scholarly journals The role of perioperative radiotherapy in gastric cancer

2012 ◽  
pp. e23
Author(s):  
Thales Paulo Batista ◽  
Lucas Marque De Mendonça ◽  
Ana Luiza Fassizoli-Fonte
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Locally Advanced Tumors ◽  
Related Mortality

Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

scholarly journals The role of perioperative radiotherapy in gastric cancer

2012 ◽  
Vol 6 (2) ◽  
pp. 23 ◽  
Author(s):  
Thales Paulo Batista ◽  
Lucas Marque De Mendonça ◽  
Ana Luiza Fassizoli-Fonte
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Locally Advanced Tumors ◽  
Related Mortality

Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 406-413 ◽  
Author(s):  
Michelle Fanale
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

scholarly journals PERIOPERATIVE CHEMOTHERAPY IN LOCALLY ADVANCED GASTRIC CANCER

2013 ◽  
Vol 50 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Thales Paulo BATISTA ◽  
Candice Amorim de Araujo Lima SANTOS ◽  
Gustavo Fernandes Godoy ALMEIDA
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Standard Treatment ◽  
Treatment Options ◽  
Locally Advanced ◽  
Special Focus ◽  
Perioperative Chemotherapy ◽  
Locally Advanced Gastric Cancer ◽  
Advanced Stages

Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy) has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic) critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

Human papillomavirus, radiation dose and survival of patients with anal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
Rafi Kabarriti ◽  
Patrik Brodin ◽  
Nitin Ohri ◽  
Rahul Narang ◽  
Renee Huang ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Advanced Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Locally Advanced Disease ◽  
Stage Disease ◽  
Hpv Status

e15071 Background: To determine if anal cancer patients with HPV positive disease have different overall survival (OS) compared to those with HPV negative disease, and to elucidate differences in the association between radiation dose and OS. Methods: We utilized the National Cancer Database (NCDB) registry to identify a cohort of non-metastatic anal cancer patients treated with curative intent between 2008 – 2015. Propensity score matching was used to account for potential selection bias between patients with HPV positive and negative disease. Multivariable Cox regression was used to determine the association between HPV status and OS. Kaplan-Meier methods were used to compare actuarial survival estimates. Results: We identified 5,927 patients with tumor HPV status for this analysis, 3,523 (59.4%) had HPV positive disease and 2,404 (40.6%) had HPV negative disease. Propensity-matched analysis demonstrated that patients with HPV positive locally advanced (T3-4 or node positive) anal cancer had better OS (HR=0.81 (95%CI: 0.68-0.96), p=0.018). For patients with early stage disease (T1-2 and node negative) there was no difference in OS (HR=1.11 (95%CI:0.86-1.43), p=0.43). In the unmatched cohort, there was an increase in 3-year OS for patients with HPV positive tumors or early stage disease up to 45-49.9 Gy (p<0.001), whereas for patients with HPV negative and locally advanced disease there was an increase in survival from 46% at 30-44.9 Gy, to 64% at 45-49.9 Gy (p=0.093) and further to 71% at 50-54.9 Gy (p=0.005). Conclusions: We found HPV to be a significant prognostic marker in anal tumors, especially for locally advanced disease. We further found that higher radiation dose up to 50-55 Gy was associated with better OS, mainly for locally advanced disease in HPV negative patients. Multivariable Cox proportional hazards regression for OS. [Table: see text]

scholarly journals Institutional experience of the multimodality treatment of cancer tongue

2017 ◽  
Vol 4 (6) ◽  
pp. 1896
Author(s):  
Mrinal Shankar ◽  
Manisa Pattanayak ◽  
Vipul Nautiyal ◽  
Sunil Saini
Keyword(s):  
Early Stage ◽  
Locally Advanced ◽  
Early Recurrence ◽  
Prognostic Indicators ◽  
Medical Sciences ◽  
Early Stage Disease ◽  
Aggressive Approach ◽  
Stage Disease ◽  
Definitive Surgery ◽  
Multimodality Approach

Background: Cancer (Ca) tongue incidence has shown a rising trend in India in the last couple of years. Increasing use of tobacco being the main risk factor. Guidelines available for management of this disease include it broadly under oral cavity cancers. However, the biological behaviour of this disease is warrant of more aggressive approach to treatment. In early stage disease, treatment is mainly with single modality, surgery being the most preferred. Locally advanced disease treated with multimodality approach with surgery and adjuvant RT/chemoRT. Adverse histopathological factors are important prognostic indicators for early recurrence. Even if the mainstay of treatment in metastatic disease is palliation, multimodality approach is preferred. The aim of the study is to study clinical profile of Ca tongue ant to study outcome of multimodality management of SCC tongue and identification of treatment failure.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months on patients attending Surgical Oncology OPD. Written informed consent and ethical committee clearance was obtained in all 64 cases included, and study type is observational.Results: This is an observational study conducted at Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months. 64 patients diagnosed with SCC tongue were included. Treatment protocols were prescribed by the multidisciplinary tumour board, and patients were followed up to 6 months after completion of the planned treatment. 68.75% patients were below 55 years of age. 87.5% were chronic tobacco chewers. 79.68% had lesion in the anterior tongue. 84.37% received treatment with curative intent (of these 16.66% patients showed early recurrence). 71.86% patients underwent definitive surgery (of these 78.26% remained disease free after 6 months of completion of treatment). Radiotherapy was used in both adjuvant and primary setting. Nodal recurrence was the commonest pattern of recurrence in patients who had underwent definitive surgery. Co-relation with adverse histopathological prognostic indicators also establish early recurrence.Conclusions: Ca tongue was found to be commoner in individuals between 36-55 years. Tobacco users were seen to be at high risk. Surgery was the preferred modality of treatment in early stage disease. Regional lymph node metastasis is the commonest site of early treatment failure. Adverse histopathological factors were important indicators of prognosis and need consideration in planning adjuvant treatment.

A retrospective analysis of epidemiology and treatment patterns for gastric cancer at a tertiary health care center in India

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4086-4086
Author(s):  
R. Digumarti ◽  
S. J. Rajappa ◽  
S. Uppalapati ◽  
A. Surath
Keyword(s):  
Gastric Cancer ◽  
Retrospective Analysis ◽  
Palliative Chemotherapy ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Treatment Patterns ◽  
The Body ◽  
Early Stage Disease

4086 Background: Gastric cancer is the second most common gastrointestinal cancer in our hospital based cancer registry. This retrospective analysis aims at studying the epidemiology and treatment patterns for gastric cancer at our hospital, which is a tertiary care cancer center for the state of Andhra Pradesh in south India. Methods: A retrospective analysis of the case records of 125 consecutive patients with gastric cancer who presented to our department between Jan 2004 and Dec 2005 were analysed. Data regarding epidemiology, stages at diagnosis and treatment plans were collected. Patients with early gastric cancer received 5FU based chemoradiation or chemotherapy only. Palliative chemotherapy included 5FU/cisplatin based regimens. Results: A total of 125 patients were analysed. The median age was 61years (range 18–82 years). 71% were males and 29% females. Being a tertiary care center, 92% were referred with a confirmed diagnosis on endoscopic biopsy. 30% were smokers, 11% consumed alcohol, 40% had both habits while 29% had neither. The most common part of the stomach involved was the antro-pyloric region (44%) followed by the body (30%), GE junction/cardia (20%) while 6% had diffuse involvement including linitis plastica. At diagnosis, 35% were early stage, 56% metastatic and 8% locally advanced tumors. 90% patients who had surgery for early stage disease had T2,3 tumors. One third had inadequate nodal staging.70% of patients who had curative resections underwent adjuvant chemoradiation and 30% had chemotherapy only. Of all patients with metastatic disease, 65% palliative chemotherapy while 45% opted for best supportive care. Conclusions: The distribution of tumors within the stomach is similar to Japanese data, which may reflect the common etiological factors like high salt diet. The fact that one third of patients had inadequate nodal dissection stresses the relevance of adjuvant chamoradiotherapy protocols. The high incidence of smoking as a contributory factor in the etiology reflects the need for aggressive anti tobacco legislation. The study reiterates the need for inexpensive and novel therapies for palliation of symptoms in patients with advanced disease and widens the scope for collaborative clinical trials. No significant financial relationships to disclose.

Cisplatin-Based Chemotherapy Is Associated with An Unacceptably High Incidence of Thromboembolic Events: A Large Retrospective Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 456-456 ◽  
Author(s):  
Russell A. Moore ◽  
Nelly G. Adel ◽  
Manisha Bhutani ◽  
Nour Elise Tabbara ◽  
Heather Landau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Retrospective Analysis ◽  
Early Stage ◽  
Locally Advanced ◽  
Primary Cancer ◽  
Thromboembolic Events ◽  
Early Stage Disease ◽  
Stage Disease ◽  
High Incidence ◽  
Extent Of Disease

Abstract Abstract 456 Introduction: Cancer is a well established risk factor for the development of venous and arterial thromboembolic events (TEEs), including deep venous thrombosis, pulmonary embolus, cerebrovascular accident, and unstable angina/myocardial infarction. In addition to cancer itself, cytotoxic chemotherapy has been shown to potentiate the risk of TEEs. Among chemotherapeutic agents, cisplatin may be associated with a particularly high incidence of TEEs as suggested by few small series. The objective of this study was to determine the incidence of TEEs in patients treated with cisplatin based chemotherapy. Patients and Methods: We performed a large retrospective analysis of all patients treated at MSKCC for a variety of malignancies with cisplatin-based chemotherapy in 2008. Patients were included if they were at least 18 years of age, had received their first dose of their planned chemotherapy regimen between January 1, 2008 and December 31, 2008, and had at least 4 weeks of follow-up since the last dose of cisplatin. Patients were identified using the pharmacy information system. The diagnosis of TEE was based on documentation provided by angiography, magnetic resonance imaging, computed tomography, venous Doppler ultrasound, ventilation/perfusion scan, as well as clinical and laboratory documentation of myocardial infarction by EKG/troponin as per the patients' electronic medical record. A TEE was considered cisplatin-associated if it occurred between the time of the first dose of cisplatin administration and 4 weeks after the last dose. Results: Overall, 1,098 patients received at least one dose of cisplatin in 2008, of whom 936 met the inclusion criteria. The underlying cancer diagnoses included lung (21.7%), head and neck (10%), gastric (8.2%), pancreatic (8.1%), and melanoma (7.3%). The extent of disease at the time of cisplatin administration included metastatic disease (46.7%), locally advanced disease (43.6%) and early stage disease (7%). Among the 936 patients, 171 (18.3%) experienced a TEE during cisplatin administration or within 4 weeks of the last dose. TEEs occurred within 90 days of initiation of treatment in 146 out of 171 (85.4%) patients. The thrombotic events included a DVT in 86 patients (50.3%); PE in 45 patients (26.3%); a DVT and a PE in 22 patients (12.9%); an arterial TEE (CVA, MI, or distal arterial thrombosis) in 13 patients (7.6%); or DVT and an arterial TEE in 5 patients (2.9%). The incidence of TEEs varied according to the underlying primary cancer diagnosis with a TEE occurring in 38.2% of patients with pancreatic cancer, 31.2% with gastric cancer, 25% with gastroesophageal junction cancer, 20.7% with ovarian cancer, and 18.9% with germ cell cancer. The incidence of TEEs also varied according to extent of disease with TEEs most frequently seen in patients with metastatic disease (97 patients, 22.2%) compared to locally advanced (60 patients, 14.7%) or early stage disease (11 patients, 16.7%). Likewise, the incidence of TEE varied according to the type of cisplatin based chemotherapeutic combinations with TEE occurring in 27.3% for gemcitabine-containing regimens; in 26.4% for docetaxel-containing regimens; in 24.6% for bevacizumab-containing regimens; in 19.5% for irinotecan-containing regimens; and in 14.1% for vinblastine-containing regimen. Of note, a TEE occurred in 11 out of 16 patients receiving cisplatin plus docetaxel plus 5-FU/leucovorin plus bevacizumab. Conclusions: This large retrospective analysis confirms the unacceptable high incidence of TEEs in patients receiving cisplatin based chemotherapy, which is 18.3% across all underlying primary cancers. As one would expect, the incidence of TEE varied according to primary cancer, extent of disease, and chemotherapeutic regimens. It is likely that the incidences reported in this retrospective analysis represent an under-estimate of the real incidence of TEEs since some patients with TEE may have been missed because of lack of adequate documentation. It is important to highlight that the majority of events occurred within 90 days of the first dose of cisplatin. This study suggests that TEE prophylaxis may be advisable for patients receiving cisplatin-based chemotherapy. A prospective study is currently in progress. Disclosures: No relevant conflicts of interest to declare.

Gastric Cancer in Southern Europe: High-Risk Disease

2017 ◽  
pp. 261-266 ◽  
Author(s):  
Ramon Andrade De Mello
Keyword(s):  
Gastric Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Global Perspective ◽  
Adjuvant Chemoradiotherapy ◽  
Southern Europe ◽  
Her2 Positive ◽  
Early Stage Disease ◽  
Cancer Pathogenesis ◽  
Metastatic Setting

Gastric cancer is an aggressive disease. Several risk factors are involved in gastric cancer pathogenesis, likely Helicobacter pylori (H. pylori) infection, genetic factors in hereditary syndromes, lifestyle, and diet. However, well-implemented screening strategies are lacking in most countries, including those in Southern Europe. Nevertheless, gastric cancer outcomes are better in some Southern European countries than in others, likely because of the incidence and distribution of different histologic types. Robotic surgery has been gaining favor as a treatment of early-stage disease, and the need for perioperative chemotherapy or adjuvant chemoradiotherapy (CRT) for locally advanced disease has been debated. In the metastatic setting, trastuzumab in combination with chemotherapy has helped to extend survival compared with chemotherapy alone for HER2-positive disease. This article will describe how gastric cancer is assessed and treated in Southern Europe in an attempt to correlate these approaches from a global perspective.

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