure at 5 years was 74%, with a 5-year overall survival of 91%. Multivariate analysis showed that advanced disease stage and high-risk international prognostic index independently predicted an adverse outcome. CONCLUSION Our Saudi patient population exhibited outcomes that were comparable to those reported in developed countries.
Collapse
|
38
|
Rimner A, Lovie S, Hsu M, Chelius M, Zhang Z, Chau K, Moskowitz AJ, Matasar M, Moskowitz CH, Yahalom J. Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience. Int J Radiat Oncol Biol Phys 2017; 97:1066-1076. [PMID: 28332991 PMCID: PMC5474094 DOI: 10.1016/j.ijrobp.2017.01.222] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We report the long-term results of integrated accelerated involved field radiation therapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation or autologous stem cell transplantation in patients with relapsed or refractory Hodgkin lymphoma (HL). METHODS AND MATERIALS From November 1985 to July 2008, 186 previously unirradiated patients with relapsed or refractory HL underwent salvage therapy on 4 consecutive institutional review board-approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18-20 Gy) was given to relapsed or refractory sites, followed by TLI (15-18 Gy) and high-dose chemotherapy. Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing-risk regression. RESULTS With a median follow-up period of 57 months among survivors, 5- and 10-year OS rates were 68% and 56%, respectively; 5- and 10-year EFS rates were 62% and 56%, respectively; and 5- and 10-year cumulative incidences of HL-related deaths were 21% and 29%, respectively. On multivariate analysis, complete response to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grade 3 or higher cardiac toxicity, with 3 deaths. Second malignancies developed in 10 patients, 5 of whom died. CONCLUSIONS Accelerated IFRT followed by TLI and high-dose chemotherapy is an effective, feasible, and safe salvage strategy for patients with relapsed or refractory HL with excellent long-term OS, EFS, and DSS. Complete response to SC is the most important prognostic factor.
Collapse
Affiliation(s)
- Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shona Lovie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Chelius
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Chau
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
39
|
Krcik EM. Radiation Therapy Plus Anti-Programmed Death Ligand 1 Immunotherapy: A Review on Overall Survival. Radiol Technol 2016; 88:123-128. [PMID: 27601709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To analyze current preclinical trials and early clinical trials on the effects of concomitant anti-programmed death ligand 1 (anti-PD-L1) immunotherapy and radiation therapy on progression-free survival (PFS) and overall survival (OS) for advanced melanoma and metastatic non-small cell lung cancer (NSCLC) patients. METHODS A literature review was conducted to find current articles about radiation and anti-PD-L1 combinatorial therapy to gain knowledge about T-lymphocyte (T-cell) mediated immune responses, preclinical mouse tumor trials, and early clinical trials. RESULTS Several preclinical studies involving mice tumor strains and 2 early clinical trials observed an increase in PFS and OS when testing radiation therapy given in combination with anti-PD-L1 immunotherapy. Abscopal effects of tumor regression and control were notable in some studies. DISCUSSION Low doses of radiation enhance the immune system by increasing T-cell activity. Radiation also increases levels of PD-L1 that inhibit tumor-fighting capabilities of T-cells. Anti-PD-L1 immunotherapy given in combination with radiation therapy has been tested in preclinical studies and hypothesized to increase PFS and OS in patients with advanced melanoma and metastatic NSCLC. CONCLUSION Anti-PD-L1 immunotherapy boosts the immune effects of radiation therapy on tumor regression by eradicating the limiting effects of PD-L1 on the immune system. The combination therapies have the potential to benefit metastatic patients who qualify for the treatment.
Collapse
|
40
|
Affiliation(s)
- Stephanie E Combs
- Institut für Innovative Radiotherapie (iRT) Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland.
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Friederike Schmidt-Graf
- Klinik für Neurologie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland
| | - Bernhard Meyer
- Klinik für Neurochirurgie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland
| |
Collapse
|
41
|
Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroenterol 2016; 22:5718-5727. [PMID: 27433085 PMCID: PMC4932207 DOI: 10.3748/wjg.v22.i25.5718] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/30/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.
Collapse
|
42
|
Sapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, Feng M, Schipper M, Eisbruch A. Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 96:354-361. [PMID: 27473816 DOI: 10.1016/j.ijrobp.2016.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/16/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE(S) Dysgeusia is a significant factor reducing quality of life and worsening dysphagia in patients receiving chemoradiation therapy for head and neck cancer. The factors affecting dysgeusia severity are uncertain. We investigated the effects on patient-reported dysgeusia of doses to the oral cavity, salivary output (required to dissolve food particles), and patient-reported xerostomia. METHODS AND MATERIALS Seventy-three patients with stage III to IV oropharyngeal cancer (OPC) (N=73) receiving definitive intensity modulated radiation therapy concurrently with chemotherapy participated in a prospective, longitudinal study of quality of life (QOL), including assessment of patient-reported gustatory function by taste-related questions from the Head and Neck QOL instrument (HNQOL) and the University of Washington Head and Neck-related QOL instrument (UWQOL), before therapy and periodically after treatment. At these intervals, patients also completed a validated xerostomia-specific questionnaire (XQ) and underwent unstimulated and stimulated major salivary gland flow rate measurements. RESULTS At 1, 3, 6, and 12 months after treatment, dysgeusia improved over time: severe dysgeusia was reported by 50%, 40%, 22%, and 23% of patients, respectively. Significant associations were found between patient-reported severe dysgeusia and radiation dose to the oral cavity (P=.005) and tongue (P=.019); normal tissue complication probability for severe dysgeusia at 3 months showed mean oral cavity D50 doses 53 Gy and 57 Gy in the HNQOL and WUQOL questionnaires, respectively, with curve slope (m) of 0.41. Measured salivary output was not statistically significantly correlated with severe taste dysfunction, whereas patient-reported XQ summary scores and xerostomia while eating scores were correlated with severe dysgeusia in the UWQOL tool (P=.04). CONCLUSIONS Taste impairment is significantly correlated with mean radiation dose to the oral cavity. Patient-reported xerostomia, but not salivary output, was correlated with severe dysgeusia in 1 of the 2 QOL questionnaires. Reduction in oral cavity doses is likely to improve dysgeusia.
Collapse
Affiliation(s)
- Eli Sapir
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yebin Tao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Felix Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Stuart Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Mary Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
43
|
Park IJ, Yu CS, Lim SB, Lee JL, Kim CW, Yoon YS, Park SH, Kim JC. Is Preoperative Chemoradiotherapy Beneficial for Sphincter Preservation in Low-Lying Rectal Cancer Patients? Medicine (Baltimore) 2016; 95:e3463. [PMID: 27149445 PMCID: PMC4863762 DOI: 10.1097/md.0000000000003463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study explored the benefit of preoperative chemoradiotherapy (PCRT) for sphincter preservation in locally advanced low-lying rectal cancer patients who underwent stapled anastomosis, especially in those with deep and narrow pelvises determined by magnetic resonance imaging.Patients with locally advanced low-lying rectal cancer (≤5 cm from the anal verge) who underwent stapled anastomosis were included. Patients were categorized into two groups (PCRT+ vs. PCRT-) according to PCRT application. Patients in the PCRT+ group were matched to those in the PCRT- group according to potential confounding factors (age, gender, clinical stage, and body mass index) for sphincter preservation. Sphincter preservation, permanent stoma, and anastomosis-related complications were compared between the groups. Pelvic magnetic resonance imaging was used to measure 12 dimensions representing pelvic cavity depth and width with which deep and narrow pelvis was defined. The impact of PCRT on sphincter preservation and permanent stoma in pelvic dimensions defined as deep and narrow pelvis was evaluated, and factors associated with sphincter preservation and permanent stoma were analyzed.One hundred sixty-six patients were one-to-one matched between the PCRT+ and PCRT- groups. Overall, sphincter-saving surgery was performed in 66.3% and the rates were not different between the 2 groups. Anastomotic complications and permanent stoma occurred nonsignificantly more frequently in the PCRT+ group. PCRT was not associated with higher rate of sphincter preservation in all pelvic dimensions defined as deep and narrow pelvis, while PCRT was related to higher rate of permanent stoma in shorter transverse diameter and interspinous distance. On logistic regression analysis, PCRT was not shown to influence both sphincter preservation and permanent stoma, while longer transverse diameter and interspinous distance were associated with lower rate of permanent stoma.PCRT had no beneficial effect on sphincter preservation in patients with locally advanced low-lying rectal cancer who had undergone stapled anastomosis. In patients with deep and narrow pelvis, PCRT had no impact on sphincter preservation but was associated with higher rate of permanent stoma.
Collapse
Affiliation(s)
- In Ja Park
- From the Department of Colon and Rectal Surgery (IJP, CSY, S-BL, JLL, CWK, YSY, JCK); and Department of Radiology (SHP), University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Cheville AL, Alberts SR, Rummans TA, Basford JR, Lapid MI, Sloan JA, Satele DV, Clark MM. Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers. J Pain Symptom Manage 2015; 50:321-7. [PMID: 25975643 PMCID: PMC5557268 DOI: 10.1016/j.jpainsymman.2015.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/02/2015] [Accepted: 03/12/2015] [Indexed: 01/14/2023]
Abstract
CONTEXT Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions. OBJECTIVES This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients' adherence to planned chemoradiation (CR) regimens. METHODS The results of two randomized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer. Of these 61 subjects, 29 participated in six to eight bi- to triweekly sessions that included exercise, education, and relaxation, and 32 received usual medical care. The primary endpoint was completion of their prescribed CR regimens. Secondary outcomes included hospitalization during CR, rates of adverse postoperative events, and complete pathological response in those undergoing neoadjuvant therapy. RESULTS Significantly, more members of the intervention than the control group completed their planned CR regimens (77.8 vs. 38.2%, P = 0.003). More participants in the control (n = 14) than the intervention (n = 5) group (P = 0.063) required hospitalization. Among those undergoing neoadjuvant CR, those in the intervention group were significantly more likely to complete CR as planned (81.0% vs. 37.5%, P = 0.005) and less likely to be hospitalized (14.3% vs. 50.0%, P = 0.011). CONCLUSION A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials.
Collapse
Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
| | - Steven R Alberts
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff A Sloan
- Department of Health Service Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel V Satele
- Department of Health Service Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
45
|
Haefner MF, Lang K, Krug D, Koerber SA, Uhlmann L, Kieser M, Debus J, Sterzing F. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. J Radiat Res 2015; 56:742-749. [PMID: 25907360 PMCID: PMC4497395 DOI: 10.1093/jrr/rrv022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome.
Collapse
Affiliation(s)
- Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Lorenz Uhlmann
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Meinhard Kieser
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg 69120, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Florian Sterzing
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, Heidelberg 69120, Germany German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| |
Collapse
|
46
|
Faienza MF, Delvecchio M, Giordano P, Cavallo L, Grano M, Brunetti G, Ventura A. Metabolic syndrome in childhood leukemia survivors: a meta-analysis. Endocrine 2015; 49:353-60. [PMID: 25154516 DOI: 10.1007/s12020-014-0395-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/12/2014] [Indexed: 01/05/2023]
Abstract
A significant number of long-term complications have been described in childhood leukemia survivors. In particular, these patients may present features of metabolic syndrome (MetS), and therefore increased risk for cardiovascular diseases. The aim of this meta-analysis is to evaluate the prevalence and the risk of MetS in survivors of childhood leukemia. Two authors independently performed a systematic literature search in PubMed and EMBASE to March 2014, reviewed and selected articles, based on pre-determined selection criteria. Twelve articles, comprising 2,337 participants (1,462 cases and 875 controls), were included in the meta-analysis. Only three of them were case-control studies eligible for the meta-analysis. The childhood leukemia survivors showed an increased risk of MetS as compared to healthy controls (OR = 4.36; 95 % CI 1.19-16.22). The risk was significantly increased only in patients treated with chemotherapy and radiotherapy (OR = 7.79; 95 % CI 1.27-47.77), and not in patients treated with only chemotherapy (OR = 2.35; 95 % CI 0.40-13.78). Childhood leukemia survivors, in particular if treated also with radiotherapy, are prone to develop MetS more than healthy controls. Monitoring of MetS components in these patients is necessary to avoid cardiovascular consequences later in life.
Collapse
Affiliation(s)
- Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatrics Unit, University of Bari 'A. Moro', Piazza G. Cesare, 11, 70124, Bari, Italy,
| | | | | | | | | | | | | |
Collapse
|
47
|
Holliday EB, Ahmed AA, Yoo SK, Jagsi R, Hoffman KE. Does Cancer Literature Reflect Multidisciplinary Practice? A Systematic Review of Oncology Studies in the Medical Literature Over a 20-Year Period. Int J Radiat Oncol Biol Phys 2015; 92:721-31. [PMID: 26104927 DOI: 10.1016/j.ijrobp.2015.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 03/06/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Quality cancer care is best delivered through a multidisciplinary approach requiring awareness of current evidence for all oncologic specialties. The highest impact journals often disseminate such information, so the distribution and characteristics of oncology studies by primary intervention (local therapies, systemic therapies, and targeted agents) were evaluated in 10 high-impact journals over a 20-year period. METHODS AND MATERIALS Articles published in 1994, 2004, and 2014 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology, Biology, Physics, Annals of Surgical Oncology, and European Journal of Surgical Oncology were identified. Included studies were prospectively conducted and evaluated a therapeutic intervention. RESULTS A total of 960 studies were included: 240 (25%) investigated local therapies, 551 (57.4%) investigated systemic therapies, and 169 (17.6%) investigated targeted therapies. More local therapy trials (n=185 [77.1%]) evaluated definitive, primary treatment than systemic (n=178 [32.3%]) or targeted therapy trials (n=38 [22.5%]; P<.001). Local therapy trials (n=16 [6.7%]) also had significantly lower rates of industry funding than systemic (n=207 [37.6%]) and targeted therapy trials (n=129 [76.3%]; P<.001). Targeted therapy trials represented 5 (2%), 38 (10.2%), and 126 (38%) of those published in 1994, 2004, and 2014, respectively (P<.001), and industry-funded 48 (18.9%), 122 (32.6%), and 182 (54.8%) trials, respectively (P<.001). Compared to publication of systemic therapy trial articles, articles investigating local therapy (odds ratio: 0.025 [95% confidence interval: 0.012-0.048]; P<.001) were less likely to be found in high-impact general medical journals. CONCLUSIONS Fewer studies evaluating local therapies, such as surgery and radiation, are published in high-impact oncology and medicine literature. Further research and attention are necessary to guide efforts promoting appropriate representation of all oncology studies in high-impact, broad-readership journals.
Collapse
Affiliation(s)
- Emma B Holliday
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Awad A Ahmed
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Karen E Hoffman
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
48
|
Kwon J, Chie EK, Kim K, Kim HJ, Wu HG, Kim IH, Oh DY, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Ha SW. Impact of multimodality approach for patients with leptomeningeal metastases from solid tumors. J Korean Med Sci 2014; 29:1094-101. [PMID: 25120319 PMCID: PMC4129201 DOI: 10.3346/jkms.2014.29.8.1094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to evaluate treatment patterns, outcome and prognosticators for patients with leptomeningeal metastases from solid tumor. Medical records of 80 patients from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was the lung (59%) followed by the breast (25%). Most patients were treated with intrathecal chemotherapy (90%) and/or whole brain radiotherapy (67.5%). Systemic therapy was offered to 27 patients (33.8%). Percentage of patients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%, respectively. Median survival was 2.7 months and 1 yr survival rate was 11.3%. Multivariate analysis showed that negative cerebrospinal fluid cytology, fewer chemotherapy regimen prior to leptomeningeal metastases, whole brain radiotherapy, systemic therapy, and combined modality treatment (median survival; single 1.4 vs. dual 2.8 vs. triple 8.3 months, P<0.001) had statistical significance on survival. Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008). Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary. Furthermore, combined modality treatment for all patients and additionally targeted therapy for NSCLC patients should be considered in the treatment of leptomeningeal metastases from solid tumor.
Collapse
Affiliation(s)
- Jeanny Kwon
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung W. Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| |
Collapse
|
49
|
Glimelius B, Påhlman L, Holm T, Blomqvist L. [Will radiotherapy be used on more or fewer patients with rectal cancer?]. Lakartidningen 2014; 111:1180-1182. [PMID: 25162107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
50
|
Cha H, Yoon HI, Lee IJ, Koom WS, Han KH, Seong J. Clinical factors related to recurrence after hepatic arterial concurrent chemoradiotherapy for advanced but liver-confined hepatocellular carcinoma. J Radiat Res 2013; 54:1069-1077. [PMID: 23633620 PMCID: PMC3823771 DOI: 10.1093/jrr/rrt034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 03/14/2013] [Accepted: 03/22/2013] [Indexed: 06/02/2023]
Abstract
Before the sorafenib era, advanced but liver-confined hepatocellular carcinoma (HCC) was treated by liver-directed therapy. Hepatic arterial concurrent chemoradiotherapy (CCRT) has been performed in our group, giving substantial local control but frequent failure. The aim of this study was to analyze patterns of failure and find out predictive clinical factors in HCC treated with a liver-directed therapy, CCRT. A retrospective analysis was done for 138 HCC patients treated with CCRT between May 2001 and November 2009. Protocol-based CCRT was performed with local radiotherapy (RT) and concurrent 5-fluorouracil (5-FU) hepatic arterial infusion chemotherapy (HAIC), followed by monthly HAIC (5-FU and cisplatin). Patterns of failure were categorized into three groups: infield, intrahepatic-outfield and extrahepatic failure. Treatment failure occurred in 34.0% of patients at 3 months after RT. Infield, intrahepatic-outfield and extrahepatic failure were observed in 12 (8.6%), 26 (18.7%) and 27 (19.6%) patients, respectively. Median progression-free survival for infield, outfield and extrahepatic failure was 22.4, 18 and 21.5 months, respectively. For infield failure, a history of pre-CCRT treatment was a significant factor (P = 0.020). Pre-CCRT levels of alpha-fetoprotein and prothrombin induced by vitamin K absence or antagonist-II were significant factors for extrahepatic failure (P = 0.029). Treatment failures after CCRT were frequent in HCC patients, and were more commonly intrahepatic-outfield and extrahepatic failures than infield failure. A history of pre-CCRT treatment and levels of pre-CCRT tumor markers were identified as risk factors that could predict treatment failure. More intensified treatment is required for patients presenting risk factors.
Collapse
Affiliation(s)
- Hyejung Cha
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Kwang-Hyub Han
- Yonsei Liver Cancer Special Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
- Yonsei Liver Cancer Special Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|