scholarly journals Some aspects of conservative treatment of patients with laryngeal cancer

2021 ◽  
pp. 27-34
Author(s):  
Erwin V. Lukach ◽  
Yurij O. Serezhko ◽  
Evgenij I. Klochkov ◽  
Valerii V. Strezhak ◽  
Evgeniya M. Tcimbalyuk ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Conservative Treatment ◽  
Laryngeal Cancer ◽  
Conservative Therapy ◽  
Tumor Response ◽  
Statistical Processing ◽  
Lower Number ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Recist 1.1

Topicality: According to the National Cancer Registry of Ukraine, the incidence of laryngeal cancer is 4.1%. The treatment of patients with laryngeal cancer depends on the stage of the tumor. The conservative therapy includes both radiation therapy and chemotherapy. Material and methods: The conservative treatment of 93 patients with laryngeal cancer was performed. All patients are divided into two groups according to the localization of cancer: glottis (n=57) and supraglottis (n=36). The course of radiation therapy was conducted in oncology centers. The course of chemotherapy was induction or combined with radiation therapy. The outcome of therapy was evaluated one month after its completion. Tumor response after therapy was assessed by RECIST 1.1. Statistical processing of the obtained results was performed in accordance with the recommendations of Glantz. Results: It was found that metastases to the lymph nodes of the neck were significantly more common in cancer of the supraglottic (χ2=16.074; φ=0.00012; р<0.05). The greater number of recurrences of the tumor of the glottis after conservative therapy (χ2=6.718; φ=0.01345; р<0.05). Three-year recurrence-free survival and overall survival of patients after conservative treatment of laryngeal cancer patients were the same in both groups. Conclusion: The treatment of 93 patients with laryngeal cancer gave an objective tumor response in 96% of patients. The conservative treatment of patients with laryngeal cancer revealed a lower number of tumor recurrences in the supraglottis cancer (20 of 36 patients) compared with the glottis (37 of 57) (χ2= 6.718; φ = 0.01345; p <0.05).

scholarly journals Stereotactic body radiation therapy for early-stage non–small-cell lung cancer in octogenarians and older: an alternative treatment

2020 ◽  
Vol 61 (4) ◽  
pp. 586-593
Author(s):  
Yanping Bei ◽  
Naoya Murakami ◽  
Yuko Nakayama ◽  
Kae Okuma ◽  
Tairo Kashihara ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Small Cell ◽  
Recurrence Free Survival ◽  
Small Cell Lung ◽  
Free Survival ◽  
Early Stage Nsclc ◽  
Lung Sbrt

ABSTRACT Surgery is the standard modality for early-stage I–II non-small-cell lung cancer (NSCLC). Generally, patients who are &gt;80 years old tend to have more comorbidities and inferior physical status than younger patients. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment for this group of patients. Here, we report our experience using SBRT to in the management of early-stage NSCLC in patients &gt;80 years old. Patients aged ≥80 years old who were diagnosed with early-stage NSCLC and treated with definitive lung SBRT from January 2000 to January 2018 were retrospectively analysed. Local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), cancer-specific survival (CSS), progression-free survival (PFS), overall survival (OS) and treatment-related toxicities were analysed for patients &gt;80 years old. A total of 153 patients were included, with a median age of 85 years (range, 80–94). The median follow-up period and OS was 39.8 months (range, 10–101 months) and 76 months, respectively. The 3-year OS, PFS, CSS, RRFS and LRFS were 65.3, 58.0, 75.7, 73.9 and 85.3%, respectively. Radiation pneumonitis grade 0–1, grade 2, grade 3 and grade 4 was observed in 135 (88.2%), 13 (8.5%), 4 (2.61%) and 1 (0.6%) patient(s), respectively. On multivariate analyses, tumor size, pretreatment C-reactive protein (CRP) value, histology and pretreatment physical state were significantly associated with OS. Definitive lung SBRT appears to have high LRFS and OS without causing high-grade radiation-related toxicities in early-stage NSCLC patients who were &gt;80 years old.

scholarly journals Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy

2019 ◽  
Vol 109 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Audrey Y Jung ◽  
Xinting Cai ◽  
Kathrin Thoene ◽  
Nadia Obi ◽  
Stefanie Jaskulski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Survivors ◽  
Postmenopausal Women ◽  
Breast Cancer Survivors ◽  
Breast Cancer Prognosis ◽  
Cancer Prognosis ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Supplement Use

ABSTRACT Background There is a paucity of information on the prevalence of dietary supplement use in breast cancer survivors. Only a few studies have examined the impact of dietary supplements, particularly antioxidants, on breast cancer prognosis and the results are inconclusive. Objective We examined pre- and postdiagnosis use of supplements in postmenopausal breast cancer survivors in Germany and investigated associations between postdiagnosis use of antioxidants and other supplements, and prognosis (total and breast cancer mortality, and recurrence-free survival) both overall and in women who received chemotherapy and radiation therapy. Design Data from 2223 postmenopausal women diagnosed with nonmetastatic breast cancer from the population-based Mamma Carcinoma Risk Factor Investigation (MARIE) study were used. Women were interviewed at recruitment in 2002–2005 and again in 2009 and followed-up until 30 June 2015. Multivariate Cox regression analysis was used to estimate HRs and corresponding 95% CIs. Results Pre- and postdiagnosis supplement use was reported by 36% and 45% of the women, respectively. There were 240 deaths (134 from breast cancer) and 200 breast cancer recurrences after a median follow-up time of 6.0 y after the 2009 re-interview. After adjusting for relevant confounders, concurrent antioxidant use with chemotherapy or radiation therapy among 1940 women was associated with increased risk of total mortality (HR: 1.64; 95% CI: 1.01, 2.66) and worsened recurrence-free survival (HR: 1.84; 95% CI: 1.26, 2.68). Overall postdiagnosis supplement use was not associated with breast cancer prognosis. Conclusions Antioxidant use during chemotherapy or radiation therapy was associated with worsened breast cancer prognosis in postmenopausal women. There was no overall association between postdiagnosis supplement use and breast cancer prognosis. Results from our study align with the current recommendation to possibly avoid the use of antioxidants during chemotherapy or radiation therapy.

Analysis of neuroendocrine, signal transduction and adhesion proteins in SCLC tissue to predict the tumor response and the rogression free survival (PFS) in limited stage SCLC (SCLC-LS) patients subjected to chemo-radiation therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17075-17075
Author(s):  
G. Benedetti ◽  
S. Damiani ◽  
A. Cancellieri ◽  
E. Magrini ◽  
M. Fedele ◽  
...  
Keyword(s):  
Signal Transduction ◽  
Radiation Therapy ◽  
Tumor Response ◽  
Neuron Specific Enolase ◽  
Progression Free Survival ◽  
Immunohistochemical Analysis ◽  
Free Survival ◽  
Thoracic Irradiation ◽  
Dependent Inhibition ◽  
E Cadherin

17075 Background: Most of SCLC-LS patients (pts) relapse within 12 months because of chemo and radio resistance. This phenomenon seems related to the induction of morphologically variant cells, which lack the neuroendocrine expression proteins and seem to trigger Akt-dependent inhibition of apoptosis. We analyzed neuroendocrine, signal transduction and adhesion molecules on tumor tissue from pts treated with chemoradiation therapy for SCLC-LS. Methods: We treated twenty-two pts with cisplatin/etoposide and concurrent thoracic irradiation. Paraffin blocks of the tumor obtained from each pt were used in the immunohistochemical analysis (IHA). Sections were stained with antibodies against phospho-Akt (p-Akt), phospho-MAP Kinase (p-MAPK), by a routine IHA method. Sections were stained in parallel with an automated immunostainer with antibodies against chromogranin A (ChrA), Neuron Specific Enolase (NSE), E-cadherin (Cad). Results: A preliminary IHA analysis obtained in ten out of twenty-two pts demonstrated that 9 out of 10 (9/10) tumor were NSE-positive; 6/10 ChrA-positive; 8/10 Cad-positive; 3/10 p-MAPK-positive; 5/10 p-Akt-positive. The correlation with tumor response and progression free survival (PFS) showed that the five patients with prolonged (10–60 months) complete remission (CR) had a p-Akt-positive, on the opposite the pts with short CR (6–18 months ) or partial remission (PR) had a p-Akt-negative staining. The two patient with prolonged and mantained CR (30+ and 60+ months) had a p-Akt-positive and Cad-negative profile. Conclusions: The expression of p-Akt and the absence of E-cadherin seems predict a prolonged CR after chemo-radiation therapy in SCLC-LS pts. Conclusive analysis will be presented at the meeting. No significant financial relationships to disclose.

Adjuvant therapy with gemcitabine and stereotactic body radiation therapy versus gemcitabine alone for resected stage II pancreatic cancer: A prospective, randomized, open label, single-center trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15765-e15765
Author(s):  
Tao Ma ◽  
Xueli Bai ◽  
Qichun Wei ◽  
Shunliang Gao ◽  
Bingfeng Huang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Stereotactic Body Radiation Therapy ◽  
Stage Ii ◽  
Recurrence Free Survival ◽  
Single Center ◽  
Free Survival ◽  
Local Disease Control ◽  
Resected Stage

e15765 Background: Although adjuvant chemotherapy with gemcitabine has for years been the standard of care for resected pancreatic cancer, the role of adjuvant radiation is still debatable. We aimed to investigate the efficacy of gemcitabine combined with stereotactic body radiation therapy (SBRT) as adjuvant therapy for resected stage II pancreatic cancer. Methods: This single center randomized controlled trial was designed to enroll 512 patients with stage II pancreatic cancer that underwent curative-intended radical resection from a large-volume tertiary pancreatic center in China. Patients were randomly assigned to gemcitabine-alone adjuvant chemotherapy or adjuvant SBRT (25 Gray in 5 fractions) followed by gemcitabine chemotherapy. The primary endpoint was recurrence-free survival (RFS). Secondary endpoints included locoregional recurrence-free survival (LRFS), overall survival (OS), and incidence of adverse events. Interim analysis was planned at the time of 2.5-years’ enrollment. Results: 40 patients were randomly assigned to treatment between Sep 1, 2015, and Mar 31, 2018 (21 to the gemcitabine group and 19 to the gemcitabine plus SBRT group). Of these, one was excluded because of ineligibility and one did not receive any treatment. The median RFS was 12.4 (9.3-15.6) months in the gemcitabine group and 14.7 (9.2-20.1) months in the gemcitabine plus SBRT group ( P= 0.753), with median LRFS of 18.2 (14.6-21.7) months in the gemcitabine group and 13.1 (9.1-16.8) months in the gemcitabine plus SBRT group ( P= 0.333). The median OS was 21.7 (19.5-24.0) months in the gemcitabine group and 16.9 (12.8-20.9) in the gemcitabine plus SBRT group ( P= 0.066). Grade 3 or 4 neutropenia, thrombocytopenia, nausea or vomiting, and liver dysfunction were all comparable between the two groups. Evaluation of data from the first 40 enrolled patients indicated that the addition of adjuvant SBRT was not associated with either better local disease control or recurrence free survival. And because of failure to achieve the accrual target, the trial was terminated prematurely. Conclusions: Adjuvant SBRT neither provided a survival benefit nor improved local disease control in resected stage II pancreatic cancer. Clinical trial information: NCT02461836.

Impact of testosterone replacement therapy after radiation therapy on prostate cancer outcomes.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 99-99
Author(s):  
Reith Sarkar ◽  
J Kellogg Parsons ◽  
John Paul Einck ◽  
Arno James Mundt ◽  
A. Karim Kader ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Biochemical Recurrence ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Treatment Groups

99 Background: Currently there is little data to guide the use of testosterone replacement therapy in prostate cancer patients who have received radiation therapy (RT). We sought to evaluate the impact of post-RT testosterone replacement on prostate cancer outcomes in a large national cohort. Methods: We conducted a population-based cohort study using the Veterans Affairs Informatics and Computing Infrastructure. We identified node-negative and non-metastatic prostate cancer patients diagnosed between 2001-2015 treated with RT. We excluded patients for missing covariate and follow-up data. Receipt of testosterone was coded as a time-dependent covariate. Other covariates included: age, Charlson Comorbidity index, diagnosis year, body mass index, race, PSA, clinical T/N/M stage, Gleason score, and receipt of hormone therapy. We evaluated prostate cancer-specific survival, overall survival, and biochemical recurrence free survival using multivariable Cox regression. Results: Our cohort included 41,544 patients, of whom 544 (1.3%) received testosterone replacement after RT. There were no differences in Charlson comorbidity, clinical T stage, median pre-treatment PSA or Gleason score between treatment groups. Testosterone patients were more likely to be of younger age, non-black, have a lower median post-treatment PSA nadir (0.1 vs. 0.2; p < 0.001), have higher BMI, and have used hormone therapy (46.7% vs 40.3%; p = 0.003). Median duration of ADT usage was equivalent between treatment groups (testosterone: 185 days vs. non-testosterone: 186 days, p = 0.77). The median time from RT to TRT was 3.52 years. After controlling for differences in covariates between treatment groups, we found no difference in prostate cancer specific mortality (HR 1.02; 95% CI 0.62-1.67; p = 0.95), overall survival (HR 1.02; 95% CI 0.84-1.24; p = 0.86), non-cancer mortality (HR 1.02; 95% CI 0.82-1.27; p = 0.86) biochemical recurrence free survival (HR 1.07; 95% CI 0.90-1.28; p = 0.45). Conclusions: Our results suggest that testosterone replacement is safe in prostate cancer patients who have received RT. Prospective data are required to confirm the safety of post-RT testosterone replacement.

Radiation Therapy Plus Tamoxifen Versus Tamoxifen Alone After Breast-Conserving Surgery in Postmenopausal Women With Stage I Breast Cancer: A Decision Analysis

2003 ◽  
Vol 21 (12) ◽  
pp. 2260-2267 ◽  
Author(s):  
Rinaa S. Punglia ◽  
Karen M. Kuntz ◽  
Jason H. Lee ◽  
Abram Recht
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Breast Conserving Surgery ◽  
Sensitivity Analyses ◽  
Recurrence Free Survival ◽  
Health States ◽  
Free Survival

Purpose: To compare outcomes for hypothetical cohorts of postmenopausal patients with estrogen receptor–positive tumors that are ≤ 2 cm in size, with pathologically uninvolved axillary nodes, treated with radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery. Methods: A Markov model was used to simulate patients’ clinical course and estimate overall survival, recurrence-free survival, time with an intact breast, and death from breast cancer. Probabilities were derived from randomized trials and retrospective studies. Analyses were performed separately by age of diagnosis in 5-year increments from 50 to 80 years. Sensitivity analyses tested the stability of radiation benefit. Results: The modeled recurrence-free survival benefit of giving radiation therapy was 3.35 years for women who were 50 years of age at diagnosis, versus 0.61 years for women who were 80 years of age. In the 50-year-old cohort, radiation therapy resulted in additional 0.60 years survival, compared with 0.04 years among 80-year-olds. A 50-year-old woman who received radiation therapy plus tamoxifen was less likely to die from breast cancer than if she received tamoxifen alone (2.43% v 5.29%; relative-risk reduction, 54%). An 80-year-old woman had a 1.17% chance of dying from breast cancer if she received radiation therapy plus tamoxifen, versus 2.02% with tamoxifen alone (relative-risk reduction, 42%). Sensitivity analyses showed that the magnitude of benefit was strongly influenced by including unequal rates of developing distant disease after breast recurrence between the treatment arms and varying rates of local recurrence. Conclusion: The absolute and relative benefits of radiation therapy and individual patient preferences for different health states should be considered when selecting treatment.

scholarly journals Atypical meningiomas: is postoperative radiotherapy indicated?

2013 ◽  
Vol 35 (6) ◽  
pp. E15 ◽  
Author(s):  
Kangmin D. Lee ◽  
John J. DePowell ◽  
Ellen L. Air ◽  
Alok K. Dwivedi ◽  
Ady Kendler ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Radiotherapy ◽  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Recurrence Free Survival ◽  
Postoperative Radiation ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
Free Survival ◽  
Atypical Meningiomas

Object The role of postoperative radiation therapy after surgery for atypical meningiomas remains controversial. In this retrospective cohort study, the authors examine the recurrence rates for atypical meningiomas after resection (with or without adjuvant radiotherapy) and identify which factors were associated with recurrence. Methods Of 90 patients with atypical meningiomas who underwent surgery between 1999 and 2009, 71 (79%) underwent gross-total resection (GTR) and 19 (21%) underwent subtotal resection (STR); 31 patients received adjuvant radiotherapy. All tumors were pathology-confirmed WHO Grade II atypical meningiomas. Univariate and multivariate analyses were performed to identify factors associated with recurrence-free survival. Results Among 90 patients, 17 developed tumor recurrence (81% recurrence-free survival at 5 years). In the overall group, adjuvant radiotherapy reduced the recurrence rate to 9% from 19% at 5 years (p = 0.048). After STR, adjuvant radiotherapy significantly reduced recurrence from 91% to 20% (p = 0.0016). However, after GTR, adjuvant radiotherapy did not significantly reduce the recurrence rate (16.7% without radiation therapy vs 11.8% with radiation therapy) (p = 1.00). Five factors independently predictive of tumor recurrence included mitotic index, sheeting, necrosis, nonuse of radiation therapy, and STR. Further recursive partitioning analysis showed significant increases in risk for patients older than 55 years with mitoses and sheeting. Conclusions Adjuvant radiotherapy was effective at lowering recurrence rates in patients after STR but delivered no significant improvement in patients after GTR. Given that rates after GTR were similar with or without adjuvant radiotherapy, close observation without postoperative radiation therapy may be a viable option for these patients. Patients older than 55 years and those with mitoses noted during pathological examination had a significant risk of recurrence after GTR; for these patients, postoperative radiotherapy is recommended.

Postoperative radiation therapy for high-risk colon carcinoma.

1993 ◽  
Vol 11 (6) ◽  
pp. 1112-1117 ◽  
Author(s):  
C G Willett ◽  
C Y Fung ◽  
D S Kaufman ◽  
J Efird ◽  
P C Shellito
Keyword(s):  
Radiation Therapy ◽  
Colon Carcinoma ◽  
Survival Rates ◽  
Fistula Formation ◽  
Subtotal Resection ◽  
Recurrence Free Survival ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Free Survival ◽  
Systemic Therapies

PURPOSE This study examines the experience of patients treated with postoperative radiation therapy after resection of high-risk colon carcinoma in an effort to assess the potential role of this modality in combination with current systemic therapies. PATIENTS AND METHODS From 1976 to 1989, 203 patients received postoperative radiation therapy with and without concurrent fluorouracil (5-FU) chemotherapy following resection of modified Astler-Coller B2, B3, C2, and C3 colon tumors. Of the 203 patients, 30 (15%) were identified as having residual local tumor after subtotal resection, whereas 173 (85%) had no known residual disease. The 173 patients treated with adjuvant radiation therapy were compared with a historical control group of 395 patients undergoing surgery only. RESULTS Three groups of patients who appeared to benefit from postoperative radiation were identified. Improved local control and recurrence-free survival rates were seen for patients with stage B3 and C3 colon carcinoma treated with postoperative radiation therapy compared with a similarly staged group of patients undergoing surgery only. Irradiated patients whose tumors had an associated abscess or fistula formation had improved local control and recurrence-free survival rates compared with a similar group of patients undergoing surgery only. There appears to be a subset of patients with residual local disease after subtotal resection that may be salvaged by high-dose postoperative radiation therapy. CONCLUSION Selected groups of patients with colon carcinoma may benefit from postoperative radiation in addition to current systemic therapies. Integration of 5-FU and levamisole with postoperative radiation therapy should be considered for patients with (1) stage B3 and C3 lesions, (2) tumors associated with abscess or fistula formation, and (3) residual local disease after subtotal resection.

The prechemoradiotherapy/nadir ratio of white blood-cell count to predict tumor response and survival in locally advanced rectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 783-783
Author(s):  
Joo Hwan Lee ◽  
Sung Hwan Kim ◽  
Jong Hoon Lee ◽  
Soo Yoon Sung ◽  
Hong Seok Jang
Keyword(s):  
Rectal Cancer ◽  
Blood Cell ◽  
Treatment Response ◽  
White Blood Cell ◽  
Tumor Response ◽  
Locally Advanced ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Cell Counts ◽  
Wbc Count

783 Background: Predicting treatment response of preoperative chemoradiotherapy (CRT) in patients with rectal cancer is important for physicians to guide a patient to the relevant treatment. We evaluate the change of white blood cell (WBC) count before and during CRT if it is associated with susceptibility to the CRT and affects tumor response. Methods: Medical records of 641 patients with rectal cancer who received preoperative CRT followed by curative surgery were retrospectively reviewed. Complete blood cell counts were measured weekly before and during the radiation therapy. We assessed the pre-CRT/nadir ratio of WBC count for the treatment response to CRT and recurrence-free survival. Results: The enrolled patients were divided into two groups of high WBC ratio (HWR) and low WBC ratio (LWR) with the cutoff value of 0.49, which was found by receiver operating characteristic curve (Sensitivity, 0.38 and 1-Specificity, 0.22; p=0.007). In 641 patients, 490 (76.4%) were HWR group and 151 (23.6%) were LWR group. Complete pathologic response rates were 12.2% in HWR group and 23.8% in LWR group, respectively (p=0.001). Downstaging rates of each group were 37.8% and 48.3%, respectively (p=0.02). In the logistic regression analysis, CEA level over 5ng/ml (Adjusted OR 0.566, 95% CI 0.351-0.912; p=0.019) and HWR (Adjusted OR 0.412, 95% CI 0.256-0.663; p=0.001) were significant adverse factors of the pathologic complete response. The 5-year recurrence-free survival rate was significantly higher in LWR group than in HWR group (67.6% and 83.3%; p=0.001). Conclusions: Low WBC ratio predicts a good tumor response to the preoperative CRT, and is significantly associated with an improved recurrence-free survival in rectal cancer.

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