Carboplatin is effective therapy for young children with progressive optic pathway tumors: a Pediatric Oncology Group phase II study

The Pediatric Oncology Group conducted a phase II study to evaluate the activity of carboplatin in children 5 years or younger with progressive optic pathway tumors (OPTs). Of the 51 patients accrued to this study, 1 was not eligible because the child was older than 6 years. Fifty patients were eligible and had either neuro-imaging or symptomatic evidence of progressive OPTs. Twenty-one of 50 had evidence of neurofibromatosis type I (NF-1). Therapy consisted of carboplatin 560 mg/m2 at 4-week intervals. Patients with stable disease or better after two courses were continued on therapy for 18 months or until progressive disease. Of the 50 eligible children, 39 had stable disease or better, and 34 completed the 18-month therapy. Our data are sufficient to conclude that the proportion of objective responses (complete, partial, or minor response or stable disease) exceeded 30% (P < 0.00001), and the approximate 95% confidence interval estimate of the objective response rate was 0.665 to 0.895. Twenty-one patients went off protocol because of progressive disease. Fifteen patients progressed during the 18-month therapy, and 6 patients progressed after completing therapy. Six children died with progressive disease. Major toxicities were neutropenia and thrombocytopenia, and 3 children experienced allergic reactions. Carboplatin is active and safe for the treatment of young children with progressive OPTs. The addition of other potentially active drugs may further increase the event-free survival for these children.

Breast conservation therapy for breast cancer treatment in Brown County

The Northeast Wisconsin Cancer Registry and a patient survey was utilized to examine the use of breast conservation surgery in Brown County between 1991 and 1997 and the factors influencing patients' treatment decisions. In all patients, the rate of breast conservation rose from approximately 30% to 44% during that time period. The percent of all patients with stage 0, I or II breast cancer who were potential candidates for breast conservation based on their stage rose from 89% in 1991 to 96% in 1997. The percent of Stage I and Stage II patients who underwent breast conserving surgery rose from 29% in 1991 to 38% in 1997. There was a higher use of breast conserving surgery in younger women (approximately 50% in age 35 to 49 years old in 1997) compared to women older than 62 (33% in 1997). Breast conservation surgery was used in 47% of patients with AJCC T1 (primary tumors less than 2 cm) and in 25% of patients with T2 lesions (primary tumors 2 to 5 cm); and more often in node negative than in node positive patients (51% vs. 20%). A patient survey revealed that a majority of patients felt that their surgeon's recommendation was the most important influence in making their surgical decision and that their fear of cancer recurrence most strongly influenced their decision on a personal level. Fewer than half of the women were referred to a medical oncologist, radiation oncologist, plastic surgeon or second opinion surgeon prior to surgery. Breast conservative treatment is increasingly utilized in Northeastern Wisconsin and women depend on their surgeon to give them clear, complete, non-biased information balanced with emotional support during the time when they are asked to make the complex decision of the type of breast cancer surgery they desire.

Testicular neoplasms: seminoma

From 1969 to 1984, 58 patients with a diagnosis of testicular seminoma were seen and treated at the University of Kansas Medical Center. The median age was 34 years (range of 20 to 62 years). The American Joint Committee on Cancer Staging System was followed: stage I (34 patients); stage II (6); stage III (8); and stage IV (10). Forty-two patients had typical seminoma, and 16 had anaplastic histology. Nine patients had elevated B subunit of human chorionic gonadotropin, and nine had a history of cryptorchidism. Fifty-six patients received radiation treatment, and seven received chemotherapy with or without radiation. The median follow-up was 7 years (range 3 to 16 years). The overall disease-free (absolute) survival according to stage was: stage I, 91% (100%); stage II, 66% (80%); stage III, 75% (85%); and stage IV, 50% (50%). There were no late complications. The survival for patients with anaplastic histology or with elevated B subunit of human chorionic gonadotropin was not significantly different from that of typical seminoma.