Prognostic significance of adjuvant radiation therapy in adenocarcinoma of the cecum

PURPOSE: Local recurrence is a common failure pattern in adenocarcinoma of the cecum. This study aimed to investigate the potential role of adjuvant radiation therapy on oncologic outcomes of patients with adenocarcinoma of the cecum. MATERIALS AND METHODS: This retrospective study was carried out at three large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of 162 patients with adenocarcinoma of the cecum that were treated and followed up between 2000 and 2013. All the patients had undergone a right hemicolectomy and received chemotherapy with (n = 48) or without (n = 114) adjuvant radiation therapy. RESULTS: The subjects were 65 females and 97 males with a median age of 56 years (range, 17 to 90 years) at diagnosis. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 72.7%, 57.2%, and 62.6% respectively. In a multivariate analysis, age, tumor stage, node stage, and adjuvant radiation therapy were determined to be independent prognostic factors. Age more than 55 years (hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.06–0.32; p = 0.003], T4 stage (HR = 6.8; 95% CI, 3.07–15.36; p < 0.001), node positive disease (HR = 4.2; 95% CI, 1.94–9.13; p < 0.001), and the absence of adjuvant radiation therapy (HR = 3.0; 95% CI, 1.39–6.46; p = 0.005) had a negative influence on OS. CONCLUSION: Adjuvant radiation therapy significantly improves DFS and OS in patients with adenocarcinoma of the cecum.

Prognostic Significance of Mucinous Histologic Subtype on Oncologic Outcomes in Patients With Colorectal Cancer

PURPOSE: Mucinous adenocarcinomas account for about 10% of all colorectal cancers. This study aimed to investigate the prognostic impact of mucinous histologic subtype on oncologic outcomes in patients with colorectal cancer. METHODS: This retrospective study was performed at two large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of patients with colorectal cancer who were treated and followed up between 2000 and 2013. RESULTS: Totally, 144 of 1,268 patients with a colorectal adenocarcinoma (11.4%) had mucinous histologic subtype. Statistically significant results found in this research are as follows: Mucinous histologic subtype tended to present in younger patients and to have larger tumor size, higher histologic grade, higher node stage, larger number of positive nodes, and higher rate of perineural invasion compared to nonmucinous histologic subtype. On the univariate analysis, mucinous subtype was a prognostic factor for disease-free and overall survival. On the multivariate analysis, primary tumor location, node stage and lymphatic-vascular invasion were independent prognostic factors for the local control rate. Rectal tumor location, higher disease stage, tumor grade II, and presence of lymphatic-vascular invasion had negative influences on disease-free survival, as did rectal tumor location, higher disease stage and presence of lymphatic-vascular invasion on overall survival. CONCLUSION: Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer; however, it was not an independent prognostic factor for oncologic outcome.

Selecting chemotherapy schedules for adjuvant treatment of early stage breast cancer, what is the rationale behind?

Breast cancer is one of the most prevalent cancers that oncologists are faced with in their clinics. The varieties of clinical features of the disease result to very different scenarios in the processes of treatment decision making. While classic factors of stage, grade, age and hormone receptor status are still the criterion for choosing treatment, a very delicate list of other prognostic and predictive factors have been entered to this field over recent two decades. The evidence-based medicine rules to treat patients based on the best evidences that have been found by powered randomized clinical trials. Different panels and guidelines gathering these evidences try to help oncologists to find the best treatment methods through the variable and sometimes contradicting results. As it is always the main objective, increasing the survival rates in addition to the ideal aim of curing the disease is usually the target. Finding the best and the most practical chemotherapy regimen against breast cancer needs to notice the biology of this disease and its varieties along with each individual patient condition. It is clear that not all patients need the most complicated and expensive treatment

Result of chemoradiotherapy in the treatment of laryngeal and hypopharyngeal carcinoma

Introduction: malignant tumors of head and neck [H and N] mostly squamous cell carcinoma [SCC] are common in Khorasan; the standard treatment consists of surgery with or without [pre or post operative] radiotherapy and occasionally only radical radiotherapy. According to many reports on high response rate of H and N metastatic tumorssometimes greater than 50% to the chemotherapeutic agents- it is accepted to use chemotherapy as a curative treatment modality in non-metastatic H and N tumors [1]. In our country there isn't any report about this treatment policy although there are many publications from European and American centers. In this paper we intend to present some parts of our experience on primary chemotherapy for nonrnetastatic SCC of laryngeal and hypopharyngeal carcinoma

Patients and methods: the study compiles 51 patients with primary SCC of larynx and hypopharynx who had been treated during 1375-1379 in Omid hospital. Twenty-four patients had been treated only by radiotherapy while 27 had been treated by chemoradiation. None of the patients in two groups had surgical treatment except for diagnostic biopsy. The reasons that surgery was not used in this groups of patients were as follow: medical contraindication, radical surgery impossibility due to advancement of primary tumor [unresectable] and refusing surgical treatment by patient. Patient's enrolments in two groups were only by physicians decision and practice and are being compared for age, sex, primary tumor site, Stage, histological grade and radiation dose [table 1]. Three endpoints are characterized: complete response [either clinical or pathologic], failure [either in local or lymphatic region] and suspicious cases, which negative biopsy but any of these: several local edema, obvious defect in barium swallow, vocal cord fixation, suspicious mucosal ulceration and progressive post treatment dysphagia. Radiotherapy was delivered by Cobalt 60 machine using classical conventional technique and dose fractionation. [For technical details see reference 2]. Chemotherapy regimen consists of commonly used combination of 5-flouracil [5FU] and cisplatin which doses are introduced in table 2. It was allowed accrual of every case whose chemotherapy was applied before [neeoadjuvant], during [concurrent] or sequential with radiotherapy and even one case after completing radiotherapy [adjuvant]. Statistical methods used are Z and T test and P value calculated which figures below 0.05 are considered significant and 0.05 up to 0.1 are considered borderline

Results: although there isn't any significant statistical difference between two groups related to age, sex, histological grade and anatomical site but as it is shown in table 1 there is a general trend toward enrolling some known and likely poorer prognostic factors in chemoradiation group. Pathologic grade 3 with 26% ratio in the chemoradiation group has higher amount than 16% in radiotherapy group and the mean age of patients in the former group is 2.5 years older. As well hypopharyngeal origin with 40% ratio has higher proportion in chemoradiation group. In distribution according to the stage of disease most of the patients in both groups are in the more advanced stages, however while no low stage cases were treated with chemoradiation in other group these are 25%. In addition clinical presentation as a large mass [more than 6 cm] is higher in patients treated with chemoradiation [37% versus 20%]