Prognostic neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in locally advanced oropharyngeal cancer: a retrospective experience of two institutions.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17548-e17548
Author(s):  
Vittoria G. Espeli ◽  
Francesco Martucci ◽  
Antonella Richetti ◽  
Alessia Pastore
Keyword(s):  
Oropharyngeal Cancer ◽  
Inflammatory Markers ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Case Series ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
University Hospital ◽  
Hpv Status ◽  
Pre Treatment

e17548 Background: the Neutrophil-to-Lymphocytes ratio (NLR) and the Platelet-to-Lymphocytes ratio (PLR) represent potential prognostic markers in different tumor types. The purpose of our study was to investigate the prognostic role of the pretreatment inflammatory markers NLR and PLR in patients with locally advanced squamous cell oropharyngeal cancer (OPSCC) treated with curative concomitant chemoradiotherapy (CRT). Methods: between 2004 and 2016, all patients with OPSCC diagnosed at the University Hospital of Varese and the Oncology Institute of Southern Switzerland were reviewed retrospectively. CRT consisted of Intensity-Modulated Radiation Therapy (IMRT) to a dose of 66-70 Gy concomitant to 3 doses of 3-weekly cisplatin. Pre-treatment NLR and PLR were registered from blood samples obtained within 14 days before treatment. 3-year disease free survival (DFS) was analyzed. Results: ninety-two patients were identified. Median follow-up was 39 months. Median NLR was 3 and median PLR was 153. The 3 year DFS was 82.9%. Univariate analysis showed that HPV status and PLR were statistically significant factors in determining 3-year DFS (p 0.01 and 0.04 respectively). Multivariate analysis showed that only HPV status was a statistically significant factor for 3-year DFS (p 0.009). High NLR and high PLR were correlated with lower DFS: patients with NLR > 4 had a 3-years DFS of 50% versus 75%in the group with NLR ≤ 4(p = 0.04) and patients with PLR > 150 had a 3-years DFS of 65% versus 82% in the group with PLR ≤ 150 (p = 0.04). Conclusions: in our case series, NLR and PLR were significantly associated with clinical outcome. Additional data are necessary to investigate the prognostic value of inflammatory markers and to identify the ideal cut-off of both markers.

Prognostic markers for oropharyngeal cancer after docetaxel, 5-FU, and cisplatin induction chemotherapy followed by concurrent chemoradiotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17005-e17005
Author(s):  
Sang-Hee Cho ◽  
Woo Kyun Bae ◽  
Hyun-Jeong Shim ◽  
Won-young Choi ◽  
Jun-Eul Hwang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Induction Chemotherapy ◽  
Oropharyngeal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Surrogate Marker ◽  
Hpv Infection ◽  
Response Analysis ◽  
P16 Protein ◽  
Hpv Status

e17005 Background: HPV is associated with prognosis of oropharyngeal cancer, and the incidence has been increased in not only western countries, but also Asian. This study aims to assess the prognostic role of HPV expression and clinical factors after induction chemotherapy followed by chemoradiotherapy for locally advanced oropharyngeal cancer in Korean patients. Methods: A retrospective review of 74 patients with known HPV status and treated with the induction chemotherapy of docetaxel, cisplatin and 5-FU followed by chemoradiotherapy was performed. HPV infection was evaluated with in situ hybridization (ISH) for HPV and p16 protein expression. Results: The median age is 65 (range 43-80) years with male 69, female 5. Among them, 36 patients (49%) are current smokers and 17 patients (23%) are heavy drinkers. Nine patients (12%) show HPV positive in ISH and 35 patients (47%) expressed p16 protein. In response analysis, there is an increasing trend of complete response (CR) in p16 positive patients (34.3%) compared with p16 negative patients (17.9%; P=0.055). HPV expression had no significance with CR. Tumor recurrence showed significantly higher in HPV-negative patients (P=0.044) and p16 (P=0.015) than HPV and p16 positive patients, respectively. In survival analysis, even though the median value was not reached until this time, it showed better trend of PFS in p16 positive patients than p16 negative patients (P=0.072). In univariate analysis of HPV status and clinical parameters, the expression of p16 or HPV had no significant association with survival. However, performance status (PS), T staging, tumor response are significant factors associated with PFS. And PS (0 vs. 1-2) showed a strong relation with PFS in multivariate analysis (HR: 0.24, P=0.001) Conclusions: p16 is a prognostic marker for oropharyngeal cancer patients treated with triple induction chemotherapy followed by CRT and it would be a better surrogate marker for HPV infection than HPV ISH. In addition to biomarker, clinical parameter such as PS has been still important factor of treatment outcome in oropharyngeal cancer patients.

scholarly journals Comparison of Selected Immune and Hematological Parameters and Their Impact on Survival in Patients with HPV-Related and HPV-Unrelated Oropharyngeal Cancer

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3256
Author(s):  
Adam Brewczyński ◽  
Beata Jabłońska ◽  
Agnieszka Maria Mazurek ◽  
Jolanta Mrochem-Kwarciak ◽  
Sławomir Mrowiec ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Oropharyngeal Cancer ◽  
Hematological Parameters ◽  
White Blood Cells ◽  
Post Treatment ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Hpv Status ◽  
Pre Treatment ◽  
The Impact

Several immune and hematological parameters are associated with survival in patients with oropharyngeal cancer (OPC). The aim of the study was to analyze selected immune and hematological parameters of patients with HPV-related (HPV+) and HPV-unrelated (HPV-) OPC, before and after radiotherapy/chemoradiotherapy (RT/CRT) and to assess the impact of these parameters on survival. One hundred twenty seven patients with HPV+ and HPV− OPC, treated with RT alone or concurrent chemoradiotherapy (CRT), were included. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (Formalin-Fixed, Paraffin-Embedded) tissue samples and/or extracellular circulating HPV DNA was determined. The pre-treatment and post-treatment laboratory blood parameters were compared in both groups. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation (SII) index were calculated. The impact of these parameters on overall (OS) and disease-free (DFS) survival was analyzed. In HPV+ patients, a high pre-treatment white blood cells (WBC) count (>8.33 /mm3), NLR (>2.13), SII (>448.60) significantly correlated with reduced OS, whereas high NLR (>2.29), SII (>462.58) significantly correlated with reduced DFS. A higher pre-treatment NLR and SII were significant poor prognostic factors for both OS and DFS in the HPV+ group. These associations were not apparent in HPV− patients. There are different pre-treatment and post-treatment immune and hematological prognostic factors for OS and DFS in HPV+ and HPV− patients. The immune ratios could be considered valuable biomarkers for risk stratification and differentiation for HPV− and HPV+ OPC patients.

scholarly journals Prognostic Value of Systemic Inflammatory Markers and the Nutrition Status in Thymic Epithelial Tumors with Complete Resection

2021 ◽  
Author(s):  
Tadashi Sakane ◽  
Katsuhiro Okuda ◽  
Takuya Matsui ◽  
Risa Oda ◽  
Tsutomu Tatematsu ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Prognostic Value ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Complete Resection ◽  
Nutrition Status ◽  
Thymic Epithelial Tumors ◽  
Lymphocyte Ratio ◽  
Masaoka Stage

Abstract BackgroundRecent studies have shown that several systemic inflammatory markers and the nutrition status, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are useful prognostic factors in several malignant tumors. The present study explored the prognostic value of the NLR, MLR, PLR, and PNI in thymic epithelial tumor (TET) patients who underwent complete resection.MethodsA total of 158 TET patients who underwent complete resection were involved in the analysis. Their NLR, MLR, PLR, and PNI values were obtained from a blood examination within one month before the initiation of treatment. A receiver operating characteristic curve analysis was conducted to determine the optimal cut-off values. ResultsThe enrolled patients were stratified by cut-offs of 4.35 for the NLR, 0.22 for the MLR, 130.18 for the PLR, and 44.02 for the PNI. A univariate analysis revealed that high-grade malignant TET, including type B2 and B3 thymoma, thymic carcinoma, and thymic neuroendocrine tumor; an advanced Masaoka stage; a high NLR; a high MLR; and a low PNI were significant predictors of a poor disease-free survival (DFS). A multivariate analysis confirmed that an advanced Masaoka stage (HR = 5.5557, P = 0.0007) and a high MLR (HR = 3.3371, P = 0.0264) were independent predictors of a poor DFS.ConclusionsOur study demonstrated that the pretreatment MLR was an independent predictor of the DFS in patients with TETs who underwent complete resection.

scholarly journals The Elevated Pre-Treatment C-Reactive Protein Predicts Poor Prognosis in Patients with Locally Advanced Rectal Cancer Treated with Neo-Adjuvant Radiochemotherapy

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 780
Author(s):  
Richard Partl ◽  
Katarzyna Lukasiak ◽  
Eva-Maria Thurner ◽  
Wilfried Renner ◽  
Heidi Stranzl-Lawatsch ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
C Reactive Protein ◽  
Adjuvant Radiochemotherapy ◽  
Free Survival ◽  
Reactive Protein ◽  
Pre Treatment

The aim of the present study was to investigate the association of the pre-treatment C-reactive protein (CRP) plasma level with survival outcomes in a cohort of 423 consecutive patients with locally advanced rectal cancer treated with neo-adjuvant radiochemotherapy followed by surgical resection. To evaluate the prognostic value of the CRP level for clinical endpoints recurrence-free survival (RFS), local-regional control (LC), metastases-free survival (MFS), and overall survival (OS), uni- and multivariate Cox regression analyses were applied, and survival rates were calculated using Kaplan–Meier analysis. The median follow-up time was 73 months. In univariate analyses, the pre-treatment CRP level was a significant predictor of RFS (hazard ratio (HR) 1.015, 95% CI 1.006–1.023; p < 0.001), LC (HR 1.015, 95% CI 1.004–1.027; p = 0.009), MFS (HR 1.014, 95% CI 1.004–1.023; p = 0.004), and OS (HR 1.016, 95% CI 1.007–1.024; p < 0.001). Additionally, univariate analysis identified the MRI circumferential resection margin (mrCRM) and pre-treatment carcinoembryonic antigen (CEA) as significant predictor of RFS (HR 2.082, 95% CI 1.106–3.919; p = 0.023 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). Univariate analysis also revealed a significant association of the mrCRM (HR 2.089, 95% CI 1.052–4.147; p = 0.035) and CEA (HR 1.006, 95% CI 1.003–1.008; p < 0.001) with MFS. Age and CEA were prognostic factors for OS (HR 1.039, 95% CI 1.013–1.066; p = 0.003 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). In multivariate analysis that included parameters with a p-level < 0.20 in univariate analysis, the pre-treatment CRP remained a significant prognostic factor for RFS (HR 1.013, 95%CI 1.001–1.025; p = 0.036), LC (HR 1.014, 95% CI 1.001–1.027; p = 0.031), and MFS (HR 1.013, 95% CI 1.000–1.027; p = 0.046). The results support the hypothesis that an elevated pre-treatment CRP level is a predictor of poor outcome. If confirmed by additional studies, this easily measurable biomarker could contribute to the identification of patients who might be candidates for more aggressive local or systemic treatment approaches or the administration of anti-inflammatory drugs.

Application of a time-varying covariate model to the analysis of CA 19–9 as a biomarker for time-to-progression (TTP) and overall survival (OS) in patients with advanced pancreatic cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15545-e15545
Author(s):  
S. Boeck ◽  
R. P. Laubender ◽  
M. Haas ◽  
C. Klose ◽  
F. Kullmann ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Predictive Biomarker ◽  
Cox Proportional Hazards ◽  
Time Varying ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Pre Treatment

e15545 Background: It remains unclear whether baseline CA 19–9 or CA 19–9 kinetics during chemotherapy may serve as predictive biomarker in patients (pts) with pancreatic cancer (PC). Methods: Main inclusion criteria for this retrospective multicenter analysis: histologically confirmed diagnosis of PC, treatment with first-line therapy, pre-treatment CA 19–9 level of > 5.2 U/ml. Analysis of CA 19–9 was exclusively performed using the Elecsys® assay (Roche Diagnostics). The effect of the pre- treatment CA 19–9 level on TTP and OS was modelled by Cox proportional hazards regression. The effect of CA 19–9 kinetics was also modelled by Cox proportional hazards regression where CA 19–9 was treated as time-varying covariate. When modelling CA 19–9 we developed univariate and multivariate Cox models where we selected additional predictors (e.g. performance status) using backward elimination performing likelihood ratio tests on a significance level of 0.05. Results: One-hundred and fifteen pts from 5 German centers were included. Median age was 63 years, 12% had locally advanced and 88% metastatic disease; 73 % of the pts were treated within prospective clinical trials. Median baseline CA 19–9 was 1059 U/ml (range 9.5–100000), median pre- treatment bilirubin 0.6 mg/dl. The median TTP in the study population was 4.4 months, median OS 9.4 months. Univariate analysis showed that the pre-treatment CA 19–9 level (as continuous variable, log [CA 19–9]) was significantly associated with TTP (HR 1.24, 95% CI 1.12–1.37, p<0.001) and OS (HR 1.16, 95% CI 1.06–1.28, p=0.002). These associations remained significant also within a multivariate analysis. For CA 19–9 kinetics during chemotherapy, data from 69 pts (TTP) and 84 pts (OS) were available, respectively; log [CA 19–9] kinetics were found to be a significant predictor for TTP in univariate (HR 1.44, 95% CI 1.25–1.67, p<0.001) and multivariate (HR 1.39, 95% CI 1.19–1.62, p<0.001) analyses, and also for OS (univariate: HR 1.34, 95% CI 1.20–1.49, p<0.001; multivariate: HR 1.39, 95% CI 1.23–1.57, p<0.001). Conclusions: According to this new statistical model, CA 19–9 may serve as a useful predictive biomarker in advanced PC. [Table: see text]

Phase I study of durvalumab and tremelimumab together with radiotherapy for the adjuvant treatment of intermediate-risk head and neck squamous cell carcinoma.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. TPS73-TPS73 ◽  
Author(s):  
Siddharth Sheth ◽  
Bhishamjit S. Chera ◽  
Benjamin Garrett Vincent ◽  
Colette J. Shen ◽  
Mark Christian Weissler ◽  
...  
Keyword(s):  
T Cell ◽  
Phase I ◽  
Phase I Study ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Therapeutic Modality ◽  
Clinical Activity ◽  
Synergistic Activity ◽  
Intermediate Risk ◽  
Pre Treatment

TPS73 Background: When surgery is used as the primary therapeutic modality for locally-advanced HNSCC, radiation therapy (XRT) is frequently recommended post-operatively due to high rates of recurrence. In high-risk patients; i.e., those with positive surgical margins or extra-nodal extension (ENE) on surgical pathology, the addition of chemotherapy to post-operative XRT (cCRT) provides a survival benefit. In contrast, there is no standard indication for adjuvant systemic therapy in intermediate risk HNSCC—defined in this study as having a T3/T4 primary tumor, perineural or lymphovascular space invasion, and/or lymph node metastasis without ENE. The anti-programmed cell death-ligand 1 (PD-L1) antibody durvalumab (D) has a manageable safety profile and encouraging clinical activity studies across multiple tumor types. Combining D with the anti-cytotoxic T-lymphocyte-associated antigen-4 (anti-CTLA-4) antibody tremelimumab (T) may amplify antitumor T-cell responses and provide synergistic activity. D+T showed antitumor activity and manageable tolerability in advanced NSCLC. Furthermore in preclinical studies, D+T combined with XRT decreased regulatory T-cells and myeloid derived suppressor cells and increased CD8 T-cell recruitment to the tumor microenvironment. Methods: This two-part phase I study will include a safety run-in period using a 3+3 dose de-escalation design based on dose limiting toxicities (DLT). In Cohort 1, D (q3 weeks) +T (q3 weeks) will be given on cycle 1 followed by concurrent XRT for Cycles 2-4. Cycle 5 and 6 will include D only. If DLT’s are met, Cohort -1 will include D (q3 weeks) and T (q6 weeks). If DLT's are found in Cohort -1, Cohort -2 would include only D. A dose expansion cohort (N=24) will follow based on the safest combination in the safety run-in. Translational studies include correlation of pre-treatment immune characteristics including PD-L1 score, TMB, and IFN-gamma signature with disease free survival. DNA and RNA sequencing of pre-treatment tissue and at treatment failure/recurrence will attempt to identify genetic and molecular determinants of IO treatment resistance. (NCT02000947). Clinical trial information: NCT03529422.

scholarly journals Gastric Cancer Surgical Experience from a single expert Western center: case series results

2020 ◽  
Author(s):  
Luigina Graziosi ◽  
Elisabetta Marino ◽  
Stefano Avenia ◽  
Maria Cristina Vannoni ◽  
Annibale Donini
Keyword(s):  
Gastric Cancer ◽  
Locally Advanced ◽  
Case Series ◽  
Disease Free Survival ◽  
Gastric Surgery ◽  
Curative Surgery ◽  
Free Survival ◽  
Entire Cohort ◽  
Time Period ◽  
Disease Free

Abstract Background Surgical treatment plays a key role in the cure of gastric cancer. Our aim was to analyzed changes both in outcomes and in the epidemiology, over a time period of 15 years.Methods410 patients operated between January 2004 and December 2018 were enrolled. Patients were subdivided into 3 groups. The entire cohort was evaluated, and a more detailed analysys was made in patients that underwent a curative surgery. Survival outcomes and oncological surgical outcomes have been described and correlated with Overall Survival. Results Results showed an increase trend in gastric cancer operation over the time period analyzed ( p< 0.05).Overall and disease free survival did not vary in the different time periods. In patients treated with the intent to cure: 5- and 10-Year survivals were respectively: 44% and 34.7%; 5- and 10 years disease free survival were 50.7 and 49.4%. Type of lymphadenectomy and number of lymphondal harvested changed significantly over the time (p < 0.05). Conclusions Gastric surgery must be done in an experienced center to obtain oncological outcomes; in selected cases an extended lymphadenectomy could give survival benefit to patients with locally advanced gastric cancer.

scholarly journals Treatment times in locally advanced oropharyngeal cancer: evolution from 2011 to 2016 in a Portuguese Head and Neck Oncology Centre

2019 ◽  
Vol 5 (5) ◽  
pp. 1131
Author(s):  
Patrícia S. Gomes ◽  
Eduardo Breda ◽  
Eurico Monteiro
Keyword(s):  
Oropharyngeal Cancer ◽  
Tumour Progression ◽  
Postoperative Radiotherapy ◽  
Waiting Times ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Cancer Evolution ◽  
Patient Anxiety ◽  
Female Ratio

<p class="abstract"><strong>Background:</strong> Delays in cancer diagnosis and treatment are usually associated with patient anxiety, tumour progression and lower survival. This study aims to analyse the potential impact of rescheduling adjuvant treatments on survival outcome of patients with locally advanced oropharyngeal squamous cell cancer (OPSCC).</p><p class="abstract"><strong>Methods:</strong> A retrospective review of medical records comprising all patients with advanced oropharyngeal cancer who underwent primary surgery and postoperative radiotherapy (PORT) in a Tertiary Oncologic Centre from 2011 to 2016 was performed.</p><p class="abstract"><strong>Results:</strong> 63 patients with a male/female ratio of 8:1 and mean age of 57.5±9.6 years were enrolled. Patients waited a mean of 47.2±18.2 days from diagnosis to surgery and a median of 61 days from surgery to radiotherapy. Median radiotherapy duration was 43 days and the mean package time was 104.5±21.0 days. Analysis of these parameters has shown decreasing intervals from 2011 to 2016, although this was only significant for duration of PORT (p=0.022). Longer time span from surgery to PORT and PORT duration were predictive of superior package times (p&lt;0.001). Five-year overall survival and disease-free survival was 63.8% and 64.8% respectively with no statistically significant impact of waiting times on clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Despite presenting favourable long-term outcomes, patients with locally advanced OPSCC have experienced longer waiting times than recommended. Waiting times were not prognostic factors in this condition, although efforts to reduce it might provide superior quality of care. Future studies assessing the factors involved in treatment delays might provide means to offer timely treatments.  </p><p class="abstract"> </p><p> </p>

Local and Systemic Inflammatory Markers as Prognostic and Predictive Markers In Locally Advanced Triple Negative Breast Cancer

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 30-30
Author(s):  
Lamiss Mohamed ◽  
Aymn Elsaka ◽  
Yomna Zamzam
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Inflammatory Markers ◽  
Triple Negative ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Complete Response ◽  
P Value ◽  
Neutrophil Lymphocyte Ratio

Local inflammatory markers have been defined as prognostic and predictive markers in triple negative markers as proved by many studies. The prognostic and predictive value of systemic inflammatory markers such as neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) remain to be elucidated. Aim of study: To evaluate pathological complete response (PCR) to neoadjuvant chemotherapy in locally advanced cancer breast in relation to tumor infiltrating lymphocytes(TILs), neutrophil lymphocyte ratio and lymphocyte monocyte ratio as well as overall survival and disease free survival. Patients and methods: In Tanta university Hospital, oncology department form January 2012 to December 2013, 67 patients with locally advanced TNBC stage IIB, IIIB 0r IIIC using TNM 8t h edition . All patients received neoadjuvant chemotherapy in the form of dose dense AC followed by paclitaxel (adriamycin & cyclophosphamide 60 mgm/m2 & 600 mgm/m2 respectively the cycle is repeated every 2 weeks for 4 cycles followed by paclitaxel 175mgm/m2 every 2 weeks for 4 cycles). All cycles with G-CSF support. Pre treatment TILs, NLR and LMR were evaluated with PCR and as prognostic factor of survival. Results: Low NLR has been detected in 74.6% of cases and has been associated with high TILs and this was statistically significant (p value=0.03). High LMR was observed in 80.6% of cases and correlated significantly with TILs (p value =0.003). Pathological CR was found to be associated with high TILs, low NLR and high LMR. In our study we evaluated the pre neoadjuvant systemic and local inflammatory markers as prognostic marker we found that in multivariate analysis, the lymphocyte monocyte ratio maintained their statistical significance with overall survival. While tumor infiltrating lymphocyte maintained their statistical significance as prognostic factors with overall survival and disease free survival. Conclusion: Systemic inflammatory markers can be used as marker of pathological complete response in locally advanced triple negative breast6 cancer with neoadjuvant chemotherapy.

Higher dose per fraction and shorter overall treatment time using intensity-modulated radiation therapy versus conventional radiation therapy with concurrent carboplatin and 5-fluorouracil for locally advanced oropharyngeal carcinoma: A comparison of toxicity and efficacy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6038-6038 ◽  
Author(s):  
S. Clavel ◽  
D. Nguyen ◽  
P. Després ◽  
B. Fortin ◽  
G. Coulombe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Treatment Time ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Oropharyngeal Carcinoma ◽  
Overall Treatment Time ◽  
Intensity Modulated ◽  
Dose Per Fraction

6038 Background: The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concomitant chemotherapy for locally advanced oropharyngeal cancer. Methods: Between January 2000 and December 2007, 249 patients with stage III-IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for four days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered five times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: Median follow-up was 33 months. Three year actuarial rates for OS, DFS, and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization and death during treatment. There was significantly less xerostomia at 24 and 36 months (p < 0.001) following the end of treatment with IMRT. Conclusions: In this retrospective study, higher dose per fraction and shorter overall treatment time using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis. No significant financial relationships to disclose.

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