Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea

We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage < or = cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.

Quimioterapia combinada neoadyuvante seguida de radioterapia externa en el tratamiento de dos casos de linfoma primario del cuello uterino / Combined chemotherapy neoadjuvant followed of external radiotherapy in the treatment of two cases of primary linfoma of the uterine cervix

Los linfomas primarios del cuello uterino son poco frecuentes. Dado que no hay esquemas de manejo definido, presentamos 2 nuevos casos tratados y controlados desde 1999 a la fecha en la Fundación Arturo López Pérez. El tratamiento consistió en quimioterapia combinada neoadyuvante seguida de radioterapia externa. Se verificó respuesta clínica y radiológica completa en ambos casos. Conclusión: Se puede lograr respuesta completa de estas neoplasias linfoides con esta modalidad de tratamiento.

Outcome of treatment of rectal cancer.

To demonstrate the trend and treatment outcome of rectal cancer after the advent of adjuvant therapy, all case notes of rectal cancer patients admitted to Chulalongkorn Hospital from 1985-1994 were reviewed and cases were followed until 1996. Mean follow-up period was 685.3 days (8-3, 193 days). Most rectal tumors were Dukes' C (43.8%), well-differentiated (54.1%) and at the distal third (53.4%). AP resection remained the most common procedure before and after the advent of adjuvant therapeutic options (62.3%). Of 146 patients treated by curative operations, 60 had adjuvant therapies of which radical radiotherapy with or without chemotherapy was the most common. However, chemotherapy was increasingly employed as the neoadjuvant and as combined chemoradiotherapy. There was a preferential selection of less well-differentiated, more distal, more Dukes' C disease and younger patients for the adjuvant therapy (p < 0.05). Recurrence rate in the adjuvant group was not different from the surgery group despite significant poorer prognostic indicators (17.4% & 21.7%, p = 0.53). Mortality was higher in Dukes' B + C patients in adjuvant group (17.3% & 3.4%, p = 0.02). The outcomes were not different among Dukes' A patients. The complications; i.e. wound problems, gut obstruction; did not increase with the adjuvant treatment. No adverse effect was observed on the healing of colorectal or coloanal anastomoses in the adjuvant group.